Case Of Paraganglioma Research Articles

Hereditary Paraganglioma-Phaeochromocytoma Syndrome: A case of malignant paraganglioma discovered following surgery for breast carcinoma

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Risk factors for postoperative complications after pheochromocytoma and/or paraganglioma: a single-center retrospective study.

Perioperative complications are higher in patients with pheochromocytoma and/or paraganglioma. The aim of this study was to identify the risk factors of postoperative complications after pheochromocytoma and/or paraganglioma resection surgery. We retrospectively reviewed 438 patients who underwent laparoscopic or open surgery for pheochromocytoma and/or paraganglioma at our center between January 2014 and December 2019. Demographic characteristics and intraoperative and postoperative data were recorded. Complications were defined as deviations from the normal postoperative course and Clavien-Dindo classification was used to grade the severity of postoperative complication. Patients with complications of grade II or above were included for analysis. Binary logistic regression was used to determine the risk factors for postoperative complications. The median age of the patients was 47 years old. There were 295 cases (67.4%) of phepchromocytoma and 143 cases (32.6%) of paraganglioma. Three hundred sixty-seven (87.8%) patients had laparoscopic approach, and 55 (12.6%) patients had laparotomy; the conversion rate from laparoscopy to laparotomy was 3.7%. Eighty-seven complications occurred in 65 patients (14.8%). No death occurred in our study and transfusion (36, 8.2%) was the most common complication. The mean follow-up length was 14 months. Independent risk factors for postoperative complications included a tumor size larger than 5.6cm (OR = 2.427, 95% CI 1.284-4.587, P = 0.006), laparotomy (OR 2.590, 95% CI 1.230-5.453, P = 0.012), conversion to laparotomy (OR = 8.384, 95% CI 2.247-31.285, P = 0.002), and the operation time longer than 188min (OR = 3.709, 95% CI 1.847-7.450, P < 0.001). Complications were not uncommon after pheochromocytoma and/or paraganglioma surgery. Tumor size, surgical type, and operation time were determined as the risk factors for postoperative complications. These factors should be considered to improve perioperative management.

Malignant carotid body tumor: a report of two cases.

Case one- A 23-year-old woman presented with a right-sided neck mass. History, physical examination, and appropriate imaging suggested malignant paraganglioma with evidence of lymph node, vertebral, and lung metastases. Surgical excision of the tumor and regional lymph nodes was done. Histopathological assessment of the retrieved specimens confirmed the diagnosis. Case two - A 29-year-old woman presented with a left submandibular swelling. She was appropriately investigated, and the diagnosis of a malignant carotid body tumor was made with evidence of lymph node metastasis. Surgical resection of the tumor with clear margins was done and histopathological analysis of the resected specimen confirmed the diagnosis. CBT's are the most common tumors of the head and neck. Most are nonfunctioning, slow growing, and benign. They typically present in the fifth decade of life but can occur at a younger age in individuals who carry certain genetic mutations. Both cases of malignant CBT's that we encountered occurred in young women. Furthermore, the 4-year and 7-year history in case number one and two, respectively, supports the fact that CBTs are slow growing tumors. In our case series, the tumors were surgically resected. Both cases were discussed in multidisciplinary meetings and were referred for hereditary testing and radiation oncology for further management. Malignant carotid body tumors are rare. Prompt diagnosis and treatment is important to improve patient outcomes.

