Carcinoma del glomus carotideo. Serie de casos / Carcinoma of the carotid glomus. Case series

Introducción. El carcinoma del glomus carotideo es infrecuente y se presenta en el 6 % de los paragangliomas carotideos. Suele haber dificultad en su diagnóstico preoperatorio y no se diferencia fácilmente de su contraparte benigna, lo que puede conllevar a complicaciones quirúrgicas. Este trabajo describe la experiencia en su abordaje clínico y quirúrgico en una serie de casos, además de una revisión de la literatura profundizando en su diagnóstico, abordaje terapéutico, sobrevida y mortalidad. Métodos. De los pacientes operados por glomus carotideos durante un periodo de 20 años, se identificaron aquellos llevados a cirugía por carcinoma. Se realizó una búsqueda bibliográfica extensa en PubMed, haciendo énfasis en diagnóstico y tratamiento. Resultados. De un total de 139 pacientes sometidos a cirugía de resección de tumor del cuerpo carotideo, tres pacientes (2,2 %) presentaron carcinoma. Dos tenían metástasis cervicales y uno metástasis hepáticas. Uno presentaba glomus bilateral asociado a trastorno genético de origen familiar. Se realizó cirugía y adyuvancia en todos los casos. Discusión. El diagnóstico diferencial preoperatorio entre glomus benigno y maligno es difícil, por lo cual deben buscarse hallazgos clínicos o factores de riesgo que puedan sugerir malignidad. Las imágenes pocas veces muestran características claras de invasión vascular. Siempre que sea posible, en el tratamiento del cáncer del glomus carotideo, debe realizarse resección quirúrgica, acompañada de un vaciamiento funcional de cuello, dejando la radioterapia, la quimioterapia y la hormonoterapia como terapias adyuvantes

Introduction. Carcinoma of the carotid glomus is rare and occurs in 6% of carotid paragangliomas. There is often difficulty in its preoperative diagnosis, and it is not easily differentiated from its benign counterpart, which can lead to surgical complications. This study describes the experience in its clinical and surgical approach in a series of cases, as well as a review of the literature of its diagnosis, therapeutic approach, survival, and mortality.Methods. Of the patients operated for carotid glomus over a 20-year period, those undergoing surgery for carcinoma were identified. An extensive literature search was conducted in PubMed, with an emphasis on diagnosis and treatment.Results. Out of a total of 139 patients who underwent carotid body tumor resection surgery, three patients (2.2%) had carcinoma. Two had cervical metastases and one had liver metastases. One had bilateral glomus associated with a genetic disorder of familial origin. Surgery and adjuvant surgery were performed in all cases.Discussion. The preoperative differential diagnosis between benign and malignant glomus is difficult, for which clinical findings or risk factors that may suggest malignancy should be sought. Images rarely show clear features of vascular invasion. Whenever possible in the treatment of carotid glomus cancer, surgical resection should be performed, accompanied by a functional neck dissection, leaving radiotherapy, chemotherapy, and hormone therapy as adjuvant therapies

Propuesta de clasificación tomográfica preoperatoria para el tumor del cuerpo carotideo / Proposal for a preoperative tomographic classification for carotid body tumor

OBJETIVO: proponer una clasificación preoperatoria a los pacientes con tumor de cuerpo Carotídeo y relacionarlos con complicaciones postoperatorias. MATERIAL Y MÉTODOS: todos los pacientes operados con diagnóstico de tumor del cuerpo Carotídeo entre el 2005 al 2014 en el Hospital Obrero N° 1 de la Caja Nacional de Salud en La Paz - Bolivia RESULTADOS: se analizaron y operaron 115 pacientes con un promedio de edad de 52 años (DE±11,725 y una moda de 57 años) de los cuales el 109 (94,80%) correspondieron al género femenino con una razón de 18:1. Todos los pacientes eran originarios y residentes de ciudades ubicadas a más de 2500 m.s.n.m. El promedio de evolución fue de 3 años (DE±2,189), y solo 7 pacientes (6,1%) presentan hábito tabáquico. 83 pacientes (72,2%) de los TCC se localizan en el lado izquierdo En las manifestaciones clínicas, todos los pacientes presentan el tumor localizado en el ángulo mandibular, por delante del musculo esternocleidomastoideo, describiéndose un crecimiento paulatino y permanente en 72 sujetos (62,6%), cefalea en 45 (39,1%), presencia de latido en 30 sujetos (26,1%), disfagia en 9 (7,9%), mareos en 16 (13,9%) y disfonía en 6 (5,2%). Entre los signos más evidentes de TCC, se describe el signo de Fontaine en 114 sujetos (99,2%), adenomegalia en 20 (17,4%) y otros menos frecuentes como soplo, abombamiento parafaringeo y compromiso de pares craneales. Todos los pacientes fueron clasificados en ambos sistemas (Shamblin y la nuestra llamada de los Andes). Se describen 39 pacientes (33,2%) con complicaciones postoperatorias, Grado I: 1 paciente sin complicaciones; Grado II: de 58 sujetos, 4 (3,5%) presentaban parálisis temporal del Hipogloso; en el Grado III: de los 41 sujetos, 24 (20,8%) presentaron ligadura de la arteria carótida externa, parálisis del hipogloso y glosofaringeo, lesión de recurrente y del laríngeo superior. En el grupo IV, de los 15 sujetos operados, 11 presentaron complicaciones (9,6% del total y 73% del grupo) entre las cuales están ligadura de la arteria carótida externa, lesión del hipogloso y un paciente con AVC y hemiparesia. Se describe una reoperación (0,86%) y ninguna mortalidad. CONCLUSIÓN: proponer una clasificación preoperatoria que tenga la posibilidad de asociarse a complicaciones y pronóstico.

