Diagnosis Of Carotid Body Tumor Research Articles

The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis

BackgroundComputed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs).MethodsWe retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated.ResultsCBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, − 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors.ConclusionsCDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.

Dural Arteriovenous Fistula with Hypoglossal Nerve Paralysis

A male in his early 30s presented with a swelling just below the angle of his left mandible for the last 2 months. The swelling had insidious onset, progressive and painless. Examination found 4 × 4cm, diffuse, soft to firm, pulsatile swelling in the upper part of the neck on left side ([Fig. 1]). An oral examination revealed left hypoglossal nerve paralysis. Further examination was noncontributory, including vagus and accessory spinal nerve examination. A probable diagnosis of carotid body tumor was kept, and the patient was subjected to computerized angiography. Angiography revealed dural arteriovenous fistula (DAVF), a rare clinical entity leading to hypoglossal nerve paralysis ([Figs. 2 (A, B)]). Patient was advised to undergo digital subtraction angiography for further management, but he refused and chose conservative care with regular follow-up.

Current trends in carotid body tumors: Comprehensive review.

Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.

Sex differences according to ethnic presentation in carotid body tumors: a systematic literature review

<p>Compare through a systematic literature review, the sex distribution of patients with carotid body tumors in Mexico and Latin America with the rest of the world. The eligibility criteria included retrospective cohort studies of more than 15 patients with a diagnosis of carotid body tumor (regardless of Shamblin's classification or clinical manifestations), which also reported the number of women and men affected, as well as their mean age. We divided the countries where the studies were conducted into regions (Latin America, USA, and Europe/Asia). The sex ratio difference between regions was calculated using a chi-square test. A p<0.05 was considered statistically significant. Thirty-eight studies met the eligibility criteria. Latin America had 1,345 cases, the United States had 808, and Europe/Asia had 672. Mexico had the most cases (1125), followed by the United States. The rest of the countries had less than 30 cases each. We found a statistically significant differences when we compared Latin American countries with the United States and Europe/ Asia (p<0.001). However, the most significant difference was observed when we compared Mexico with the United States, Europe/Asia, and other Latin American countries. When comparing other Latin American countries with Europe/Asia, we found a statistical difference (p=0.01); however, there was no statistical difference (p=0.05) when we compared other Latin American countries with the United States. Mexico has the highest number of reported cases of carotid body tumors in the world. Women account for 90% of cases.</p>

Surgical Excision of a Functional Carotid Body Tumor Presenting Intraoperative Hypertensive Crisis: A Case Report and Literature Review

Carotid body tumor (CBT) is a rare neoplasm arising from the carotid bifurcation. Functional CBTs are extremely rare and are usually associated with elevated serum catecholamine and catecholamine-induced symptoms such as paroxysmal hypertension, palpitations, dizziness, flushing and tachycardia. We reported a 47-year-old female with a functional CBT that was biochemically silent and had no catecholamine-induced symptoms preoperatively, but experienced hypertensive crisis during surgical excision of the lesion. Postoperative pathology confirmed the diagnosis of CBT, and a functional tumor was considered due to the hypertensive crisis during surgical manipulation of the lesion. Under careful management of intraoperative blood pressure and close monitoring of vital sign along with adequate crystalloid infusion after surgery, the tumor was successfully excised and the patient recovered uneventfully during a follow-up period of 12 months. To the best of our knowledge, this is an unusual report of functional CBT presenting merely hypertensive crisis during surgery, with no elevated serum catecholamine or catecholamine-induced symptoms preoperatively. Clinicians should be aware of such lesions so that appropriate medication and gentle manipulation are given when encountering hypertensive crisis during surgical excision of CBTs, to prevent life-threatening cardiovascular complications. The appropriate management and recognition of functional CBTs were also discussed by means of a review of the literature.