Case of Conus Paraganglioma: Case Report with Review

AbstractParagangliomas of spine are rare neuroendocrine tumors. They are World Health Organization grade 1 tumors with common location in cauda equina and filum terminale. We report a case of conus paraganglioma. A 57-year-old lady was admitted with low back pain with radiculopathy without bowel and bladder complaints. Magnetic resonance imaging (MRI) lumbosacral spine showed well-defined round-to-oval extramedullary lesion isointense on T1 and hyperintense on T2-weighted images at the level of L1 vertebra (suggestive of) neurogenic tumor. Intraoperatively reddish-brown capsulated tumor arising from conus with extension to filum and compressing the nerve roots was seen. Gross total excision of tumor was done. Microscopic examination showed well-encapsulated cellular tumor composed of sheets, anastomosing lobules, and nests of small, oval-to-round cells interspersed with blood vessels with mild nuclear atypia and occasional mitosis. Immunohistochemistry analysis was positive for synaptophysin and chromogranin suggestive of paraganglioma. Postoperative period was uneventful. MRI of dorso-lumbar spine showed no residual tumor. Patient was asymptomatic 5 months after surgery. The clinical, radiological, and pathological features of this rare tumor entity is presented.

PARAGANGLIOMA OF NECK IN MIDDLE AGED MALE: A CASE REPORT

Aim: To present a rare case of Paraganglioma of neck in an adult. Introduction: Paragangliomas of the head and neck represent rare benign tumors of neural crest origin that comprises of &lt;0.5% of all head and neck tumors. A schwannoma, also referred to as neurilemmoma, is relatively uncommon slowly growing benign lesion which originates from peripheral neural sheath of any myelinated nerve. Parapharyngeal space tumours are very rare and account for only 1 % of all head and neck tumours. The clinical presentation of schwannoma varies with the anatomical area involved. Surgical excision has been the treatment of choice and recurrence is very rare. Methodology: A 24-year, male presented in ENT OPD with the complaints of swelling on the right side of neck since 2 years. On Examination, the patient had a swelling on right side of neck, extending from angle of mandible upto supraclavicular region, 10 x 6 cm in size, ovoid in shape, non-tender, smooth surface, well defined rounded margins &amp; firm in consistency. On CECT Neck, a well circumscribed hypodense mass with poor enhancement not invading surrounding tissue was seen. On MRI-NECK study, a well-defined heterogenous mass on the right-side posterior to carotid vessels, suggestive of neoplastic lesion, mostly neurogenic stroma. Results: Surgical excision of swelling approximately 9 X 6 cm was performed under general anaesthesia. Conclusions: Schwannoma of the parapharyngeal tumor, should be included in the differential diagnosis of well circumscribed neck mass MRI &amp;CT are highly informative and definitive diagnosis requires histopathological evaluation. From the literature review and experience in our patient, we conclude that in early-stage Cervical paraganglioma with a low risk of surgical complications, primary resection for cure is recommended.

Gross hematuria as the presentation of ureteral paraganglioma: a case report and literature review

BackgroundParaganglioma of genitourinary tract is uncommon, and origin from ureter is even rarer. We aim to present a case of paraganglioma from ureter in a 48-year-old female patient, who presented with gross hematuria.Case presentationWe present a 48-year-old female who complained of gross hematuria for one week. A left ureteral tumor was found by image study. However, hypertension was unexpectedly recorded during diagnostic ureteroscopy survey. Due to persisted gross hematuria and bladder tamponade, she underwent left nephroureterectomy with bladder cuff resection. Blood pressure surged again when the tumor was surgically approached. Ureteral paraganglioma was confirmed according to pathological report. After the surgery, the patient recovered well, and no more gross hematuria was noted. She is now under regular follow-up at our outpatient clinic.ConclusionUreteral paraganglioma should be kept in mind not only when blood pressure fluctuates during operation, but also before we manipulate the ureteral tumor when gross hematuria is the only sign. Whenever the presumption of paraganglioma is raised, laboratory evaluation and anatomical or even functional imaging should be considered. The concomitant anesthesia consultation before the surgery should not be deferred, either.

Coexistence of Primary External Auditory Canal Cholesteatoma and Tympanomastoid Paraganglioma: A Diagnostic Dilemma.