OBJECTIVE: to propose a preoperative classification of patients with Carotid Body Tumor and relate them to postoperative complications. MATERIAL AND METHODS: all patients operated with a diagnosis of Carotid Body Tumor between 2005 and 2014 at the Obrero Hospital No. 1 of the National Health Fund in La Paz - Bolivia RESULTS: 115 patients with an average age of 52 years (SD±11.725 and a mode of 57 years) were analyzed and operated on, of which 109 (94.80%) corresponded to the female gender with a ratio of 18: 1. All the patients were from and residents of cities located more than 2,500 meters above sea level. The mean evolution was 3 years (SD±2.189), and only 7 patients (6.1%) had a smoking habit. 83 patients (72.2%) of CBTs are located on the left side In the clinical manifestations, all patients present the tumor located in the mandibular angle, in front of the sternocleidomastoid muscle, describing a gradual and permanent growth in 72 subjects (62.6%), headache in 45 (39.1%), presence of heartbeat in 30 subjects (26.1%), dysphagia in 9 (7.9%), dizziness in 16 (13.9%) and dysphonia in 6 (5.2%). Among the most obvious signs of CBT, the Fontaine sign is described in 114 subjects (99.2%), adenomegaly in 20 (17.4%) and other less frequent signs such as murmur, parapharyngeal bulging and cranial nerve involvement. All patients were classified in both systems (Shamblin and ours called from the Andes). 39 patients (33.2%) with postoperative complications were described, grade I: 1 patient without complications; Grade II: of 58 subjects, 4 (3.5%) had temporary hypoglossal paralysis; in Grade III: of the 41 subjects, 24 (20.8%) presented external carotid artery ligation, hypoglossal and glossopharyngeal paralysis, recurrent lesion and superior larynx. In group IV, of the 15 operated subjects, 11 presented complications (9.6% of the total and 73% of the group), among which are external carotid artery ligation, hypoglossal injury and one patient with stroke and hemiparesis. A reoperation (0.86%) and no mortality are described. CONCLUSION: propose a preoperative classification that has the possibility of being associated with complications and prognosis.

Paraganglioma del cuerpo carotídeo: reporte de caso / Carotidbody tumor: case report

Los tumores de cuerpo carotídeo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originados en los quimiorreceptores del cuerpo carotídeo. Se presenta el caso clínico de un tumor de glomuscarotídeo, en una mujer de 63 años que debutó con un aumento de volumen cervical derecho. El estudio con tomografía computarizada en fase angiográfica (Angio TC) demostró un tumor heterogéneo a nivel de la bifurcación carotídea que provocaba efecto de masa desplazando, pero sin infiltración en vasos carotídeos. Posteriormente, se realizó la extirpación completa del tumor con disección subadventicial. El informe histopatológico concluyó tumor de glomuscarotídeo con áreas de necrosis y pleomorfismo celular.

Carotid body tumors (paraganglioma) are highly vascular neoplasms, which are rare but usually benign. They are originated in the chemoreceptors of the carotid body. We present the clinical case of a carotid glomus tumor in a 63 year old woman who debuted with an increase in right cervical volume. The conducted studywith computed tomography at angiographic phase (Angio CT) demonstrated a heterogeneous tumor at the level of carotid bifurcation that caused a displacing mass effect but not infiltrating the carotid vessels. Complete excision of the tumor was performed with subadventitial dissection. The histopathological report concluded a carotid glomus tumor with necrosis areas and cell pleomorphism.