Diagnostic Dilemma in a Carotid Body Tumor: A Case Report

An asymptomatic swelling in the neck region has many differential diagnoses. Most common of them is reactive lymphadenitis and carotid body tumor being the last thing. We present here a case of carotid body tumor that misguided us on clinical and radiological ground. It was suspected intra-operatively and confirmed by histopathological examination. Carotid body tumors are rare neoplasm. It arises from the chemoreceptor cells of the carotid bulb. We report a case of carotid body tumor in a 57-year-old female, who presented with painless, gradually progressive lateral neck swelling. The diagnosis is suspected on the basis of clinical radiological and per-operative examination findings. Histopathological examination confirms the diagnosis of carotid body tumor

Carotid body tumour in a dog: computed tomography and histopathology findings and evaluation of surgical management

A 2.5-kg, eight-year-old, neutered male Yorkshire Terrier was presented for evaluation of a cervical mass that had first been noticed a year earlier. A firm spherical mass located caudal to the left mandible was found on physical examination. Ultrasonography revealed a well-defined, round-shaped mass located medial to the left mandibular salivary gland that was approximately 2.6 cm in height, 2.3 cm in width and 3 cm in length. Volume-rendered images obtained by computed tomography (CT) showed that the left external and internal carotid arteries and internal jugular vein were encased in the mass. A definitive diagnosis of carotid body tumour was made based on histopathology. The tumour and the carotid arteries and internal jugular vein encased in the tumour were resected using CT-based surgical planning. The regional neural structures were preserved by careful blunt dissection. The dog had a mild hacking cough after swallowing and hoarseness that disappeared spontaneously five days and two months, respectively, after surgery. There was no evidence of recurrence or distant metastasis at 18 months postoperatively. This case report describes successful surgical management of a carotid body tumour with ligation and transection of the carotid arteries in a dog. To the authors’ knowledge, this is the first report of successful surgical treatment of an advanced carotid body tumour based on CT findings.

Actual methods of carotid body tumor diagnosis

The aim — to improve the carotid body tumors (CBT) diagnosis.Materials and methods. The article presents with the analysis of the structure and the results of the diagnosis and surgical treatment of 65 patients who were hospitalized in the department of vascular surgery Lviv Regional Clinical Hospital for the period 1995 to 2016. There were 36 cases of carotid body tumor and 29 cases other tumors of the neck, which were directed from other medical institutions with a diagnosis of «carotid body tumor». The examination of patients included physical examination, ultrasonography, computer tomography, MRI. Final diagnosis verification was confirmed with pathological and histological clinical report.Results and discussion. At the initial examination of patients the symptom «plus» tissue was identified palpatory on the neck: left or right side in the projection of the bifurcation of the common carotid artery in 36 patients. In 5 (14 % of the CBT) patients synchronous lesions were found on both sides of the neck in the projection of the bifurcation of the common carotid artery. On palpation the carotid body tumor was of stiffly — elastic consistency, painless, not soldered to surrounding tissues and slightly shifted transverse axis of the neck, pulsing in sync with carotid artery. All patients underwent carotid ultrasonographic examination with the calculated diagnostic sensitivity of ultrasound to detect tumors, that was 93 %, specificity — 92 %, accuracy — 92 %/In the study patients’ ultrasonography was complemented with contrast computer tomography in 14 (22 %) cases and MRI in 2 (3 %). Biopsy of the tumor and sentinel node was performed in 2 (3 %) patients with CBT and 5 (8 %) patients with tumors of different origin. However, biopsy was not informative because received histological material was without specific changes and prevented from identification of tumor genesis pre surgery stage.Conclusions. Ultrasound is a highly informative and specific method for diagnosis of carotid body tumor. USG can be used for differential diagnosis of the neck carotid body tumor from other tumors on pre surgey stage.

Carotid Body Tumor Masquerading as Metastatic Cervical Lymph Node on Fluorodeoxyglucose Positron-emission Tomography-Computed Tomography.

Carotid body tumors, although representing about 65% of head and neck paragangliomas, are rare neoplasms. Doppler ultrasonography, contrast-enhanced computed tomography (CECT), and MRI have been routinely used in the diagnosis of carotid body tumor. We hereby represent a case of 56-year-old male suspected to have lymph node metastasis from carcinoma pyriform sinus detected as carotid body tumor in fluorodeoxyglucose positron-emission tomography-CECT imaging and subsequently confirmed by histopathology.

