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      Huge carotid body paraganglioma

      case-report

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          Abstract

          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 × 56 × 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.

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          Most cited references8

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          Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases.

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            Combined endovascular and surgical treatment of head and neck paragangliomas--a team approach.

            Paragangliomas are highly vascular tumors of neural crest origin that involve the walls of blood vessels or specific nerves within the head and neck. They may be multicentric, and they are rarely malignant. Surgery is the preferred treatment, and these tumors frequently extend to the skull base. There has been controversy concerning the role of preoperative angiography and embolization of these tumors and the benefits that these procedures offer in the evaluation and management of paragangliomas. Forty-seven patients with 53 paragangliomas were treated from the period of 1990-2000. Initial evaluation usually included CT and/or MRI. All patients underwent bilateral carotid angiography, embolization of the tumor nidus, and cerebral angiography to define the patency of the circle of Willis. Carotid occlusion studies were performed with the patient under neuroleptic anesthesia when indicated. The tumors were excised within 48 hours of embolization. Carotid body tumors represented the most common paraganglioma, accounting for 28 tumors (53%). All patients underwent angiography and embolization with six patients (13%), demonstrating complications (three of these patients had embolized tumor involving the affected nerves). Cerebral angiography was performed in 28 patients, and 5 of these patients underwent and tolerated carotid occlusion studies. The range of mean blood loss according to tumor type was 450 to 517 mL. Postoperative cranial nerve dysfunction depended on the tumor type resected. Carotid body tumor surgery frequently required sympathetic chain resection (21%), with jugular and vagal paraganglioma removal frequently resulting in lower cranial nerve resection. These patients required various modes of postoperative rehabilitation, especially vocal cord medialization and swallowing therapy. The combined endovascular and surgical treatment of paragangliomas is acceptably safe and effective for treating these highly vascular neoplasms. Adequate resection may often require sacrifice of one or more cranial nerves, and appropriate rehabilitation is important in the treatment regimen. Copyright 2002 Wiley Periodicals, Inc.
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              Imaging and management of head and neck paragangliomas.

              Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). Diagnostic imaging can be considered in two clinical situations: (1) patients who present with clinical symptoms suggestive of a paraganglioma, and (2) individuals from families with hereditary paragangliomas. It is not only necessary to detect and characterize the lesion, but also to study the presence of multiplicity. For these purposes, MR imaging, and especially 3D TOF MRA, is the modality of choice. CT scanning is especially useful to show destruction of the temporal bone. Angiography in combination with embolization will mainly be used prior to surgical resection, but can also be used for diagnostic purposes when the diagnosis is not yet clear. Many parameters play a role in the decision to treat of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Resection however, should be balanced against a more conservative "wait and scan" policy or palliative treatments such as radiotherapy.
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                Author and article information

                Journal
                J Korean Surg Soc
                JKSS
                Journal of the Korean Surgical Society
                The Korean Surgical Society
                2233-7903
                2093-0488
                October 2011
                28 October 2011
                : 81
                : 4
                : 291-294
                Affiliations
                Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
                [1 ]Department of Vascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                Author notes
                Correspondence to: Sang Jun Park. Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. Tel: +82-52-250-7109, Fax: +82-52-250-7350, ud3012md@ 123456medimail.co.kr
                Article
                10.4174/jkss.2011.81.4.291
                3219857
                22111087
                3c92e009-2b11-4b39-9b3c-1f996af8a269
                Copyright © 2011, the Korean Surgical Society

                Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 November 2010
                : 19 January 2011
                : 07 February 2011
                Categories
                Case Report

                Surgery
                carotid body tumor,hoarseness,horner syndrome
                Surgery
                carotid body tumor, hoarseness, horner syndrome

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