Synchronous presentation of cholesteatoma and tympanomastoid paraganglioma is extremely rare. Due to the overlapping clinical features, the clinical diagnosis of coexistence is difficult. Only two cases of tympanomastoid paraganglioma coexisting with middle ear cholesteatoma have been reported in the literature, but simultaneous presentation of primary external auditory canal cholesteatoma and tympanomastoid paraganglioma has not been reported till date. Coexistence of external auditory canal cholesteatoma and paraganglioma is an incidental diagnosis in this current case. The advancement of imaging techniques could help the diagnosis of this very rare clinical coexistence in preoperative assessment.

Molecular basis of carotid body tumor and associated clinical features in Japan identified by genomic, immunohistochemical, and clinical analyses.

Carotid body tumor (CBT) is classified as a paraganglioma (PGL). Here, we report the genetic background, protein expression pattern, and clinical findings of 30 Japanese CBT cases. Germline pathogenic or likely pathogenic (P/LP) variants of genes encoding succinate dehydrogenase subunits (SDHs) were detected in 15 of 30 cases (50%). The SDHB variants were the most frequently detected, followed by SDHA and SDHD variants. One case with SDHAF2 variant was bilateral CBT, and other two multiple PGL cases were not detected P/LP variants. The three cases with germline variants that could be tested did not have somatic P/LP variants of the same genes. Immunohistochemical analysis showed negative SDHB signals in CBT tissues in five cases with germline P/LP variants of SDHB, SDHD, or SDHA. In addition, SDHB signals in CBT tissues were negative in four of nine cases without germline P/LP variants of SDHs. These findings suggest the involvement of unidentified molecular mechanisms affecting SDHs.

Bladder Paraganglioma: Report of Two Cases and A Literature Review

Objective: We report two incidental cases of bladder paraganglioma and a review of the literature published to date. Methods: Medline was searched for the last 10 years for the terms "paraganglioma" and "urinary" and "bladder". Results: Bladder paraganglioma (BP) is extremely rare. It represents 10% of all paragangliomas and concerns less than 0.06% of bladder tumors. Often discovered by chance, it can nevertheless be symptomatic, particularly during micturition. The most common symptoms are hematuria, hypertension and headache. About 14% of these tumors are malignant and radio-chemically resistant. Surgery is therefore the cornerstone of treatment. We recommend, cystoscopy, partial cystectomy and regular follow-up based on regular cystoscopy and imaging. Their rarity explains why, at present, there are no recommendations for treatment and monitoring. However, their risk of malignancy recurrence and metastasis requires regular and long-term follow-up. Conclusions: Bladder paragangliomas are rare tumors. Treatment should be based on partial cystectomy and their follow-up should be regular.

Per-Operative Discovery of Tympanic Paraganglioma: A Case Report

Background: Tympanic paragangliomas are common middle ear benign neoplasias that develop from endocrines cells situated along the great blood vessels of the head and neck, as well as those of the thoracic and lumbar spine. Primary symptoms of tympanic locations include hearing loss and pulsatile tinnitus. Otoscopy often shows a retrotympanic reddish mass, causing tympanic bulging. Computerized tomography scan findings include a tissue density regular mass located at the promontory and limited within the middle ear cavity. Surgical management comprises tumour excision with control of bleeding, with or without prior embolization. Aim: The aim of this presentation is to report an unusual case of tympanic paraganglioma. Case Presentation: We report the case of a 56-year-old patient whose clinical and paraclinical presentations were consistent with cholesteatoma, though a tympanic paraganglioma was discovered per-operatively. Conclusion: In some rare cases, tympanic paraganglioma can be present like a cholesteatoma.