Carotid Body Tumors

Carotid body tumors (CBTs) are derived from parasympathetic autonomic nervous system cells and are the most common type of head and neck paragangliomas, accounting for 65-80% of lesions. CBTs may occur sporadically, may be familial with identified gene mutations on the succinate dehydrogenase subunit, or a component of familial neuroendocrine syndromes. Environments or medical conditions leading to chronic hypoxia can increase the risk of CBTs. The differential diagnosis of CBT include other neck masses such as enlarged lymph nodes or other neck tumors. Computed tomography or magnetic resonance angiography is often diagnostic as CBTs cause a characteristic splaying of the carotid bifurcation. The degree of encasement of the carotid arteries is classified by Shamblin Type I-III, and the higher Shamblin category correlates to highest risk of nerve injury after surgical resection. All tumors should be removed in healthy patients, with observation or radiotherapy reserved for high-risk or elderly asymptomatic patients. Tumor embolization may be considered in CBTs larger than 4cm. Resection, with or without tumor embolization, requires adequate exposure of the distal carotid with consideration of nasotracheal intubation or mandibular subluxation. The surgeon must be prepared to resect and replace the carotid artery in large CBTs using techniques similar to carotid endarterectomy to reduce stroke risk. Cranial nerves should be carefully exposed and preserved during a systematic dissection. Despite careful resection, cranial nerve injury may be as high as 30-40%, although only 5% are permanent. Stroke risk (1%) and mortality (<1%) are low. KEY WORDS: Carotid body tumor, succinate dehydrogenase, Shamblin Type, neuroendocrine tumors, parasympathetic autonomic nerve cells, tumor embolization

Anesthetic approaches in carotid body tumor surgery.

OBJECTIVE:Carotid body tumors (CBT) are benign tumors that originate from neural non-chromaffin cells that are typically localized near carotid bifurcation. Surgical removal of the tumor is the most appropriate treatment. General anesthesia is preferred anesthetic technique for CBT surgery. Basic elements of anesthetic management are protection of hemodynamic stability and maintaining cerebral perfusion pressure (CPP). The aim of this study was to evaluate anesthetic management of CBT surgery and present the literature knowledge.METHODS:The study included 10 consecutive patients with diagnosis of CBT who underwent surgery at Antalya Training and Research Hospital, in Antalya, Turkey, between 2013 and 2016. Preoperative demographic details; comorbidities; side of surgical site; duration of operation; length of intensive care unit (ICU) and hospital stay; change of intraoperative blood pressure; use of inotropic drugs, blood products, and analgesics; postoperative visual analogue scale (VAS) pain score; and complications were recorded.RESULTS:According to Shamblin classification, 3 tumors were type I and the remaining 7 were type II. Tumors were located on right side in 6 patients, and on left in 4. Blood loss sufficient to require transfusion was observed in 1 patient. Average intraoperative blood loss was 287±68 mL. Tachycardia and hypertension were observed in 1 patient; bradycardia and hypotension were seen in 4 patients. Infusion for inotropic support was administered to 1 patient. Mean duration of operation was 109±20 minutes. Mean VAS score was 4±1, mean ICU tramadol consumption was 80±25 mg. Duration of stay in ICU and hospital were 2.4±1.1 hours and 3.8±0.7 days, respectively. Mortality and neurological complications were not seen in postoperative period.CONCLUSION:CBT surgery requires close and complex anesthesia management. Protection of hemodynamic stability against sudden hemodynamic changes, monitoring, and maintaining CPP are the most important aspects of anesthetic management.

Fine-needle aspiration cytology diagnosis of paraganglioma (carotid body tumor)

A case of carotid body tumor was diagnosed based on fine-needle aspiration cytology (FNAC) in 22-year-old female who presented with a mass in the right lower cervical region. Provisional diagnosis was made as metastatic deposits. However, this case was diagnosed on FNAC as carotid body tumor due to the presence of definite diagnostic features on cytology like hemorrhagic aspirate, with clusters and as well as discrete cells, which are round to oval with moderate anisokaryosis, indistinct cell outlines, stippled chromatin and fine granular cytoplasm. Focal attempted acinar formation was also seen. Based on these cytologic findings and the location of the swelling, a diagnosis of carotid body tumor was made. The diagnosis was confirmed on histopathological examination. Carotid body tumor is arising from the chief cells of the carotid body, which is situated at the bifurcation of the common carotid artery. Though the fine needle aspiration was seldom suggested for the diagnosis of carotid body tumor due to its location, there were no complications during the procedure in this case. As the role of FNAC in the diagnosis of carotid body, tumor is minimized due to the severe bleeding complications of the procedure and only few cases were reported in the literature until now. However in this case, the main diagnosis was made by FNAC without any complications.

