Paragangliomas of the head and neck.

OBJECTIVES: The purpose of this study was to determine the clinical characteristics of carotid body tumors and to analyze the benefits of different treatment modalities. SUBJECTS AND METHODS: The clinical records of 13 patients with paragangliomas treated during the period of 1995-2005 were reviewed for age at diagnosis, sex, initial symptoms, duration of symptoms, evidence of secretory function, family history, radiographic studies, pre- and posttreatment cranial nerve deficits, multicentric tumors, angiography, operative procedures and findings, and complications. The diagnoses were established by computerized tomography and magnetic resonance imaging scanning. Angiography was performed on 3 patients with carotid body tumor. RESULTS: All of the patients were followed up for a duration ranging from 16 months to 9 years. The median follow-up was 5 years. Of all 18 head and neck tumors confirmed in 13 patients, 16 were in the carotid body, 1 in the vagus nerve and 1 in the middle ear cleft. Four patients had multiple paragangliomas, 2 bilateral synchronous and 1 bilateral asynchronous paragangliomas. The remaining patient had 3 asynchronous paragangliomas, i.e. left jugulotympanic, right carotid body and left vagal paraganglioma. All patients underwent successful surgical resection of the tumor after appropriate preoperative investigation. CONCLUSION: This study shows that surgical treatment is acceptably safe and effective in treating these neoplasms.

Morphologic alteration induced by short-term smoke exposure in rats.

BACKGROUND: It is a well-established fact that cigarette smoking causes degenerative, inflammatory, and respiratory diseases in humans. Because many factors such as air pollution and harsh working conditions can easily be eliminated in animal studies, we conducted this study to identify the effect of tobacco on rat trachea. METHODS: 24 male Wistar rats were divided randomly into an experimental and a control group. The experimental group of rats was exposed to cigarette smoke for 2 h each day over a duration of 60 consecutive days and the control group was treated in an identical fashion yet exposed only to room air. A morphometric study was performed on tracheal specimens taken from 22 rats (10 smoke-exposed rats and 12 control rats). RESULTS: Our results show that many of the morphological changes of the tracheal epithelium were found in the experimental group and significant quantitative differences were observed between the two groups. Loss of cilia, basal cell hyperplasia, goblet cell hyperplasia and an increased number of subepithelial inflammatory cells were observed by light microscopic examination of the trachea of experimental rats. We found very high levels of plasma thiocyanate after exposure to smoke in the experimental group, but no increase in the control group. CONCLUSIONS: The oxidants contained tobacco which could play an important role in the development of these structural and functional abnormalities in the trachea after smoke exposure. In addition, smoking can recruit inflammatory cells to the trachea.

Carotid body tumors and adrenal pheochromocytomas in siblings of a Turkish family.

OBJECTIVE: This is a report of 2 hypertensive siblings with a history of carotid body tumors and subsequent benign adrenal pheochromocytomas (pheos) in a family where the mother had died of possible adrenal carcinoma. CLINICAL PRESENTATION AND INTERVENTION: The first case was a 35-year-old woman with paroxysmal hypertensive attacks and a right adrenal mass. She had earlier undergone surgery to remove bilateral carotid body tumors. Investigation revealed excessive excretion of catecholamines and their metabolites in the urine. Abdominal MRI and (131)I-MIBG scintigraphy revealed a right adrenal tumor. Right adrenalectomy was performed. The second case, the 45-year-old brother of the first case, was found to have a left adrenal mass on abdominal MRI. Catecholamines and their metabolites in the urine were found to be increased. He had also had surgery to remove bilateral carotid body tumors of the neck. Left adrenalectomy was performed. Both siblings showed no evidence of other familial syndromes, such as multiple neoplasia type 2, von Hippel-Lindau disease or neurofibromatosis type 1. CONCLUSION: Although the combination of familial carotid body tumors and pheo is rare, a patient who remains hypertensive after removal of a carotid body tumor deserves a careful evaluation to exclude pheo. Such tumors may be extra-adrenal or multifocal.

Familial paraganglioma.

Paragangliomas are unusual tumors that are sometimes familial. We treated a family who exhibited multiple head and neck paragangliomas (HNPGs) and pheochromocytomas. The purpose was to determine the clinical characteristics of paragangliomas with familial history and to define a better standardized proceeding in the management of these tumors. Patients diagnosed with head and neck paragangliomas and identified retrospectively through clinical otolaryngology practices were given a medical and family history questionnaire. We studied a family who exhibited familial paragangliomas. This relationship was examined by reviewing the medical records of family members with verified tumors, carrying out neck computed tomography or magnetic resonance imaging on their relatives to look for tumors that had been unrecognized in the past. All patients underwent a complete head and neck examination. The initial evaluation usually included CT and/or MRI. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Angiography was performed in every patient with carotid body tumor, with one undergoing therapeutic embolization to reduce the tumor size. Eleven tumors were identified in four patients with a familial history. Familial disease was initially determined by pedigree analysis. Four patients with a median age of 31 years (range: 25-42) underwent surgery. Median follow-up was 5 years (range 2-14); carotid angiography provided essential mainstays for the definite diagnosis. All patients underwent successful surgical resection of the tumor after the appropriate preoperative preparation. There were no perioperative deaths or hemiplegia. Three patients had bilaterality carotid body paragangliomas. One patient had three paragangliomas, and two patients had bilateral carotid body paragangliomas associated with pheochromocytoma. Clinically functioning tumors and malignant tumors were not identified, and none of the patients died after surgery. During follow-up, none of the patients developed recurrence or metastatic disease. The carotid body paraganglioma (CBPG) and glomus vagale manifested as asymptomatic neck masses. The clinical pheochromocytomas typically present with uncontrolled hypertension. In conclusion, paragangliomas are rare, with multicentricity being more common in patients with a familial history. In patients with familial paragangliomas, high-resolution computed tomography and magnetic resonance imaging are recommended for early screening and contributed additional information about the tumor extension and definitive treatment. Early surgery is recommended to minimize major risks.

Environmental tobacco smoke in rats.

OBJECTIVE: We conducted this study to identify the effect of subchronic cigarette smoke inhalation on the vocal cord mucosa of the rat. DESIGN: Experimental study. SETTING: Department of Otolaryngology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey METHODS: Twenty-four male Wistar rats were divided randomly into experimental and control groups. The experimental group of rats was exposed to cigarette smoke for 2 hours each day over 60 consecutive days, and the control group was treated in an identical fashion but was exposed only to room air. MAIN OUTCOME MEASURES: Transmission electron microscopic examination of the rat vocal cords. RESULTS: We found very high levels of plasma thiocyanate after exposure to smoke in the experimental group but no increase in the control group. In the experimental group, mean plasma thiocyanate concentrations of 3.7 +/- 0.5 and 119 +/- 11.4 mmol/L were measured before and after exposure to tobacco smoke, respectively (p < .05). On the contrary, mean plasma thiocyanate levels of control rats were found to be 3.0 +/- 0.4 and 3.9 +/- 0.4 mmol/L, respectively, before and after exposure. In the experimental group, the epithelium covering the true vocal cords shows disturbed stratification. Some cells exhibit loss of desmosomal connections between cells and enlargement of the intercellular space. CONCLUSION: Our study demonstrates that the larynx in laboratory animals is one of the sensitive and useful targets for assessing the harmful effects associated with environmental tobacco smoke.