A Rare Case of Intra-Renal Paraganglioma in a Child Masquerading as Renal Cell Carcinoma

Background: Renal cell carcinomas (RCCs) are rare in children, accounting for around 2% of all pediatric renal tumors. Paragangliomas are extra-adrenal locations of phaeochromocytomas. They originate from chromaffin cells arising along the sympathetic paraganglia and are secretory in most cases. Sequential imaging is often required to ascertain the etiology of a renal mass; ultrasound (USG), contrast-enhanced computerized tomography scan (CECT), and magnetic resonance imaging (MRI). Tissue diagnosis is confirmatory. Clinical Description: An 11-year-old girl presented with a right-sided abdominal and flank pain that was dull aching and nonradiating. She had no history of jaundice, hematuria, dysuria, bowel symptoms, sweating, palpitations, or syncope. The vitals were stable, without tachycardia or hypertension. No abnormal findings were found on clinical examination. Initially, the possibility of a renal stone was considered. Management and Outcome: Baseline blood tests were normal. Abdominal USG detected a heterogeneous mass in the right kidney. CECT ascertained that it was very vascular and exhibited contrast enhancement, suggesting a renal tumor. MRI showed that the right renal artery was acting as the feeding vessel to the tumor. RCC was suspected based on imaging. The vascular nature prevented us from performing a Tru-cut biopsy. A right-sided nephrectomy was planned, preceded by angiography and embolization of the right renal artery to reduce vascularity. Intraoperative episodes of hypertension were noted. Gross appearance suggested RCC; however, histopathology revealed evidence of an intrarenal PGL. Conclusions: Diagnosing a nonfunctional PGL in an asymptomatic patient is challenging and may only be possible by intraoperative histopathology.

A young patient with heart failure was diagnosed with extra-adrenal paraganglioma: a case report

BackgroundWe present a case of pelvic paraganglioma that presented with heart failure as the primary symptom.Case presentationA 35-year-old man was admitted to hospital due to heart failure. Contrast-enhanced pelvic CT showed mass shadows in the posterior wall of the bladder and multiple enlarged lymph nodes in the retroperitoneal area. Ultrasound-guided puncture was performed, and the pathologic diagnosis was extra-adrenal paraganglioma. The patient refused any chemotherapy and died within six months of diagnosis.ConclusionThe possibility of neuroendocrine-related tumors, for example paragangliomas, should be considered in young patients with heart failure, especially those with concomitant hypertension and diabetes.

A case of paraganglioma that mimicked a duodenal tumor

A case of paraganglioma that mimicked a duodenal tumor

Genotype-Phenotype Correlations and Clinical Outcomes in 155 Cases of Pheochromocytoma and Paraganglioma.

Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumours, often associated with germline mutations that influence the disease biology and clinical course. We aimed to describe the genotypic and phenotypic characteristics of a consecutive series of PPGL patients and correlate mutation status with clinical outcomes. We performed a retrospective cohort study of all PPGL patients who presented to a tertiary referral centre between March 2005 and February 2022. Genotypic, phenotypic and follow-up data were analysed. A total of 140 patients were included. Of these, 94 (67%) patients underwent genetic testing and a mutation was detected in 36 (38%) patients. Mutation presence was associated with younger age, smaller tumour size and bilateral adrenal tumours. Disease recurrence occurred at a median time of 5.4 (IQR 2.8-11.0) years after treatment in 21 (15%) patients, of which 14 (67%) had a mutation in a susceptibility gene. Recurrence pattern was influenced by mutation type; higher local recurrence risk for SDHA, SDHB, and MEN2B disease, and higher metastatic risk for SDHB, VHL and MEN2A disease. Recurrence occurred in three (3%) patients with mutation absence. Multivariate analysis revealed that age ≤40years and mutation presence were associated with increased risk of disease recurrence. Genotypic characteristics strongly influence disease presentation and recurrence risk, which may occur more than 5years after initial treatment. Routine genetic testing of PPGL patients is warranted given the high prevalence of mutations, allowing for prognostication and tailored follow-up. In the presence of germline mutations, follow-up should be life-long.

