Paraganglioma de cuerpo carotideo / Carotid Body Paraganglioma

Introducción: Los paragangliomas de cuerpo carotideo son tumores neuroendocrinos hipervascularizados raros. Aunque su presentación clínica es frecuentemente asintomática, con el transcurso de los años puede manifestarse como tumores cervicales con o sin déficit neurológico. Objetivo: Presentar el caso de una paciente con tumoración cervical pulsátil de 10 años de evolución que requirió tratamiento quirúrgico. Presentación de caso: Mujer de 42 años procedente del Cusco, Perú, sin antecedentes médicos ni personales de importancia. La paciente acude al Servicio de Cirugía de Cabeza y Cuello por presentar tumoración cervical pulsátil de crecimiento lento progresivo, cefalea y disfagia. Tras realizar ultrasonografía Doppler y angiotomografía se pesquisa tumor cervical derecho hipervascularizado a nivel de la bifurcación de arteria carótida común. Se propone tratamiento quirúrgico de tumoración cervical con resultado anatomopatológico de paraganglioma de cuerpo carotideo. Tuvo una evolución posquirúrgica favorable sin evidencia de recurrencias en el seguimiento. Conclusión: El paraganglioma del cuerpo carotideo es una tumoración rara, de presentación clínica frecuentemente asintomática. Una evaluación minuciosa clínica e imagenológica permiten un diagnóstico adecuado para una planificación quirúrgica óptima(AU)

Introduction: Carotid body paragangliomas are rare hypervascularized neuroendocrine tumors. Although their clinical presentation is frequently asymptomatic, they may manifest as cervical tumors with or without neurological deficit over the years. Objective: To present the case of a patient with a pulsatile cervical tumor of 10 years' evolution that required surgical treatment. Case presentation: A 42-year-old woman from Cusco, Peru, with no medical or personal history of importance. The patient came to the head and neck surgery service for presenting a pulsatile cervical tumor with slow progressive growth, as well as headache and dysphagia. After performing Doppler ultrasonography and angiotomography, a hypervascularized right cervical tumor was observed at the level of the common carotid artery bifurcation. Surgical treatment of the cervical tumor was proposed, whose anatomopathological result was carotid body paraganglioma. Postoperative evolution was favorable, with no evidence of relapses during follow-up. Conclusion: Carotid body paraganglioma is a rare tumor of frequently asymptomatic clinical presentation. A thorough clinical and imaging-based assessment allows an adequate diagnosis for optimal surgical planning(AU)

Paraganglioma cuerpo carotídeo: experiencia en 20 años y revisión de la literatura / Carotid body paraganglioma: 20-year experience and literature review

Resumen El paraganglioma carotideo es un tumor infrecuente, originado de las células de la cresta neural. Raramente son secretores y tienen un bajo potencial maligno. El diagnóstico es difícil y requiere una alta sospecha clínica, combinada con estudios imagenológicos. Su tratamiento está basado en la cirugía, con especial cuidado de las estructuras vasculonerviosas que se encuentran en intimo contacto. Se describe la casuística de paragangliomas de cuerpo carotídeo en Clínica Las Condes y compararla con una revisión de la literatura actualizada del tema.

Abstract Carotid paraganglioma is a rare tumor, originated from neural crest cells. Usually they lack hormone secretion function, and have a low malignant potential. Diagnosis is difficult, and requires high clinical suspicious, combined with image and pathologic findings. Its treatment is based on surgery, with special care of close anatomic relation with important vascular-nervous structures. Here, we present cases of carotid paragangliomas evaluated at Clinica Las Condes comparing them with an updated literature review.

Paragangliomas cervicais: experiência de 114 casos em 14 anos / Cervical paragangliomas: experience of 114 cases in 14 years