Paraganglioma de cuerpo carotideo / Carotid body paraganglioma

Contexto: Los paragangliomas del cuerpo carotideo son tumores adrenales de mayor frecuencia entre los paragangliomas; en términos generales, son infrecuentes y deben ser diagnosticados por técnicas de imagen para caracterizar la anatomía y grado de invasión del tumor, a fin de su planificación quirúrgica. Objetivo: evaluar la experiencia institucional del Hospital Carlos Andrade Marín en el manejo de los tumores del cuerpo carotideo. Sujetos y métodos: el estudio retrospectivo analizó los registros médicos de 26 pacientes con paragangliomas del cuerpo carotideo tratados en el Hospital Carlos Andrade Marín de Quito, en un periodo de 21 meses; se complementa con una revisión de la bibliografía. Resultados: del total del universo estudiado el paragaglioma se presentó en 20 mujeres que corresponde al 76%, y en 6 hombres que corresponde al 23. El tamaño promedio del tumor en los pacientes fue de 3,7 ± 1,4 cm. Según la clasificación de Shamblin el paraganglioma en el 74% de los pacientes se encontraba en clasificación ll, el 22% se encontraban en clasificación l, mientras que el 37% se encontraban en clasificación lll. El promedio de sangrado en los pacientes fue 331 ± 284 ml .El tiempo quirúrgico fue de 112 ± 37 minutos. La resección completa del tumor se realizó en el 100 % de los pacientes, en donde en el 7,4% hubieron complicaciones de lesion del nervio craneal y otras complicaciones ocurrieron en el 7,4 % de los pacientes. Conclusión: la experiencia del equipo quirúrgico del Hospital Carlos Andrade Marín ofreció una alternativa segura, con resultados satisfactorios y baja incidencia de secuelas a largo plazo. (AU)

Context: The paragangliomas of the carotid body are adrenal tumors of greater frequency among the paragangliomas; In general terms, they are infrequent and must be diagnosed by imaging techniques to characterize the anatomy and degree of tumor invasion, in order to plan their surgery. Objective: To evaluate the institutional experience of the Hospital Carlos Andrade Marin in the managemen of tumors of the carotid body. Subjects and methods: The retrospective study analyzed the medical records of 26 patients with paragangliomaof the carotid body treated in the Carlos Andrade Marín Hospital in Quito, in a period of 21 months; It icomplemented by a review of the bibliography. Results: of the total universe studied, paragaglioma was present in 20 women, corresponding to 76%, and in 6 men, corresponding to 23%. The average tumor size in the patients was 3.7 ± 1.4 cm. According to the classification of Shamblin paraganglioma in 74% of patients were in classification II, 22% were in classification I, while 37% were in classification III. The average bleeding in the patients was 331 ± 284 ml. The surgical time was 112 ± 37 minutes. Complete resection of the tumor was performed in 100% of the patients, where in 7.4% there were cranial nerve lesions and other complications occurred in 7.4% of the patients. Conclusions: The experience of the surgical team of the Hospital Carlos Andrade Marín offers a safe alternative, with satisfactory results and low incidence of long-term sequelae. (AU)

Caracterización Epidemiológica de los Pacientes con Diagnóstco de Glomus Carotdeo Sometdos a Resección en la Unidad de Cirugía Cardiovascular de Guatemala / Epidemiological Characterization of patients with carotid body tumors who underwent resection in the vascular unit in Guatemala (UNICAR)

Introducción: Los tumores del cuerpo carotideo son tumores infrecuentes, generalmente benignos y muy vascularizados, por lo que su resección es un reto para el cirujano. El objetivo de este estudio es realizar una caracterización epidemiológica de los pacientes con glomus carotideo operados en la Unidad de Cirugía Cardiovascular de Guatemala (UNICAR) Metodología: El estudio fue descriptvo retrospectivo analizando los registros clínicos de todos los pacientes sometidos a resección de glomus carotideo en UNICAR de enero de 2,002 a diciembre de 2,015. Resultados: Se documentaron 17 pacientes a quienes se les realizo resección de glomus en la unidad, de los cuales 1 expediente no fue posible analizar porque no se encontró en el archivo. El 93% de los pacientes fueron de sexo femenino lo cual está descrito que es el género más afectado. La altitud es característica de esta patología ya que el 93%, 15 de los 16 venían de una altura mayor de los 1,500 mts sobre el nivel del mar. No se pudo determinar la etnia como factor de riesgo ya que el 50% de los pacientes fueron de etnia indígena y el 50% de etnia ladina. Se obtuvo un caso de herencia familiar ya que tanto la abuela como la nieta presentaron glomus carotideo. Las biopsias que se documentaron fueron solamente en 5 pero pensamos que hay un subregistro ya que consultando con los especialistas estás pudieron haber sido más. Conclusiones: El Glomus Carotideo es una patología poco frecuente, sin embargo, debe ser tratado en unidades especializadas vasculares debido a su compleja resección y el importante riesgo de sangrado. En este estudio se logró caracterizar epidemiológicamente a los pacientes, coincidiendo con lo reportado en la literatura mundial.

