Carotid body tumor natural history, complications and prognosis: Difference between revisions
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{{Carotid body tumor}} | {{Carotid body tumor}} | ||
{{CMG}}; {{AE}} {{Sahar}} | {{CMG}}; {{AE}} {{Sahar}} {{MV}} | ||
==Overview== | ==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%. | If left untreated, patients with [[carotid body]] [[tumor]] may progress to develop [[Cranial nerve disease|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, Complications, and Prognosis== | ||
===Natural History=== | ===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.<ref name="LeeOh2006">{{cite journal|last1=Lee|first1=Ki Yeol|last2=Oh|first2=Yu-Whan|last3=Noh|first3=Hyung Jun|last4=Lee|first4=Yu Jin|last5=Yong|first5=Hwan-Seok|last6=Kang|first6=Eun-Young|last7=Kim|first7=Kyeong Ah|last8=Lee|first8=Nam Joon|title=Extraadrenal Paragangliomas of the Body: Imaging Features|journal=American Journal of Roentgenology|volume=187|issue=2|year=2006|pages=492–504|issn=0361-803X|doi=10.2214/AJR.05.0370}}</ref> | *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]].<ref name="LeeOh2006">{{cite journal|last1=Lee|first1=Ki Yeol|last2=Oh|first2=Yu-Whan|last3=Noh|first3=Hyung Jun|last4=Lee|first4=Yu Jin|last5=Yong|first5=Hwan-Seok|last6=Kang|first6=Eun-Young|last7=Kim|first7=Kyeong Ah|last8=Lee|first8=Nam Joon|title=Extraadrenal Paragangliomas of the Body: Imaging Features|journal=American Journal of Roentgenology|volume=187|issue=2|year=2006|pages=492–504|issn=0361-803X|doi=10.2214/AJR.05.0370}}</ref> | ||
** In familial cases, it tends to manifest at a younger age.<ref name="BurgessCalderon2017">{{cite journal|last1=Burgess|first1=Alfred|last2=Calderon|first2=Moises|last3=Jafif-Cojab|first3=Marcos|last4=Jorge|first4=Diego|last5=Balanza|first5=Ricardo|title=Bilateral carotid body tumor resection in a female patient|journal=International Journal of Surgery Case Reports|volume=41|year=2017|pages=387–391|issn=22102612|doi=10.1016/j.ijscr.2017.11.019}}</ref> | ** In [[familial]] cases, it tends to manifest at a younger age.<ref name="BurgessCalderon2017">{{cite journal|last1=Burgess|first1=Alfred|last2=Calderon|first2=Moises|last3=Jafif-Cojab|first3=Marcos|last4=Jorge|first4=Diego|last5=Balanza|first5=Ricardo|title=Bilateral carotid body tumor resection in a female patient|journal=International Journal of Surgery Case Reports|volume=41|year=2017|pages=387–391|issn=22102612|doi=10.1016/j.ijscr.2017.11.019}}</ref> | ||
*This tumor is a slowly growing mass with the median growth rate of 1.0mm/year. | *It may be clinically silent for years before [[Presenting symptom|presenting]] as a painless [[mass]] in the [[neck]].<ref name="pmid22584701">{{cite journal |vauthors=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 |title=Head and neck paragangliomas: clinical and molecular genetic classification |journal=Clinics (Sao Paulo) |volume=67 Suppl 1 |issue= |pages=19–28 |date=2012 |pmid=22584701 |pmc=3328838 |doi= |url=}}</ref> | ||
*The median time needed for the tumor to be doubled | *The [[tumor]] can also present with a pulsating [[mass]] in the [[lateral side]] of the [[neck]]. | ||
*If left untreated, patients with carotid body tumor may progress to develop cranial nerve involvement, airway obstruction, and malignant transformation of the tumor. | *This [[tumor]] is a slowly growing mass with the median growth rate of 1.0mm/year.<ref name="BurgessCalderon2017">{{cite journal|last1=Burgess|first1=Alfred|last2=Calderon|first2=Moises|last3=Jafif-Cojab|first3=Marcos|last4=Jorge|first4=Diego|last5=Balanza|first5=Ricardo|title=Bilateral carotid body tumor resection in a female patient|journal=International Journal of Surgery Case Reports|volume=41|year=2017|pages=387–391|issn=22102612|doi=10.1016/j.ijscr.2017.11.019}}</ref> | ||
*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 disease|cranial nerve involvement]], [[airway obstruction]], and [[malignant]] [[transformation]] of the [[tumor]]. | |||
===Complications=== | ===Complications=== | ||