Resumo Introdução e objetivo: Relatar a experiência de um único centro com casos de paraganglioma do corpo carotídeo tratados pelo mesmo cirurgião em uma cidade com alta prevalência de paragangliomas devido à alta altitude. Método: Foram investigados retrospectivamente os dados demográficos, clinico-patológicos e radiológicos de 104 pacientes com diagnóstico de paragangliomas cervicais entre 2003 e 2017. Os pacientes foram classificados de acordo com a classificação de Shamblin. Resultados: Neste estudo, foram incluídos 104 pacientes (33 homens e 71 mulheres, com média de 54,6 ± 13 anos, entre 2003 e 2017) com diagnóstico de paraganglioma cervical na bifurcação carotídea. Entre esses pacientes, 10 tinham tumores bilaterais e, no total, 114 paragangliomas foram tratados nesse período. O diâmetro médio dos tumores foi de 5,12 ± 1,45 cm. Um tumor maligno foi determinado em apenas um (0,9%) paciente. Todos os pacientes foram operados. Em 12 pacientes com diâmetro do tumor maior do que 5 cm, foi possível fazer embolização pré-operatória com molas; em 14 pacientes, foi feita embolização angiográfica e em 4 pacientes foram aplicadas injeções de agentes esclerosantes. Após o tratamento cirúrgico, paralisia facial foi observada em 2 pacientes, disfagia em um, síndrome de Horner em um e rouquidão em 7. Todas essas complicações melhoraram durante o acompanhamento. Não foi relatada mortalidade. Conclusão: A cirurgia é o tratamento definitivo em pacientes com paragangliomas cervicais. Embora possa ser difícil em pacientes com os tipos avançados de Shamblin, em mãos experientes as taxas de complicações são muito baixas.

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.

Tumor del cuerpo carotídeo. A propósito de un caso / Tumor of the carotid body.Concerning a case

Los tumores del cuerpo carotídeo son relativamente infrecuentes y raramente se diagnostican antes de la exposición quirúrgica, su diagnóstico es benigno, pero suelen ser muy vasculares por lo que su extirpación quirúrgica muchas veces resulta difícil. Estos tumores son de crecimiento lento y pueden evolucionar durante años. El objetivo de este estudio es presentar un caso con un tumor del cuerpo carotídeo en región lateral derecha del cuello. Clínicamente se observó un aumento de volumen de aproximadamente 4 cm, no doloroso a la palpación, de tipo gomoso y adherido a planos profundos, asintomático, tratado en nuestra institución durante el año 2014. Se le realizó exéresis simple de la lesión, y el departamento de Anatomía Patológica reportó el diagnóstico de referencia. La evolución de la paciente después de 17 meses ha sido satisfactoria (AU).

The tumors of the carotid body are relatively uncommon and rarely diagnosed before the surgical exeresis, their diagnosis is benign, but they are usually very vascular and its extirpation is very difficult. These tumors have a slow growth and it can evolve during years. The aim of this study is to present a case with a tumor of the carotid body in the right lateral region of the neck. An increase of volume was observed of approximately 4 cm, not painful, of gummy type and stuck to deep, asymptomatic plans, treaty in our institution during the year 2014. It was carried out exeresis of the lesion, and the department of Pathological Anatomy reported the reference diagnosis. The patient's evolution after 17 months has been satisfactory (AU).

Paciente con tumor de cuerpo carotideo / Patient with carotid body tumor

Los tumores de cuerpo carotideo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotideo. Se presenta el caso de un paciente de 54 años, con aumento de volumen cervical derecho, asintomático, con estudio preoperatorio y angiografía realizados por tomografía axial computarizada, que resultan compatibles con tumor de cuerpo carotideo. Se realiza disección subadventicial, informando la biopsia paraganglioma. El tumor fue completamente resecado, sin evidencia de recurrencia y sin complicaciones(AU)

Carotid body tumors (paragangliomas) are highly vascularized, infrequent and generally benign neoplasms that emerge in the carotid body chemoreceptors. This is a male patient aged 54 years with increased right cervical volume, preoperative study and angiography by computerized tomography; the result was carotid body tumor. Subadventitial dissection was made for biopsy which yielded the diagnosis of paraganglioma. The tumor was completely excised, with no evidence of recurrence or complication(AU)

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.

Carotid body tumor: retrospective analysis on 22 patients / Tumor de corpo carotídeo: análise retrospectiva de 22 pacientes