Incidental Succinate Dehydrogenase (SDH) Deficient Renal Cell Carcinoma and Paraganglioma in a 24-Year-Old

Abstract Introduction/Objective Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is rare neoplasm (&amp;lt;0.2% of all RCCs) caused by SDH-subunit gene mutation, usually SDHB. Patients carrying such mutations are also predisposed to other SDH-deficient neoplasms such as paraganglioma, gastrointestinal stromal tumor, and pituitary adenoma. Here, we report a case of incidental SDH-deficient RCC and paraganglioma. Methods/Case Report A 24-year-old male without past medical or family history presented to ED for perianal abscess. Imaging showed 8-cm heterogeneous left renal mass (figure-A) and 3.3-cm mass below aortic bifurcation, highly concerning for RCC with metastasis. Biopsy of kidney mass showed nested and trabecular epithelial neoplasm with weakly eosinophilic and occasionally vacuolated cytoplasm (figure-B). Nuclei were round with smooth contour and inconspicuous nucleoli. Tumor was immunopositive for PAX8, e-cadherin, P504S, and CD10, while negative for CK7, CD117, and Melan-A. SDHB immunostain was negative in tumor with intact staining in intervening endothelium. Findings were consistent with SDH-deficient RCC. Biopsy of pelvic mass showed low-grade neoplasm that was immunopositive for synaptophysin, chromogranin, and GATA3, with S100-positive sustentacular cells, consistent with paraganglioma. Patient underwent radical nephrectomy which revealed 7.5-cm, well-circumscribed, tan-red, predominantly solid mass with few cysts. Histologically, tumor had thin fibrous capsule and morphologically similar to biopsy. Tumor was limited to kidney without necrosis, sarcomatoid/rhabdoid differentiation, or vascular invasion. Results (if a Case Study enter NA) NA. Conclusion SDH-deficient RCC is rare low-grade entity with risk of metastasis and development of other neoplasms, which requires continued follow-up and potential genetic testing for patient and family members. Therefore, including SDH-deficient RCC in differential diagnosis of eosinophilic renal neoplasms is essential.

ODP538 A Case of Multiple Endocrine Neoplasia Type 2A with Malignant Paraganglioma

Abstract Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant hereditary cancer syndrome due to germline variants in the REarranged during Transfection (RET) proto-oncogene. There are two distinct clinical entities: MEN 2A and MEN 2B. MEN 2A is associated with medullary thyroid carcinoma (MTC), pheochromocytoma/paraganglioma and primary hyperparathyroidism. Case presentation At the age of 54, the patient became aware of a thyroid mass and went to the hospital. She was diagnosed as MTC by cytology. She was referred to our hospital for treatment. No thyroid cancer patients were found in her relatives. Her thyroid gland was elastic and soft, and a hard nodule about 1.5 cm in the lower pole of her left thyroid lobe was found. An Ultrasonography found the multiple nodules in both lobes of the thyroid gland, suggesting multiple or metastases of MTC. Although there was no family history, MEN2 was suspected, and screening of the abdominal organs by a CT scan revealed a 35 mm nodular lesion with calcification on the ventral side of the inferior vena cava (IVC). Multiple neoplastic lesions were found in her liver S2, S6 and S8 region. A CT scan also found the overall thickened right adrenal gland. An MIBG scintigraphy showed abnormal accumulations in these lesions. Laboratory data showed the increased the catecholamine metabolites both in blood and urine, and slightly increased CEA and calcitonin levels in the serum. After the genetic counselling, an informed consent was obtained and genetic test of RET oncogene was performed. A germline mutation was found in codon 634. Based on these findings, we diagnosed her as MEN2A with MTC, malignant paraganglioma and multiple liver metastases. First, IVC ventral lesions, multiple hepatic lesions, and right adrenal gland resection were performed. One month after the operation, total thyroidectomy and cervical lymph node dissection were performed. Pathologically, the IVC ventral tumor was a ganglion tumor covered with a pseudocapsule, with fibrous vitrification and coarse calcification inside. The histology of the liver regions were almost the same, and there was no finding suggesting the metastasis of MTC, and the histological image was consistent with the liver metastasis of paraganglioma. The right adrenal gland was diagnosed with adrenal medulla hyperplasia. Since then, she has been receiving continuous Cyclophosphamide Hydrate/ Vincristine Sulfate/Dacarbazine chemotherapy, and at the end of the 24th course, she has progressed without recurrence or the appearance of new metastases. It was reported that most Paragangliomas and pheochromocytomas in MEN2 with RET germline mutation are characterized by nonaggressive behavior, and paraganglioma was thought to be rare in onset than pheochromocytoma in MEN2A. In particular, cases of malignant paraganglioma in MEN2 with the RET634 germline mutation are extremely rare. Presentation: No date and time listed