Background: Carotid body tumors are uncommon, generally benign, hypervascular turmors; resection is a challenge for surgeons. The aim of this study is to characterize patents with carotid body tumors who underwent resection at the Cardiovascular Surgical Unit in Guatemala (UNICAR) Methods and Results: There were a total of 17 patents in this descriptve and retrospectve trial who underwent resection of carotid body tumor during 2002 to 2015, but we only had access to 16 of the patents clinical records. 93% were female patents, this is the same as reported in other trials being women more affected than men. Altitude of more than 1,500 m from sea level was present in 93% of the patents. This is remarkable due to the country's geography where there can be in some department's altitudes from 0 m at sea level to as high as 2,800 m. Their background in race speaking isn't related to the presence of this pathology, 50% were indigenous and 50% were ladinos. There was only one case of family related heritage where grandmother and granddaughter had a carotid body tumor resection. Previous biopsy was only recorded in 5 clinical records but we think this can be a sub registry due to the experience of some of the surgeons who said most of them had previous scars and it made the resection more difficult. Conclusions: Carotid body tumors are rare in presentation and they must be treated in a specialized vascular unit due to its complex resection and hemorrhage risk.

Serie de casos: Tumores del Golfo de la yugular / Case series: Glomus jugulare tumors

Introducción: Los tumores del foramen yugular son lesiones de la base del cráneo poco frecuentes, que presentan dificultades tanto para el diagnóstico como para el manejo. El objetivo del presente reporte es presentar una serie de casos y el manejo que se dio a estos pacientes. Métodos: El presente estudio descriptivo incluye pacientes con tumores del foramen yugular manejados quirúrgicamente desde el 2002 hasta 2006 en el Hospital Oncológico "Solón Espinosa Ayala", donde se revisó la técnica quirúrgica y el pronóstico. Los tumores fueron abordados por un mismo equipo multidisciplinario, neurocirujano, cirujano otorrinolaringólogo y radio-oncólogo. Resultados: Se presentan 10 casos. El nervio facial fue reconstruido con injertos del nervio auricular mayor o con anastomosis en cinco casos. Los paragangliomas fueron las lesiones más frecuentes seguidas por Schwannomas y meningiomas. La escisión completa fue posible en 8 casos de tumores benignos y en 4 paragangliomas. Los nervios craneales bajos fueron los más frecuentemente comprometidos con lesiones transitorias en cuatro pacientes. Y la función del nervio facial se recobró espontáneamente en 3 casos. Dos casos desarrollaron fístula de líquido céfalo raquídeo. Un paciente falleció después de la cirugía. Conclusión: Los paragangliomas con extensión intracraneal deben ser radicalmente resecados a través de abordajes multidisciplinarios con preservación de los nervios. La embolización preoperatoria debería considerarse. La extubación precoz, traqueotomía en casos seleccionados y temprana rehabilitación son muy importantes en el manejo postoperatorio.

Introduction: Jugular foramen tumors are rare lesions of the base of the skull, which present difficulties for both diagnosis and management. The objective of this report is to present a series of cases and the management that was given to these patients. Methods: The present descriptive study includes patients with jugular foramen tumors managed surgically from 2002 to 2006 in the "Solón Espinosa Ayala" Oncological Hospital, where the surgical technique and prognosis were reviewed. The tumors were treated by the same multidisciplinary team, neurosurgeon, otolaryngologist and radiation oncologist. Results: 10 cases are presented. The facial nerve was reconstructed with grafts of the greater auricular nerve or with anastomosis in five cases. Paragangliomas were the most frequent lesions followed by Schwannomas and meningiomas. Complete excision was possible in 8 cases of benign tumors and in 4 paragangliomas. Low cranial nerves were the most frequently compromised with transient lesions in four patients. And the function of the facial nerve recovered spontaneously in 3 cases. Two cases developed cerebrospinal fluid fistula. One patient died after surgery. Conclusion: Paragangliomas with intracranial extension must be radically resected through multidisciplinary approaches with preservation of the nerves. Preoperative embolization should be considered. Early extubation, tracheotomy in selected cases and early rehabilitation are very important in postoperative management.

Cuerpo carotídeo: un enfoque anatómico y fisiológico / Carotid body: an anatomical and physiological approach

Resumen:Este trabajo describe la presencia del cuerpo carotídeo y su relación con el seno carotídeo. Además, se presenta una revisión bibliográfica de la historia, anatomía y fisiologia del órgano y su importancia como quimioreceptor del cuerpo humano.

Abstract:This work describes the presence of carotid body and its relationship to the carotid sinus. In addition, a literature review of the history, anatomy and physiology of the body and its importance as chemoreceptory the human body is presented.