CONTEXT AND OBJECTIVE: Carotid body tumors, or chemodectomas, are the most common head and neck paragangliomas, accounting for 80% of the cases. They may present minor symptoms; however, they deserve special attention in order to achieve accurate diagnosis and adequate treatment. The objectives of this study were to show the approach towards chemodectomas and evaluate the complications of the patients treated surgically without previous embolization. DESIGN AND SETTING: Retrospective study on chemodectomas followed up at the Head and Neck Surgery Service, Department of Surgery, Unicamp. METHODS: Twenty-two patients were evaluated between 1983 and 2009. The diagnosis was based on clinical findings and imaging methods. The epidemiological characteristics, lesion characteristics, diagnostic methods, treatment and complications were analyzed. RESULTS: The paragangliomas were classified as Shamblin I (9%), II (68.1%) and III (22.7%). Angiography, magnetic resonance imaging and computed tomography confirmed the diagnosis in 20 patients (90.9%). Five (22.7%) had significant bleeding during the surgery, while four (18.1%) had minor bleeding. Four patients (18.1%) developed neurological sequelae. Seven (31.8%) needed ligatures of the external carotid artery. Three patients (13.6%) underwent carotid bulb resection. The postoperative follow-up ranged from 3 months to 14 years without recurrences or mortality. CONCLUSIONS: In our experience and in accordance with the literature, significant bleeding and neurological sequelae may occur in chemodectoma cases, particularly in Shamblin III patients. The complications from treatment without previous embolization were similar to data in the literature data, from cases in which this procedure was applied prior to surgery. .

CONTEXTO E OBJETIVO: O tumor de corpo carotídeo, ou quimiodectoma, é o paraganglioma mais comum em cabeça e pescoço, com aproximadamente 80% dos casos. Pode apresentar poucos sintomas; no entanto, necessita atenção especial para o diagnóstico e tratamento adequado. Os objetivos deste estudo são mostrar a abordagem do quimiodectoma e avaliar as complicações nos pacientes tratados cirurgicamente sem embolização prévia. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo de quimiodectomas acompanhados pelo Serviço de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Unicamp. MÉTODOS: Vinte e dois pacientes foram avaliados entre 1983 e 2009. O diagnóstico foi baseado em achados clínicos e métodos de imagens. Foram analisados aspectos epidemiológicos, características das lesões, métodos diagnósticos, tratamento e complicações. RESULTADOS: Os paragangliomas foram classificados em Shamblin I (9%), II (68,1%) e III (22,7%). Angiografia, ressonância nuclear magnética e tomografia computadorizada confirmaram o diagnóstico em 20 pacientes (90,9%). Cinco (22,7%) tiveram sangramento significativo durante a cirurgia, enquanto quatro (18,1%) tiveram sangramento mínimo. Quatro pacientes (18,1%) tiveram sequelas neurológicas. Sete (31,8%) necessitaram de ligadura da artéria carótida externa. Três (13,6%) foram submetidos a ressecção do bulbo carotídeo. O acompanhamento variou de 3 meses a 14 anos, sem recorrências ou óbitos. CONCLUSÕES: Em nossa experiência e de acordo com a literatura, sangramentos significativos e sequelas neurológicas podem ocorrer nos quimiodectomas principalmente em pacientes Shamblin III. As complicações do tratamento sem embolização prévia foram similares aos relatos observados ...

Paraganglioma de corpo carotídeo com abaulamento de orofaringe: relato de caso / Carotid body paraganglioma with bulging oropharynx: case report

Os paragangliomas são tumores altamente vascularizados frequentemente benignos e unilaterais. Localizados no corpo carotídeo, predominam no espaço parafaríngeo. O objetivo deste relato é apresentar um caso de paraganglioma de corpo carotídeo unilateral com extensão ao espaço parafaríngeo. Paciente feminina, 66 anos, observou a presença de assimetria na região amigdalina à direita há aproximadamente um ano sem outros sintomas. A oroscopia e a videotelelaringoscopia evidenciaram assimetria da loja amigdalina direita com suspeita de massa expansiva que projetava a amígdala e pilar posterior para a linha média estendendo-se inferiormente até a vertente externa do seio piriforme. No exame do pescoço apresentava à direita extensão da massa para a região júgulo-carotídea (nível II) de consistência aumentada. A suspeita clínica de glomus foi confirmada por estudo tomográfico computadorizado contrastado do pescoço, ressonância nuclear magnética e angiorressonância de vasos cervicais que definiram uma lesão ovalada com 5X4X6 cm, na topografia do espaço carotídeo direito, deslocando a artéria carótida externa e interna na região do bulbo carotídeo, hipervascularizada, com extensão ao espaço parafaríngeo e sugestiva de paraganglioma carotídeo. O tratamento indicado foi a ressecção cirúrgica sem a realização de embolização prévia. O paraganglioma carotídeo é um tumor raro e de crescimento lento que acomete a região júgulo-carotídea. A extensão parafaríngea é rara e deve estar no diagnóstico diferencial das patologias do espaço parafaríngeo (AU)