ODP280 A Unique Case of Coexisting Paraganglioma, Primary Hypoaldosteronism and Primary Hyperparathyroidism in a Single Patient

Abstract Introduction To date, case reports have shown an association between paraganglioma and primary hyperaldosteronism, and primary hyperparathyroidism with primary aldosteronism, but not for all three of the aforementioned endocrinopathies combined. Clinical Case A 54-year-old woman with history of uncontrolled HTN, hypokalemia, DM2, CKD stage III, Takotsubo cardiomyopathy and primary hyperparathyroidism presented to the hospital with back pain. CT scan showed a 4.3 cm necrotic retroperitoneal mass. Due to her labile blood pressure, ranging from 194/102 mmHg to 106/60 mmHg, endocrinology was consulted for evaluation of secondary hypertension. Plasma normetanephrines were 3447 pg/mL (n ≤ 57 pg/mL), 24-hour urine normetanephrines 5954 mcg/24 hours (n 122-676 mcg/24 hours) and 24-hour urine norepinephrines 476 mcg/24 hours (n 15-100 mcg/24 hours). 24-hour urine cortisol and 24-hour urine metanephrines were within normal limits. Plasma aldosterone level and plasma renin activity (PRA) were 19 ng/dL and 0.78 ng/mL/h (n 0.25-5.82 ng/mL/h),. However, the patient was also taking spironolactone and telmisartan which interfered with results, and withdrawal of interfering medications was considered unsafe. 68Ga-DOTATATE PET/CT showed mild uptake in a left para-aortic mass. Genetic testing did not show pathogenic mutations of AP2S1, CASR, MEN1, NF1, RET, SDHA, SDHAF2, SDHB, SDHC, TMEM127 or VHL genes. The patient was started on doxazosin and underwent successful removal of the left retroperitoneal mass consistent with paraganglioma. Six months later, surveillance testing showed normalization of fractionated plasma metanephrines and of 24-hour urine metanephrines. However, due to blood pressure of 152/100 mmHg and K of 2.8 mmol/L (n 3.5-4.7 mmol/L), concern was raised for primary hyperaldosteronism. After potassium repletion, labs showed plasma aldosterone of 37 ng/dL, PRA of 0.2 ng/mL/h (n 0.25-5.82 ng/mL/h) and ARR of 185 with potassium of 4.1 mmol/L (n 3.5-4.7 mmol/L) consistent with primary hyperaldosteronism. MRI of adrenal glands showed a left adrenal gland that was thickened and nodular but without discrete nodules &amp;gt; 1 cm. The patient was referred for adrenal vein sampling. Five years previously, the patient had been diagnosed with primary hyperparathyroidism, with PTH of 188.5 pg/mL (n 14-64 pg/dL), Calcium of 10.6 mg/dL (n 8.5-10.1 mg/dL) and GFR of 39. Pre-operative imaging with MRI neck had shown enlargement of two parathyroid glands. She had undergone two-gland parathyroidectomy with intraoperative PTH decrease of &amp;gt; 50% and normalization of calcium. However two weeks later, her PTH returned to pre-operative levels (with normal 25(OH)D) and continues to remains elevated. This has been attributed to underlying secondary hyperparathyroidism from her chronic kidney disease. Conclusion To our knowledge, this is a unique case of combined paraganglioma, primary hyperaldosteronism and primary hyperparathyroidism, as thorough literature review has not shown such a coexistence in the past. Presentation: No date and time listed