Paragangliomas bilaterales del cuerpo carotideo / Bilateral paragangliomas of the carotid body

El paraganglioma del cuerpo carotideo, lo describe la literatura universal, como una neoplasia muy rara que se origina a partir de las células tipo I del glomus carotideo normal, presente en la bifurcación de la carótida común. Afecta ambos sexos proporción 3:1 a predominio femenino con un bajo potencial de malignidad. Se ha relacionado con vivir en las alturas. Los tumores paraganglionares carotideos son de poca frecuencia, lo que hace importante su presentación. Se trata de un paciente masculino de 52 años de edad, de color de piel blanca, el cual comenzó a notar un aumento de volumen en ambos lados del cuello. Al examen físico se palparon tumoraciones pulsátiles en ambas regiones laterales del cuello con signo de Fontaine positivo. Al estudio por ultrasonido doppler se constataron masas hipervascularizadas a ambos lados del cuello, la mayor del lado izquierdo, las cuales recibían aferencias por ramas de la carótida externa. El diagnóstico temprano es de suma importancia y es la imagenología el procedimiento que facilita esta condición ya que proporciona diagnósticos más sensibles y específicos, que permite la detección del tumor incluso antes de ser palpable. El tratamiento definitivo fue quirúrgico con buenos resultados(AU)

International literature describes the paranganglioma of the carotid body as a very rare neoplasia that originates in type I cells of the normal carotid glomus present in the bifurcation of the common carotid. It affects both sexes at a ratio of 3 to 1, being predominant in females with low malignancy potential. It has also been related to living in high places. Carotid ganglionic tumors are infrequent, so their presentation is significant. This is a 52 years-old Caucasian male patient, who noticed swellings at both sides of the neck. On the physical examination, pulsating tumors were detected in both sides of the neck with positive Fontaine's sign. The color Doppler ultrasound revealed the existence of hypervascularized masses at both sides of the neck, being the largest those located on the left side, which received afferents through the external carotid branches. Early diagnosis is of utmost importance and imaging is the method that makes it easier to detect this condition and that provides the most sensitive and specific diagnosis, thus leading to the detection of a tumor even before it becoming palpable. Surgical treatment is the therapy of choice with good results(AU)

Carotid body Thermoreceptors, sympathetic neural activation, and cardiometabolic disease

The carotid body (CB) is the main peripheral chemoreceptor that senses the arterial PO2, PCO2 and pH. In response to hypoxemia, hypercapnia and acidosis, carotid chemosensory discharge elicits reflex respiratory, autonomic and cardiovascular adjustments. The classical construct considers the CB as the main peripheral oxygen sensor, triggering reflex physiological responses to acute hypoxemia and facilitating the ventilatory acclimation to chronic hypoxemia at high altitude. However, a growing body of experimental evidence supports the novel concept that an abnormally enhanced CB chemosensory input to the brainstem contributes to overactivation of the sympathetic nervous system, and consequent pathology. Indeed, the CB has been implicated in several diseases associated with increases in central sympathetic outflow. These include hypertension, heart failure, sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome. Indeed, ablation of the CB has been proposed for the treatment of severe and resistant hypertension in humans. In this review, we will analyze and discuss new evidence supporting an important role for the CB chemoreceptor in the progression of autonomic and cardiorespiratory alterations induced by heart failure, obstructive sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome.

Is Primary Hyperparathyroidism a Risk Factor for Papillary Thyroid Cancer? An Exemplar Study and Literature Review

Introduction Primary hyperparathyroidism (PHPT) is associated with several cancer types, including papillary thyroid carcinoma (PTC). Objective To explore further the relation between PHPT and PTC. Methods By considering patients with PHPT as extra-suspicious for PTC, we studied an exemplar group of patients with PHPT with a small (1 cm) thyroid nodule, which was negative in preoperative cytologic examination. During parathyroidectomy, a frozen section biopsy of the thyroid nodule confirmed PTC, as did the final surgical specimen, revealing that the preoperative cytology was false-negative. Additionally, relevant reports retrieved from the English literature addressing thyroid cancer and hyperparathyroidism were reviewed and processed. Results Four patients with PHPT were studied. Three had a multifocal thyroid disease, and three had neck lymph node metastasis. Processing previous report data supported an association between PHPT and PTC. Although thyroid nodularity among patients with PHPTwas similar to the general population, PTC incidence was higher. This was true also for patients with secondary hyperparathyroidism. Conclusions This study emphasized that PHPT should be considered as a noteworthy risk factor for PTC. Fine needle aspiration of a thyroid nodule is the most valuable diagnostic procedure for thyroid cancer. Yet, false-negative results were reported in up to 10% of cases, especially in small, subcentimeter nodules. In line with our data and the literature, patients with PHPT should have both a detailed ultrasound addressing the thyroid and cytology of any thyroid nodule, including small subcentimeter lesions. Moreover, surgical flexibility, allowing intraoperative thyroid nodule sampling, should be considered even for "innocent" nodules. .