*Carotid body tumor growth may cause local damage such as:<ref name="pmid978">{{cite journal |vauthors=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 |title=Outpatient phenothiazine use and bone marrow depression. A report from the drug epidemiology unit and the Boston collaborative drug surveillance program |journal=Arch. Gen. Psychiatry |volume=32 |issue=11 |pages=1416–8 |date=November 1975 |pmid=978 |doi=10.1016/0006-2944(75)90147-7 |url=}}</ref> | *[[Carotid body]] [[tumor]] growth may cause local damage such as:<ref name="pmid978">{{cite journal |vauthors=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 |title=Outpatient phenothiazine use and bone marrow depression. A report from the drug epidemiology unit and the Boston collaborative drug surveillance program |journal=Arch. Gen. Psychiatry |volume=32 |issue=11 |pages=1416–8 |date=November 1975 |pmid=978 |doi=10.1016/0006-2944(75)90147-7 |url=}}</ref> | ||
** | **[[Cranial nerve disease|Cranial nerve dysfunction]] | ||
**Airway obstruction | **[[Airway obstruction]] | ||
*Carotid body tumor may result in neurovascular complications peri and | *[[Carotid body]] [[tumor]] may result in neurovascular [[complications]] peri and [[Postoperative complication|postoperatively]].<ref name="pmid20607078">{{cite journal |vauthors=Lim JY, Kim J, Kim SH, Lee S, Lim YC, Kim JW, Choi EC |title=Surgical treatment of carotid body paragangliomas: outcomes and complications according to the Shamblin classification |journal=Clin Exp Otorhinolaryngol |volume=3 |issue=2 |pages=91–5 |date=June 2010 |pmid=20607078 |pmc=2896739 |doi=10.3342/ceo.2010.3.2.91 |url=}}</ref><ref name="pmid11578296">{{cite journal |vauthors=Plukker JT, Brongers EP, Vermey A, Krikke A, van den Dungen JJ |title=Outcome of surgical treatment for carotid body paraganglioma |journal=Br J Surg |volume=88 |issue=10 |pages=1382–6 |date=October 2001 |pmid=11578296 |doi=10.1046/j.0007-1323.2001.01878.x |url=}}</ref> | ||
*These complications include cranial nerve damage as well as carotid vessel hemorrhage. | *These [[complications]] include cranial nerve damage as well as [[Carotid arteries|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 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. | **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. | *[[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]]. <ref name="LvChen2016">{{cite journal|last1=Lv|first1=Han|last2=Chen|first2=Xiaohong|last3=Zhou|first3=Shuai|last4=Cui|first4=Suping|last5=Bai|first5=Yunlong|last6=Wang|first6=Zhenchang|title=Imaging findings of malignant bilateral carotid body tumors: A case report and review of the literature|journal=Oncology Letters|volume=11|issue=4|year=2016|pages=2457–2462|issn=1792-1074|doi=10.3892/ol.2016.4227}}</ref> | |||
**[[Malignant]] [[carotid body]] [[tumor]] is usually [[Diagnose|diagnosed]] by the presence of: | |||
***Local recurrence of the [[tumor]] | |||
***Regional [[Lymph node metastases|lymph node involvement]] | |||
***Distant [[metastasis]] | |||
***[[Tumor]] may [[Metastasis|metastasizes]] locally or to the distant [[organs]] via [[lymphatics]] or [[vasculature]].<ref name="XiaoShe2015">{{cite journal|last1=Xiao|first1=Zebin|last2=She|first2=Dejun|last3=Cao|first3=Dairong|title=Multiple paragangliomas of head and neck associated with hepatic paraganglioma: a case report|journal=BMC Medical Imaging|volume=15|issue=1|year=2015|issn=1471-2342|doi=10.1186/s12880-015-0082-z}}</ref> | |||
****The most common sites of distant [[metastasis]] are [[bone]], [[liver]] and [[lungs]]. | |||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally good after complete surgical removal of the tumor.<ref name="WienekeSmith2009">{{cite journal|last1=Wieneke|first1=Jacqueline A.|last2=Smith|first2=Alice|title=Paraganglioma: Carotid Body Tumor|journal=Head and Neck Pathology|volume=3|issue=4|year=2009|pages=303–306|issn=1936-055X|doi=10.1007/s12105-009-0130-5}}</ref> | *[[Prognosis]] is generally good after complete [[surgical]] removal of the [[tumor]].<ref name="WienekeSmith2009">{{cite journal|last1=Wieneke|first1=Jacqueline A.|last2=Smith|first2=Alice|title=Paraganglioma: Carotid Body Tumor|journal=Head and Neck Pathology|volume=3|issue=4|year=2009|pages=303–306|issn=1936-055X|doi=10.1007/s12105-009-0130-5}}</ref> | ||
*In case of malignant metastasis, the follow-up must be done continuously, however, recurrence or metastasis may occur years later. | *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%. | *The 10-year [[survival rate]] of patients with [[malignant]] [[paraganglioma]] is approximately 50%. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
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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.