Paragangliomas are highly vascularized tumors often benign and unilaterais. Located in the carotid body, they predominate within parafaringeo space. The aim of tyhis repor was to describe a case of unilateral carotid body paraganglioma extending into space parafaríngeo. A female, 66 years-old patient noted the presence of asymmetry in the tonsillar region right about 1 year without other symptoms symptoms. Oroscopy and videotelelaryngoscopy showed asymmetry in right tonsillar store with suspected expansive mass that projected the amygdala and posterior pillar to the middle line extending inferiorly to the lateral aspect of the piriform sinus. On examination of the neck showed right extension of mass for jugular-carotid region (level II) consistency increased. A clinical suspicion of glomus was confirmed by computerized tomography scan study contrasted neck, magnetic resonance imaging and Magnetic resonance angiography of the cervical vessels that defined an injury with oval 5X4X6cm, the topography of the right carotid space shifting the external carotid artery and the internal carotid bulb hypervascular region, extending to the parapharyngeal space and suggestive of carotid paraganglioma. The treatment indication was surgical resection without performing previous embolization. The carotid paraganglioma is a rare tumor and growth slow that affects the jugular-carotid region. The parapharyngeal extension is rare and should be in the differential diagnosis of parapharyngeal space (AU)

Head and neck paragangliomas: clinical and molecular genetic classification

Head and neck paragangliomas are tumors arising from specialized neural crest cells. Prominent locations are the carotid body along with the vagal, jugular, and tympanic glomus. Head and neck paragangliomas are slowly growing tumors, with some carotid body tumors being reported to exist for many years as a painless lateral mass on the neck. Symptoms depend on the specific locations. In contrast to paraganglial tumors of the adrenals, abdomen and thorax, head and neck paragangliomas seldom release catecholamines and are hence rarely vasoactive. Petrous bone, jugular, and tympanic head and neck paragangliomas may cause hearing loss. The internationally accepted clinical classifications for carotid body tumors are based on the Shamblin Class I-III stages, which correspond to postoperative permanent side effects. For petrous-bone paragangliomas in the head and neck, the Fisch classification is used. Regarding the molecular genetics, head and neck paragangliomas have been associated with nine susceptibility genes: NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, SDHAF2 (SDH5), and TMEM127. Hereditary HNPs are mostly caused by mutations of the SDHD gene, but SDHB and SDHC mutations are not uncommon in such patients. Head and neck paragangliomas are rarely associated with mutations of VHL, RET, or NF1. The research on SDHA, SDHAF2 and TMEM127 is ongoing. Multiple head and neck paragangliomas are common in patients with SDHD mutations, while malignant head and neck paraganglioma is mostly seen in patients with SDHB mutations. The treatment of choice is surgical resection. Good postoperative results can be expected in carotid body tumors of Shamblin Class I and II, whereas operations on other carotid body tumors and other head and neck paragangliomas frequently result in deficits of the cranial nerves adjacent to the tumors. Slow growth and the tendency of hereditary head and neck paragangliomas to be multifocal may justify less aggressive treatment strategies.

Tumor de cuerpo carotídeo / Carotid body tumor

Carotid body tumors (paragangliomas) are very rare, highly vascularized and usually benign tumors, originated in the carotid body chemoreceptors. We present the cases of two asymptomatic patients referred for left cervical mass; preoperative study was CT and CT angiography, respectively, which are consistent with carotid body tumors. The tumors were completely removed by subadventitial disection without complications; the biopsy was compatible with paraganglioma. No evidence of recurrence could be found.

Los tumores de cuerpo carotídeo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotídeo. Se presentan los casos de dos pacientes derivados por aumento de volumen cervical izquierdo, asintomáticos, con estudio preoperatorio realizado por TAC y angiografía por TAC, respectivamente, que resultan compatibles con tumores de cuerpo carotídeo. Se resuelven quirúrgicamente, mediante disección subadventicial, informando la biopsia paraganglioma. Los tumores fueron completamente removidos, sin evidencia de recurrencia y sin mayores complicaciones.