Quality of Life in Swallowing Disorders after Nonsurgical Treatment for Head and Neck Cancer

Introduction Radiotherapy or chemoradiotherapy can result in severe swallowing disorders with potential risk for aspiration and can negatively impact the patient's quality of life (QOL). Objective To assess swallowing-related QOL in patients who underwent radiotherapy/ chemoradiotherapy for head and neck cancer. Methods We interviewed 110 patients (85 men and 25 women) who had undergone exclusive radiotherapy (25.5%) or concomitant chemoradiotherapy (74.5%) from 6 to 12 months before the study. The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was employed to evaluate dysphagia-related QOL. Results The QOL was reduced in all domains for all patients. The scores were worse among men. There was a relationship between oral cavity as the primary cancer site and the fatigue domain and also between advanced cancer stage and the impact of food selection, communication, and social function domains. Chemoradiotherapy association, the presence of nasogastric tube and tracheotomy, and the persistence of alcoholism and smoking had also a negative effect on the QOL. Conclusions According to the SWAL-QOL questionnaire, the dysphagia-related impact on QOL was observed 6 to 12 months after the treatment ended. .

Synchronous Intra-Thyroid Paraganglioma with Carotid Body Tumor / 대한이비인후과학회지

Paraganglioma is an uncommon and slowly-growing benign neuro-endocrine tumor originating from the extra-adrenal paraganglia. The most common site of head and neck paraganglioma is the carotid body. Paraganglioma of thyroid gland is a rare disease, and is hard to diagnose preoperatively since the pathologic features are similar to thyroid neoplasm, especially to medullary carcinoma. Occasionally, multiple paragangliomas can be found in the body. To our knowledge, there are two cases of synchronous carotid body tumor with thyroid paraganglioma that have been reported to date. We report a case of 34-year-old female with carotid body paraganglioma synchronous with intra-thyroid paragangloma, which was misdiagnosed as papillary thyroid carcinoma in the preoperative evaluation. After the tumors were successfully excised, there were no signs of complications and the patient has survived the 2-year-follow-up period without recurrence.

Tumor de glomus carotídeo / Carotid glomus tumor

Los paragangliomas son tumores benignos, altamente vascularizados. La localización del tumor del glomus carotídeo rodea el 0,01% en relación a todos los paragangliomas; su incidencia parece estar incrementada proporcionalmente con la altitud, la mayoría se presenta de forma esporádica, su malignidad es rara y tiene ligera preponderancia en el sexo femenino. Clínicamente se presenta como una tumoración en la región cervical de crecimiento progresivo, no dolorosa con frémito. Como métodos auxiliares del diagnostico se citan la ecodoppler, la tomografía axial computalizada, la resonancia magnética y una arteriografía. Tiene indicación quirúrgica, la técnica más utilizada es la disección subadventicial del tumor. Presentamos el caso de una mujer de 47 años con tumor cervical a quien se le realizó una ecodoppler y una tomografía multislide y fue sometida a la resección parcial del tumor y anatomía patológica que informa paraganglioma.

Paragangliomas are benign tumors, highly vascularized. The location of the carotid Glomus tumor surrounds 0.01% in relation to all paragangliomas; its incidence seems to be increased proportionally with the altitude, the majority appears sporadically, its malignancy is rare and has slight superiority in the feminine sex. Clinically it appears like a tumor that grows progressively in the cervical region, generally non painful with thrill. Auxiliary diagnostic methods are ecodoppler, computed axial tomography, magnetic resonance and arteriography. It has surgical indication; the more used technique is the subadventicial dissection of the tumor. We presented the case of a 47 year old woman with a cervical tumor that was submitted to an ecodoppler and a multislide tomography and was put under a partial resection of the tumor, with a pathology report that informs paraganglioma.

Mechanisms of maladaptive responses of peripheral chemoreceptors to intermittent hypoxia in sleep-disordered breathing / 生理学报

Peripheral chemoreceptors in the carotid body play important roles in the transduction of chemical stimuli in the arterial blood to the central for eliciting the chemoreflex, which mediates the ventilatory and circulatory responses to hypoxia. The activity of carotid chemoreceptor is modulated and significantly contributes to the ventilatory acclimatization at high altitude. In addition, the carotid chemoreceptor activity is augmented in patients with sleep-disordered breathing, notably in central or obstructive sleep apnea, and also in experimental animals. Thus, the carotid body functions to maintain the oxygen homeostasis, whereas anomalous carotid chemoreceptor activities could be both adaptive and pathogenic in sleep apnea. This review aims to summarize the cellular and molecular mechanisms that could mediate the augmented chemoreceptor activity induced by intermittent hypoxia. Our recent findings suggest a pathogenic role of inflammation mediated by an upregulation of renin-angiotensin system in the carotid body in the over-activity of the chemoreflex. These locally regulated mechanisms are proposed to be a significant part of the hypoxia-mediated maladaptive changes of the carotid body function, which could play a role in the pathophysiology of sleep apnea.