Surgery of the carotid body tumour: A case report and review of literature

The carotid body tumour is the most common head and neck paraganglioma arising from the carotid bodies located at the bifurcation of the common carotid arteries. These are very rare tumors with an incidence of 0.012% in general population. They present as slow growing, asymptomatic neck masses of varying duration. They occur in sporadic, hereditary and hyperplastic variants. The hereditary forms tend to be bilateral, functional and carry higher risk of malignancy. The angiography is the modality of choice for diagnosis and treatment planning. The surgical resection is the mainstay of treatment which can be performed with acceptable complication rates in experienced centres. We report the case of a 37-year-old lady who presented with a slowly growing mass on the right side of the neck for which she under went surgery and histopathological examination confirmed the diagnosis of carotid body tumour.

Role of duplex ultrasound in the diagnosis and assessment of carotid body tumour: A literature review.

Carotid body tumour is a rare disease, a slow growing highly vascular tumour of the carotid body tissue and the most common type of the paraganglioma. This article reviews the pathological, clinical and ultrasound features of carotid body tumours and discusses the role of duplex ultrasound in the diagnosis and assessment of this condition. The initial presentation of carotid body tumour is usually a painless palpable neck mass. Some patients may experience local pressure symptoms as well as symptoms from vagal, hypoglossal and cervical sympathetic nerve impingement. Percutaneous needle aspiration or incisional biopsy is contraindicated for the diagnosis of carotid body tumours. Duplex ultrasound, computed tomography scan, magnetic resonance scan and angiography are commonly used diagnostic tools for this condition. Complete surgical excision of carotid body tumour is the treatment of choice as radiation therapy and chemotherapy are unsatisfactory. Based on vascularity and location, duplex ultrasound scan is able to diagnose carotid body tumour and differentiate it from many other masses in the neck. This non-invasive, inexpensive and readily available diagnostic tool can be used as a first-line imaging modality for the diagnosis and assessment of carotid body tumours.

68Ga-DOTATATE PET/CT Imaging in Carotid Body Tumor

Imaging modalities like Doppler ultrasonography, contrast-enhanced computed tomography and magnetic resonance imaging are routinely used in the diagnosis of carotid body tumors. Ga-DOTATATE PET/CT is another promising noninvasive technique in the diagnosis of carotid body tumors. We present F-FDG PET/CT and Ga-DOTATATE PET/CT in a 30-year-old man with carotid body tumor.

Ultrasound evaluation of carotid body tumours

Carotid body tumour (CBT) is a rare neoplasm that usually presents as an asymptomatic slow-growing neck mass at the carotid bifurcation. Due to these benign attributes, CBTs often go undiagnosed for a few years before a lateral neck mass becomes clinically obvious or is found incidentally on imaging. Herein we report one such patient with unilateral CBT incidentally diagnosed on ultrasound and we describe its characteristic sonographic features of a hypervascular mass splaying the carotid bifurcation. Duplex sonography is increasingly used as the first-line non-invasive investigative tool of choice for the primary diagnosis of CBTs and additionally may be used as a reliable cost-effective tool in the sequential follow-up of non-operatively managed tumours.

1525: Case Study: Upper Neck Mass - A Carotid Body Tumour or Not?

