Carotid body tumor natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Maria Fernanda Villarreal, M.D. [3]
Overview
If left untreated, patients with carotid body tumor may progress to develop cranial nerve dysfunction, airway obstruction, and malignant transformation of the tumor. Prognosis is generally good, and the 10-year survival rate of patients is approximately 50%.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of carotid body tumor usually develop in the fifth decade of life and start with symptoms such as asymptomatic mass in the anterior triangle of the neck.[1]
- It may be clinically silent for years before presenting as a painless mass in the neck.[3]
- The tumor can also present with a pulsating mass in the lateral side of the neck.
- This tumor is a slowly growing mass with the median growth rate of 1.0mm/year.[2]
- The median time needed for the tumor to be doubled in 4.2 years.
- If left untreated, patients with carotid body tumor may progress to develop cranial nerve involvement, airway obstruction, and malignant transformation of the tumor.
Complications
- Carotid body tumor growth may cause local damage such as:[4]
- Carotid body tumor may result in neurovascular complications peri and postoperatively.[5][6]
- These complications include cranial nerve damage as well as carotid vessel hemorrhage.
- Neurovascular complication rate differs according to the Shamblin subtype and the size of the tumor.
- For type I and II, the peri and post-surgical complications are low and around 0% to 3% of the cases.
- For Type III, it may be as high as 7% to 35% of the cases.
- Carotid body tumor may transform into malignant form in almost 10% of the cases.
- There is no accepted guideline on the diagnosis of malignancy via histology of the tumor and it has been observed that pathological examination of the tumor is unable to differentiate between benign and malignant tumor. [7]
- Malignant carotid body tumor is usually diagnosed by the presence of:
- Local recurrence of the tumor
- Regional lymph node involvement
- Distant metastasis
- Tumor may metastasizes locally or to the distant organs via lymphatics or vasculature.[8]
- The most common sites of distant metastasis are bone, liver and lungs.
Prognosis
- Prognosis is generally good after complete surgical removal of the tumor.[9]
- In case of malignant metastasis, the follow-up must be done continuously, however, recurrence or metastasis may occur years later.
- The 10-year survival rate of patients with malignant paraganglioma is approximately 50%.
References
- ↑ Lee, Ki Yeol; Oh, Yu-Whan; Noh, Hyung Jun; Lee, Yu Jin; Yong, Hwan-Seok; Kang, Eun-Young; Kim, Kyeong Ah; Lee, Nam Joon (2006). "Extraadrenal Paragangliomas of the Body: Imaging Features". American Journal of Roentgenology. 187 (2): 492–504. doi:10.2214/AJR.05.0370. ISSN 0361-803X.
- ↑ 2.0 2.1 Burgess, Alfred; Calderon, Moises; Jafif-Cojab, Marcos; Jorge, Diego; Balanza, Ricardo (2017). "Bilateral carotid body tumor resection in a female patient". International Journal of Surgery Case Reports. 41: 387–391. doi:10.1016/j.ijscr.2017.11.019. ISSN 2210-2612.
- ↑ Offergeld C, Brase C, Yaremchuk S, Mader I, Rischke HC, Gläsker S, Schmid KW, Wiech T, Preuss SF, Suárez C, Kopeć T, Patocs A, Wohllk N, Malekpour M, Boedeker CC, Neumann HP (2012). "Head and neck paragangliomas: clinical and molecular genetic classification". Clinics (Sao Paulo). 67 Suppl 1: 19–28. PMC 3328838. PMID 22584701.
- ↑ Swett C, Makar AB, McMartin KE, Palese M, Tephly TR, Corgier M, Pacheco H, Gailani S, McLimans WF, Mundy GR, Nussbaum A, Roholt O, Zeigel R, Wiesmann UN, DiDonato S, Herschkowitz NN (November 1975). "Outpatient phenothiazine use and bone marrow depression. A report from the drug epidemiology unit and the Boston collaborative drug surveillance program". Arch. Gen. Psychiatry. 32 (11): 1416–8. doi:10.1016/0006-2944(75)90147-7. PMID 978.
- ↑ Lim JY, Kim J, Kim SH, Lee S, Lim YC, Kim JW, Choi EC (June 2010). "Surgical treatment of carotid body paragangliomas: outcomes and complications according to the Shamblin classification". Clin Exp Otorhinolaryngol. 3 (2): 91–5. doi:10.3342/ceo.2010.3.2.91. PMC 2896739. PMID 20607078.
- ↑ Plukker JT, Brongers EP, Vermey A, Krikke A, van den Dungen JJ (October 2001). "Outcome of surgical treatment for carotid body paraganglioma". Br J Surg. 88 (10): 1382–6. doi:10.1046/j.0007-1323.2001.01878.x. PMID 11578296.
- ↑ Lv, Han; Chen, Xiaohong; Zhou, Shuai; Cui, Suping; Bai, Yunlong; Wang, Zhenchang (2016). "Imaging findings of malignant bilateral carotid body tumors: A case report and review of the literature". Oncology Letters. 11 (4): 2457–2462. doi:10.3892/ol.2016.4227. ISSN 1792-1074.
- ↑ Xiao, Zebin; She, Dejun; Cao, Dairong (2015). "Multiple paragangliomas of head and neck associated with hepatic paraganglioma: a case report". BMC Medical Imaging. 15 (1). doi:10.1186/s12880-015-0082-z. ISSN 1471-2342.
- ↑ Wieneke, Jacqueline A.; Smith, Alice (2009). "Paraganglioma: Carotid Body Tumor". Head and Neck Pathology. 3 (4): 303–306. doi:10.1007/s12105-009-0130-5. ISSN 1936-055X.