Coexistence of a Carotid Body Tumor and Thyroglossal Duct Carcinoma With Cervical Lymph Node Metastasis

Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct remnants. This rare neoplasm is characterized by relatively nonaggressive behavior with infrequent lymph nodal spread. Another rare neoplasm of the head and neck region is a carotid body tumor. A 78-year-old woman with a 3-year history of midline and bilateral neck masses was referred to us. Fine needle aspiration biopsies and a computed tomography scan suggested the diagnosis of thyroglossal duct carcinoma with cervical lymph node metastasis. Interestingly, the left-side neck mass was found to be splaying the carotid bifurcation, on computed tomography imaging. Carotid arteriography demonstrated a highly vascular mass in the bifurcation of the carotid artery that was compressing the internal and external carotid arteries. To our knowledge, this is the first reported instance of a thyroglossal duct carcinoma with neck metastasis accompanied by a carotid body tumor. In addition, the carotid body tumor in this case mimicked neck metastasis from the thyroglossal duct carcinoma.

Hemodynamic and ventilatory response to different levels of hypoxia and hypercapnia in carotid body-denervated rats

OBJECTIVE: Chemoreceptors play an important role in the autonomic modulation of circulatory and ventilatory responses to changes in arterial O2 and/or CO2. However, studies evaluating hemodynamic responses to hypoxia and hypercapnia in rats have shown inconsistent results. Our aim was to evaluate hemodynamic and respiratory responses to different levels of hypoxia and hypercapnia in conscious intact or carotid body-denervated rats. METHODS: Male Wistar rats were submitted to bilateral ligature of carotid body arteries (or sham-operation) and received catheters into the left femoral artery and vein. After two days, each animal was placed into a plethysmographic chamber and, after baseline measurements of respiratory parameters and arterial pressure, each animal was subjected to three levels of hypoxia (15, 10 and 6% O2) and hypercapnia (10% CO2). RESULTS: The results indicated that 15% O2 decreased the mean arterial pressure and increased the heart rate (HR) in both intact (n = 8) and carotid body-denervated (n = 7) rats. In contrast, 10% O2did not change the mean arterial pressure but still increased the HR in intact rats, and it decreased the mean arterial pressure and increased the heart rate in carotid body-denervated rats. Furthermore, 6% O2 increased the mean arterial pressure and decreased the HR in intact rats, but it decreased the mean arterial pressure and did not change the HR in carotid body-denervated rats. The 3 levels of hypoxia increased pulmonary ventilation in both groups, with attenuated responses in carotid body-denervated rats. Hypercapnia with 10% CO2 increased the mean arterial pressure and decreased HR similarly in both groups. Hypercapnia also increased pulmonary ventilation in both groups to the same extent. CONCLUSION: This study demonstrates that the hemodynamic and ventilatory responses varied according to the level of hypoxia. Nevertheless, the hemodynamic and ventilatory responses to hypercapnia did not depend on the activation of the peripheral carotid chemoreceptors.

Effect of NADPH oxidase inhibitor apocynin on the expression of hypoxia-induced factor-1α and endothelin-1 in rat carotid body exposed to chronic intermittent hypoxia / 华中科技大学学报（医学）（英德文版）

The effects of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor apocynin on the enhanced hypoxia induced factor-1α (HIF-1α) and endothelin-1 (ET-1) expression, elevated systolic blood pressure under chronic intermittent hypoxia (CIH) condition and its action mechanism were investigated. Thirty healthy 8-week old Sprague-Dawley (SD) male rats were randomly divided into three groups (n=10 each): sham group, CIH group, and apocynin-treated CIH group. Tail artery systolic blood pressure was measured by tail-cuff method. Real-time fluorescence quantitative polymerase chain reaction (PCR) was used to detect the mRNA expression of HIF-1α and ET-1 in the carotid body, and the HIF-1α protein expression was examined by using Western blotting. The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were determined by using colorimetric method. In addition, the plasma ET-1 and HIF-1α levels were measured by using enzyme-linked immunosorbent assay. It was found that CIH exposure was associated with increased MDA levels, and apocynin-treated CIH animals showed reduction in MDA levels. Apocynin treatment prevented CIH-induced hypertension as well as CIH-induced decrease in SOD. The increases of HIF-1α and ET-1 mRNA along with HIF-1α protein expression in the carotid body, and elevated circulating HIF-1α and ET-1 levels were observed in CIH-exposed animals. Treatment with apocynin significantly decreased the ET-1 mRNA, HIF-1α protein expression and circulating HIF-1α level in CIH-exposed animals, and there was no statistically significant difference in the HIF-1α mRNA expression between CIH group and apocynin-treated group. These results indicated that apocynin alleviated CIH-induced hypertension by inhibiting NADPH oxidase, further leading to the reduced vasoconstrictor ET-1 level and oxidative stress. HIF-1α/ET-1 system signal pathway may interact with CIH-induced NADPH oxidase-dependent oxidative stress. Inhibition of NADPH oxidase activity may hopefully serve as a useful strategy for prevention and treatment of obstructive sleep apnea hypopnea syndrome-induced hypertension.