Carotid body tumors: 16 years experience at the Jordanian Royal Medical Services

Of all the paragangliomas in the head and neck, carotid body tumors are the most common. They are rare hyper- vascular neoplastic lesions derived from the neural crest paraganglion cells. In this study, we present our 16 years experience in dealing with this neoplasm. The medical records of 33 patients with 37 surgically treated carotid body tumors between the year 1993 and 2009 at the Vascular Unit of Queen Alia Military Hospital and King Hussein Medical Center were retrospectively reviewed. Twenty patients were females and 13 were males. The mean age was 46 years. All the patients presented with a painless neck mass that was investigated by duplex ultrasound, CT angiogram and arteriography. Two patients had hoarseness of voice and dyspnea, one had dysphagia and one had vertigo. Complete surgical excision was performed in all the patients with close follow-up in respect to complications, recurrence and behavior of the tumor. According to Shamblin Classification, 5 tumors were type I, 22 were type II and 10 were type III confirmed intraoperatively. Four patients had bilateral involvement at the time of presentation. Six patients had positive family history of the tumor. After successful surgical resection, a mean follow-up period of 24 months showed a zero mortality rate and no evidence of recurrence. Transient neuropraxia of the facial nerve was noticed in one patient, injury of recurrent laryngeal nerve in another patient while post operative localized hematoma had to be evacuated in two patients. Although rare, carotid body tumor should be kept in mind in the differential diagnosis of anterior triangle neck mass. Complete surgical excision after adequate investigations is the treatment of choice. This is best achieved in a specialized centre with experienced vascular surgeons to get the finest outcome

Tumor de corpo carotídeo: relato de caso / Carotid body tumor: case report

Tumor de corpo carotídeo, também conhecido com o paraganglioma ou quim odectoma, " uma neoplasia rara, geralm ente benigna, podendo apresentar, em alguns casos, com portamento maligno, ao manifestar invasão de estruturas adjacentes e comprometimento metastático regional e/ou sistêmico. O rigina-se dos pequenos órgãos quim iorreceptores localizados na adventícia da bifurcação da artéria carótida com um . Não há prevalência entre os sexos e podem ser vistos dos 12 aos 69 anos de idade. A suspeita clínica e o diagnóstico precoce são muito importantes, pois a ressecção de pequenos tumores diminui a morbimortalidade, o risco de malignidade e de complicaçes neurovasculares. Este trabalho mostra um caso de tumor de corpo carotídeo, cujo tratamento obteve resultados satisfatórios.

Tumor de glomus carotídeo, a propósito de un caso / Carotid body tumor: a case report

Se presenta el caso clínico de un tumor de glomus carotídeo en una mujer de 27 años que debutó con un aumento de volumen cervical derecho. El estudio con tomografía computada en fase angiográfica (Angio TC) demostró un tumor heterogéneo a nivel de la bifurcación carotídea que provocaba efecto de masa desplazando, pero no infiltrando los vasos carotídeos. Se realizó la extirpación completa del tumor con diseccion subadventicial, durante la cual fue necesaria la ligadura de la arteria carótida externa distal al nacimiento de la arteria tiroídea superior. El informe histopatológico concluyó tumor de glomus carotídeo con áreas de necrosis y pleomorfismo celular. Se realizó una revisión de la literatura nacional e internacional sobre esta infrecuente enfermedad.

A importância da embolização pré-operatória no tratamento do tumor do corpo carotídeo: relato de caso e revisão da literatura / The importance of preoperative embolization for the treatment of the carotid body tumor: case report and review of the literature

Os tumores do corpo carotídeo são neoplasias raras, que se originam dos pequenos órgãos quimio e barorreceptores localizados na adventícia da bifurcação da artéria carótida comum. Constituem-se uma doença de grande interesse para o cirurgião vascular, na medida em que crescem aderidos à adventícia dos vasos que compõem essa bifurcação. Por isso, sua cirurgia requer não só o conhecimento anatômico da região, mas também perfeito reconhecimento das técnicas de reconstrução vascular. Representam um problema especial quanto a seu manejo, devido à sua rica vascularização e intimidade com estruturas nobres da região cervical, como nervos e grandes vasos. Neste caso, apresentamos um homem com um tumor de corpo carotídeo aderido à carótida direita, diagnosticado por punção biópsia e tratado em dois tempos, sendo o primeiro por tratamento endovascular, realizando embolização percutânea do tumor, e, no segundo, a ressecção cirúrgica do mesmo, o que evidencia o tratamento combinado, segundo atual literatura.