Different intraoperative decisions for undiagnosed paraganglioma: Two case reports

Paragangliomas may be preoperatively misdiagnosed as non-functioning retroperitoneal tumors and are sometimes suspected only at the time of intraoperative manipulation. Without preoperative alpha blockade preparation, a hypertensive crisis during tumor manipulation and hypotension after tumor removal may result in critical consequences. Therefore, primary consideration should be given to the continuation or discontinuation of surgery on the basis of the possibility of gentle surgical manipulation and hemodynamic stabilization. We report two cases of paragangliomas detected intraoperatively. A 65-year-woman underwent laparoscopic small-bowel wedge resection. A hypertensive crisis occurred during manipulation of the mass, and an unrecognized catecholamine-producing paraganglioma was suspected. The surgeon and anesthesiologists believed that tumor excision could be performed with minimal manipulation of the tumor because the tumor was in a favorable location. Serious hemodynamic instability did not occur with aggressive use of vasoactive drugs. A week later, a 54-year-man underwent open resection of a 3-cm-sized retroperitoneal mass and showed the same findings during mass manipulation. For this patient, continuous manipulation of the mass seemed inevitable due to adhesion between the right adrenal gland and the mass in a narrow surgical field. The surgeon and anesthesiologists decided to cancel the surgical procedure and planned to perform a reoperation after alpha blockade therapy. Two weeks later, the tumor was uneventfully removed with small doses of vasoactive drugs. When an undiagnosed paraganglioma is suspected intraoperatively, reoperation after adequate preparation should be considered as an option to avoid fatal outcomes.

Application of internal carotid artery stent in skull base surgery

Objective: To report the experience of the application of internal carotid artery stent in skull base surgery, and to clarify the important role of internal carotid artery stent in skull base surgery. Methods: A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People's Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted. Among them, 17 were male and 5 were female, aged between 33 and 75 years. There were 5 cases on the left, 16 cases on the right, and 1 case on both sides. Of these, there were 4 cases of jugular paraganglioma, 1 case of chondrosarcoma in the jugular foramen, 1 case of carotid body paraganglioma, and 16 cases of nasopharyngeal carcinoma after radiotherapy. Results: The degree of internal carotid artery erosion was assessed by computed tomography angiography (CTA), magnetic resonance imaging and digital subtraction angiography (DSA) images in 22 patients before surgery. It was found that the internal carotid artery was involved to varying degrees in all patients, so internal carotid artery stents were implanted before surgery. Tumor tissue was found to surround the internal carotid artery to varying degrees. Total or subtotal tumor resection was performed in all patients, and no intraoperative and postoperative complications occurred. The postoperative follow-up was 5 months to 2 years, and all patients had no complications such as spontaneous bleeding and pseudo aneurysm. There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases. Conclusions: For patients with skull base tumors, preoperative imaging indicates the limited involvement of the internal carotid artery, and internal carotid artery stent implantation before surgery is a safe and effective treatment.

Paraganglioma of External Auditory Canal

Paragangliomas (PGLs) are benign tumors of neuroectodermal origin. In the ear, they are commonly found in the middle ear or jugular bulb. PGL of external auditory canal (EAC) is extremely rare. To date, only a few cases of PGL of EAC have been reported. Here, we present a case of a 52-year-old female, who presented with complaints of decreased hearing and painful left ear discharge. On evaluation, she was found to have a soft-tissue mass arising from the posterosuperior wall of the left EAC, which was excised under general anesthesia and histopathologically confirmed to be EAC PGL. At 1 year of follow-up, the patient has a patent EAC and is disease-free. Although rare, PGL should be considered in the differential diagnosis of soft-tissue mass in EAC.