Glomus carotideo: presentación de un caso y revisión de la literatura / Carotid Glomus: a case report and literature review

Presentamos un paciente con glomus carotídeo y diagnóstico intraoperatorio sin compromiso hemodinámico en el período anestésico. El caso corresponde a una mujer de 63 años, que ingresa por el departamento de cabeza y cuello por recurrencia de patología tumoral en la región cervical izquierda, sin datos mayores como síntomas cardiacos o neurológicos. Realizándose resección de tumoración, tiroidectomía complementaria y disección cervical, con estudio anatomo-patológico que corrobora glomus carotídeo.

We present a patient with Carotid Body Paraganglioma and operative diagnosis lacking hemodynamic compromise during the anesthetic time. This is a 63 year old female, admitted to the Head and Neck Unit due to tumoral recurrence in the left cervical area, there are no major cardiac or neurological symptoms. The patient undergone tumor resection, complementary thyroidectomy and cervical disection, leading to pathological diagnosis that confirmed Carotid Body Paraganglioma.

Position and blood supply of the carotid body in a Kenyan population / Posición y suministro sanguíneo del cuerpo carotídeo en una población de Kenia

Position and source of blood supply to the human carotid body displays population variations. These data are important during surgical procedures and diagnostic imaging in the neck but are only scarcely reported and altogether missing for the Kenyan population. The aim of this study was to describe the position and blood supply of the carotid body in a Kenyan population. A descriptive cross-sectional study at the Department of Human Anatomy, University of Nairobi, was designed. 136 common carotid arteries and their bifurcations were exposed by gross dissection. The carotid body was identified as a small oval structure embedded in the blood vessel adventitia. Position and source of blood supply were photographed. Data are presented by tables and macrographs. 138 carotid bodies were identified. Commonest position was carotid bifurcation (75.4 percent) followed by external carotid artery (10.2 percent), internal carotid artery (7.2 percent) and ascending pharyngeal artery (7.2 percent). Sources of arterial blood supply included the carotid bifurcation (51.4 percent), ascending pharyngeal (21.0 percent), external carotid (17.4 percent) and internal carotid (10.2 percent) arteries. Position and blood supply of the carotid body in the Kenyan population displays a different profile of variations from those described in other populations. Neck surgeons should be aware of these to avoid inadvertent injury.

La posición y la fuente de suministro sanguíneo del cuerpo carotídeo humano muestra variaciones en la población. Estos datos son importantes durante los procedimientos quirúrgicos y de diagnóstico por imagen en el cuello, pero son poco informados e inclusive faltan por completo en la población de Kenia. El objetivo de este estudio fue describir la posición y el aporte sanguíneo del cuerpo carotídeo en una población de Kenia. Se diseñó un estudio descriptivo de corte transversal en el Departamento de Anatomía Humana de la Universidad de Nairobi. 136 arterias carótidas comunes y sus bifurcaciones fueron expuestas mediante disección simple. El cuerpo carotídeo fue identificado como una pequeña estructura oval ubicada en la adventicia del vaso sanguíneo. La posición y la fuente de suministro sanguíneo fueron fotografiados. Los datos obtenidos fueron presentados en las tablas y fotomacrografías. 138 cuerpos carotídeos fueron identificados. La posición más frecuente fue la bifurcación carotídea (75,4 por ciento), seguida de la arteria carótida externa (10,2 por ciento), arteria carótida interna (7,2 por ciento) y la arteria faríngea ascendente (7,2 por ciento). Las fuentes de suministro sanguíneo arterial incluyeron la bifurcación carotídea (51,4 por ciento), arteria faríngea ascendente (21,0 por ciento), arteria carótida externa (17,4 por ciento) y arterias carótidas internas (10,2 por ciento). La posición y el suministro sanguíneo del cuerpo carotídeo en la población de Kenia muestra un perfil de variaciones diferente a las descritos en otras poblaciones. Los cirujanos de cuello deben conocer estas variaciones para así evitar lesiones accidentales.

Huge carotid body paraganglioma / 대한외과학회지

A 33-year-old woman was admitted to our hospital with a slow-growing mass in the left side of her neck. The mass was found to be a huge (73 x 56 x 54 mm) carotid body paraganglioma. Another 21 mm-size tumor was incidentally detected at the right carotid bifurcation. She had hoarseness and Horner's syndrome of her left side. Both tumors were surgically removed. There were no cerebrovascular complications but some neurologic complications occurred when the left tumor was removed.