Carotid body tumors are rare neoplasms originating from the small chemo- and baroreceptors located in the adventitia of the common carotid artery bifurcation. They are a disease of great interest for vascular surgeons, given that they grow adhered to the adventitia of vessels comprising this bifurcation. For that, their surgery requires not only anatomical knowledge of the region, but also perfect familiarization with vascular repair techniques. Carotid body tumors are a particular problem as to their management, due to rich vascularization and intimacy with important structures of the cervical region, such as nerves and large vessels. We report on a male patient with carotid body tumor adhered to the right carotid artery, diagnosed by puncture biopsy and treated at two different time periods: first by endovascular treatment, with percutaneous embolization of the tumor; and later by surgical resection, which represents the combined treatment suggested in the current literature.

Tumor del cuerpo carotídeo: A propósito de 10 casos tratados / Carotid body tumors: Report of ten cases

Background: Carotid body tumors arise from a cellular conglomerate located at the carotid bifurcation. Progressive enlargement can involve the arterial wall and neighbor cranial nerves. Aim: To report a series of 10 patients treated of carotid body tumors and review national experience. Patients and methods: Between 1984 and 2006, we operated 8 women and 2 men, aged 19 to 75 years, with this type of tumor. Results: The most common cause for consultation was a cervical mass in 90 percent, with a mean evolution lapse of 13.2 months (range 3 to 126). In all cases, diagnosis was confirmed with angiographic imaging and histopathology. Ten tumors were surgically removed with no complications. Eighty percent of tumors were in stage II according to Shamblin classification. During long term follow up all patients have remained asymptomatic. Only 31 carotid body tumors have been reported in Chilean medical literature during a 43 year period. Conclusions: Paragangliomas of the carotid body can be diagnosed in clinical grounds, requiring vascular imaging. These infrequent lesions are generally benign, early surgical removal by surgeons with vascular expertise avoids neurological and or vascular complications.

Embolização intra-arterial pré-operatória de tumor do corpo carotídeo / Preoperative intraarterial embolization of carotid body tumor

Os autores relatam um caso de tumor de corpo carotídeo (paraganglioma) em um paciente de 74 anos de idade, submetido a embolização intra-arterial com micropartículas esféricas, de polivinil acetato, com casca de polivinil álcool (PVAc + PVA), previamente à ressecção do tumor. O estudo angiográfico demonstrou massa altamente vascularizada na bifurcação carotídea esquerda, sendo a embolização pré-operatória utilizada no intuito de diminuir a vascularização e reduzir a perda sangüínea, aumentando a segurança do tratamento cirúrgico. O estudo histopatológico confirmou a presença de trombose e isquemia tecidual.

The authors report a case of carotid body tumor (paraganglioma) in a 74-year-old male patient, submitted to intraarterial embolization with spherical core/shield polyvinyl acetate and polyvinyl alcohol (PVAc + PVA) microparticles prior to surgical excision. Angiography has demonstrated a highly vascularized mass in the left carotid bifurcation, and preoperative embolization was used in order to decrease vascularity, reduce blood loss and improve safety of surgical treatment. Microscopic study confirmed presence of thrombosis and tissue ischemia.

Paragangliomas de cabeza y cuello / Parangangliomas of the head and neck

Los parangangliomas son tumores altamente vascularizados que se originan de células provenientes de la cresta neural. El tratamiento de elección es la resección quirúrgica completa, lo cual se ve dificultado por su abundante irrigación y por su estrecha relación anatómica con importantes estructuras vásculo-nerviosas. En el presente estudio se revisa retrospectivamenete la experiencia del Departamento de Otorrinolaringología de Clínica Las Condes en el manejo quirúrgico de estas neoplasias. Entre los años 1998 y 2003 se trataron 5 pacientes portadores de paragangliomas de cabeza y cuello: un glomus yugular (GY), 2 glomus carotídeo (GC) y 2 glomus timpánicos (GT). El estudio imagenológico consistió en tomografía computarizada (TC) para todos los casos, complementada con resonancia nuclear magnética (RNM) y/o angiografía en algunos pacientes. El abordaje quirúrgico fue el indicado para cada lesión: timpanotomía retroauricular (GT), cervicotomía (GC) y abordaje infratemporal tipo A de Fisch (GY). En todos se logró una resección tumoral completa, sin presentarse complicaciones perioperatorias de consideración ni recurrencias hasta la fecha. Contando con un adecuado estudio imagenológico y una cuidadosa planificación quirúrgica, la resección de los paragangliomas de cabeza y cuello puede realizarse con un bajo índice de complicaciones, reservando la radioterapia como alternativa terapéutica únicamente en aquellos casos inoperables.