頸動脈合併切除を要した頸動脈小体腫瘍例

Abstract

Carotid body tumor (CBT) is a rare disease, with previously reported cases only numbering about 150 in Japan. Although the tumor is known to be a benign neoplasm, ten percent of reported cases were malignant. So, surgical resection is recommended for the treatment of CBT. However, the surgery is not always straightforward and management of the carotid artery is one of the key points of surgery. We report herein a case of CBT that required reconstruction of the internal carotid artery. A 28-year-old man visited our hospital complaining of hoarseness and a swelling in his left neck. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a hypervascularized tumor involving the common carotid, internal, and external carotid arteries. The balloon Matas test showed sufficient cerebral blood flow, suggesting the safety of scarification of the common carotid and/or internal carotid artery without vessel grafting. In order to make a definite diagnosis, a biopsy was performed under local anesthesia. The pathological examination demonstrated typical findings of CBT. Although complete removal of the tumor was attempted without resection of the carotid artery, the tumor had invaded the vessel wall and could not be removed from the carotid artery. After simple clamping of the internal and common carotid arteries, the tumor was dissected together with the carotid arteries in 30 minutes. Then, vascular reconstruction was performed using the saphenous vein to avoid complications due to the blockade of the carotid artery. The patient was discharged without any brain damage 20 days after surgery.