Tumor de glomus yugulotimpánico, a propósito de un caso / Jugulotympanic glomus tumor, case presentation

Resumen Los tumores de glomus yugulo-timpánico o paragangliomas son originados de células de la cresta neural y representan un número bajo de los tumores de cabeza y cuello (0,5 %). Su crecimiento lento y síntomas progresivos provocan que se retarde el diagnóstico. Conocer la clínica que frecuentemente cursa con pérdida auditiva unilateral, tinnitus pulsátil y afectación de algún par craneal, puede ayudar a sospechar el diagnóstico de glomus. Se mencionan diferentes tipos de métodos diagnósticos, así como nuevas opciones de tratamiento. Dada la localización y su importante vascularización, hay casos en los que la cirugía abierta es muy riesgosa y se buscan procedimientos terapéuticos que disminuyan las complicaciones y morbilidades en estos pacientes, tanto como procedimientos endovasculares. En el artículo se discute el caso de una femenina de 31 años con clínica de inicio insidioso con hipoacusia izquierda progresiva, tinnitus pulsátil izquierdo y disfonía. En 2013, se realiza resonancia magnética nuclear donde se observa proceso infiltrativo tumoral sugestivo de paraganglioma. Se hace embolización endovascular con onyx de glomus yugulotimpánico en cuatro ocasiones, con seguimiento cada 6 meses por no ser candidata a otro tipo de tratamiento, debido al tamaño y localización de la masa y su condición no resecable.

Abstract Jugulo-tympanic glomus tumors or paragangliomas originate from neural crest cells and represent a low number of head and neck tumors (0.5%). Its slow growth and progressive symptoms cause the diagnosis to be delayed. The knowledge of the clinic that frequently involves unilateral hearing loss, pulsatile tinnitus and cranial nerve involvement can help to suspect the diagnosis. Different types of diagnostic methods are helpfun, as well as new treatment options have been proposed. Given the location and its important vascularization, there are cases in which open surgery is highly risky and alternative therapeutic procedures trying to reduce complications and morbidities in these patients need to be considered, as well as endovascular procedures. This article discusses the case of a 31-year-old female with an insidious onset of progressive left hearing loss, left pulsatile tinnitus and dysphonia. In 2013, nuclear magnetic resonance imaging was performed and a tumor infiltrative process suggesting paraganglioma was observed. Endovascular embolization was performed with onyx of jugulotympanic glomus on four occasions, with follow-up every 6 months, due to the size and location of the mass and its unresectable condition the tumor was considered non surgically resectable.

Transcanal resection of a type 1 glomus tympanicum

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present a case of type 1 glomus tympanicum, its clinical presentations, surgical management and outcome.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 44-year-old woman with pulsatile tinnitus, vertigo, headache, ear fullness and decreased hearing on the right had a pulsatile reddish mass behind the tympanic membrane and Brown sign. Weber test lateralized to the right with mild conductive hearing loss on pure tone audiometry. Contrast CT scan demonstrated a 5x6 mm well-defined enhancing mass in the meso- and hypotympanum. Internal auditory canal MRI showed an avidly enhancing 5x3x4 mm nodule within the right middle ear adjacent to the cochlear promontory and anterior to the lateral semicircular canal. Impression was glomus tympanicum, type 1. The mass was excised via transcanal approach with post-operative resolution of tinnitus, headache, vertigo and improvement of hearing. Final histopathology was consistent with glomus tumor.<br /><strong>CONCLUSION:</strong> Glomus tympanicum tumors are rare, benign middle ear paragangliomas that arise from Jacobson's nerve are slow-growing and locally destructive. CT scan and MRI may detect involvement of other structures. Surgical resection is the primary treatment modality. Type 1 glomus tympanicum tumors are small and limited to the promontory and a less-invasive transcanal approach may be employed.</p>

Glomus tumors

Glomus tumours of the temporal bone occur in the region of the jugular bulb middle ear. They are rare, highly vascular, slow growing tumours and most are benign. Tumours that originate from the jugular bulb and extend to involve the middle ear are referred to as glomus jugular tumours. Those that are found in the middle ear around the otic ganglia in the tympanic plexus are known as Glomus tympanicum. Yhese tumours occur predominantly in women in the fifth and sixth decades of life. Because of the insidious onset of symptoms, these tumours often go unnoticed and there is often a significant delay in diagnosis. Morbidity in these cases is determined by their size and position. 1. To study the age/sex incidence of patients suffering from glomus tumours of the temporal bone. 2. To see various clinical presentations with which these tumours present and their variation according to the age and sex. Our study design was non-inter-ventional descriptive. This study was performed at CMH Rawalpindi and Multan from January 2000 to June 2002. We included ten patients of glomus tumours of the temporal bone in our study. 8 out of these were females and two were males. Though most of the patients belonged to middle age group yet few were also from the younger and older groups. All the patients underwent CT scan with and without contrast, MRI of the requisite site and carotid angiography. We found that these tumours were predominantly present in females, mostly in the middle age group. Individual symptoms were studied in detail and their presence was found to be directly proportional to the increasing age of patients. It is concluded that due to the slow growth of this tumour the diagnosis is often delayed until it is extensive. Therefore clinicians should be more vigilant about this rare disease and must keep it in their differentials

Paragangliomas timpânicos: relato de casos / Tympanic paragangliomas: case reports

Os tumores glômicos, também chamados de paragangliomas, são formados por células não cromafins. O tumor é tipicamente vascular formado por vasos capilares e pré-capilares, interposto por células epiteliais. Para a sua abordagem inicial, deve-se ressaltar que os sintomas mais comumentes encontrados são o zumbido pulsátil e hipoacusia. A investigacão através de imagem (tomografia computadorizada e ressonância magnética) se faz necessária. Apresentaremos neste trabalho 5 pacientes portadores de paragangliomas timpânicos atendidos no Hospital (de 1995 a 2001). O sexo predominante foi o feminino, a idade variou de 48 a 60 anos, com média de 50 anos. A queixa predominante foi o zumbido pulsátil e a hipoacusia. A conduta foi cirúrgica em todos os casos.

Intraoperative HistoacrylR Injection of Glomus Tympanicum Tumor / 대한이비인후과학회지

The therapeutic options for glomus tumor management are either palliative (ie, radiation, embolization or a combination) or definitive (ie, surgery or combinations of surgery-radiation, radiation-surgery or embolization-surgery). Of these, surgical excision is the standard treatment modality for glomus tympanicum tumors. As glomus tympanicum tumor has highly vascular nature, profuse hemorrhage may be intermittently induced during its removal. Preoperative embolization is used frequently to reduce intraoperative bleeding. We report a case of glomus tympanicum tumor which was removed completely with the help of direct inject of HistoacrylR into the mass during the operation. This method allows almost bloodless ablation of the entire tumor.