ObjectiveTo determine whether Carotid Duplex Ultrasound (CDU) allows definitive differentiation of Carotid Body Tumour (CBT) from other masses.CDU has historically been used in diagnosing patients presenting with an upper neck mass. Diagnosis would be made on CDU features (anatomic location of the mass, splaying of the carotid bifurcation with a colour blush enhancing a subtle mass) to differentiate CBT from other masses.MethodsA 53 year old female presented with history of headaches and episodes of feeling faint. She was unaware of neck swelling until other investigations disclosed this. CDU was performed to assess extracranial carotid circulation for presence of possible disease, haemodynamically significant lesions etc. The nature and relation of the neck mass to the carotid vessels was established.ResultsCDU demonstrated anatomic location of the mass, splaying of the right carotid bifurcation with a colour blush enhancing a subtle mass. Findings were consistent with a diagnosis of CBT. CT findings demonstrated glomus vagale tumour with differential diagnoses including schwannoma of the carotid space or carotid body paraganglioma. Angiography demonstrated right glomus jugulare tumour supplied by ascending pharyngeal & occipital arteries. Diagnosis was confirmed with operative findings and histology results.ConclusionCDU is a useful tool in distinguishing CBT from other upper neck masses, but this case illustrates that CDU features alone cannot adequately and universally differentiate between CBT & other paragangliomas, such as glomus vagale tumours. We recommend reporting of these lesions should suggest initial diagnosis of paraganglioma, not CBT, pending further diagnostic studies. ObjectiveTo determine whether Carotid Duplex Ultrasound (CDU) allows definitive differentiation of Carotid Body Tumour (CBT) from other masses.CDU has historically been used in diagnosing patients presenting with an upper neck mass. Diagnosis would be made on CDU features (anatomic location of the mass, splaying of the carotid bifurcation with a colour blush enhancing a subtle mass) to differentiate CBT from other masses. To determine whether Carotid Duplex Ultrasound (CDU) allows definitive differentiation of Carotid Body Tumour (CBT) from other masses. CDU has historically been used in diagnosing patients presenting with an upper neck mass. Diagnosis would be made on CDU features (anatomic location of the mass, splaying of the carotid bifurcation with a colour blush enhancing a subtle mass) to differentiate CBT from other masses. MethodsA 53 year old female presented with history of headaches and episodes of feeling faint. She was unaware of neck swelling until other investigations disclosed this. CDU was performed to assess extracranial carotid circulation for presence of possible disease, haemodynamically significant lesions etc. The nature and relation of the neck mass to the carotid vessels was established. A 53 year old female presented with history of headaches and episodes of feeling faint. She was unaware of neck swelling until other investigations disclosed this. CDU was performed to assess extracranial carotid circulation for presence of possible disease, haemodynamically significant lesions etc. The nature and relation of the neck mass to the carotid vessels was established. ResultsCDU demonstrated anatomic location of the mass, splaying of the right carotid bifurcation with a colour blush enhancing a subtle mass. Findings were consistent with a diagnosis of CBT. CT findings demonstrated glomus vagale tumour with differential diagnoses including schwannoma of the carotid space or carotid body paraganglioma. Angiography demonstrated right glomus jugulare tumour supplied by ascending pharyngeal & occipital arteries. Diagnosis was confirmed with operative findings and histology results. CDU demonstrated anatomic location of the mass, splaying of the right carotid bifurcation with a colour blush enhancing a subtle mass. Findings were consistent with a diagnosis of CBT. CT findings demonstrated glomus vagale tumour with differential diagnoses including schwannoma of the carotid space or carotid body paraganglioma. Angiography demonstrated right glomus jugulare tumour supplied by ascending pharyngeal & occipital arteries. Diagnosis was confirmed with operative findings and histology results. ConclusionCDU is a useful tool in distinguishing CBT from other upper neck masses, but this case illustrates that CDU features alone cannot adequately and universally differentiate between CBT & other paragangliomas, such as glomus vagale tumours. We recommend reporting of these lesions should suggest initial diagnosis of paraganglioma, not CBT, pending further diagnostic studies. CDU is a useful tool in distinguishing CBT from other upper neck masses, but this case illustrates that CDU features alone cannot adequately and universally differentiate between CBT & other paragangliomas, such as glomus vagale tumours. We recommend reporting of these lesions should suggest initial diagnosis of paraganglioma, not CBT, pending further diagnostic studies.

Role of the Genetic Study in the Management of Carotid Body Tumor in Paraganglioma Syndrome

Diagnosis of carotid body tumor (CBT) was made in a 36 years old woman. The pre-operative examination included genetic analysis of the succinate dehydrogenase that showed a mutation in his subunit D responsible of multiple paraganglioma at slow growth. Subsequently a thoraco-abdominal CT and indium 111 octreotide body scan were performed and another paraganglioma was detected in the anterior mediastinum. CBT was surgically removed; differently the thoracic lesion due to his benign genetic profile was not treated. During a 3-years follow-up the thoracic paraganglioma as expected, didn't increase. Genetic analysis of succinate dehydrogenase, should be performed in the management of CBT.

Bilateral carotid body tumor: The role of fine‐needle aspiration biopsy in the preoperative diagnosis

Carotid body (CB) is a round to ovoid or flattened structure situated within the adventitia of the common carotid artery bifurcation on both sides of the neck. CB contains two basic types of cells: chief cells (or glomus type 1) and sustentacular cells (glomus type 2). Carotid body tumor (CBT) or paraganglioma arises from the chief cells of the carotid body. The diagnosis of CBT is typically made with radiological studies. Fine needle aspiration biopsy (FNAB) is seldom requested for this purpose due to rare but dreadful reported complications such as hemorrhage and damage to the carotid artery. In this report we discuss the cytological findings of a malignant CBT diagnosed by FNAB in a 22 year-old female.

Cervical neurofibroma in the differential diagnosis of carotid body tumour.

Cervical neurofibroma in the differential diagnosis of carotid body tumour.