Carotid Body Tumor: A Case Report and Review of Literature
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Carotid Body Tumor: A Case Report and Review of Literature Gunjan Dwivedi1 • Sanjeeva Bharadwaja2 • Uday Bhanu Kovilapu3 Pranati Swain4 • Abha Kumari1
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Received: 31 August 2020 / Accepted: 28 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Carotid body tumour (CBT) is a rare hypervascular tumor in the head and neck region. It develops from neural crest origin paraganglionic tissue which is an arterial chemoreceptor. It presents as a slow growing mass at the carotid bifurcation. Its optimal evaluation and treatment requires involvement of multiple specialities. Because of the high rate of neurovascular complications, resection of this tumor is challenging for surgeons. Early tumor detection, meticulous evaluation and multidisciplinary approach are vital for successful management of these tumors. A case of CBT in a 50 year-old lady managed at our centre is being reported here along with a review of literature. Keywords Carotid body tumor Paraganglioma Embolization Shamblin Succinate dehydrogenase
hypoxia and these tumors, incidence increased proportionally with altitude, due to the chronic hypoxic stimulus that induces hyperplasia in the carotid body [1]. Only 3% of paragangliomas (PGs) occur in head and neck region and 85% in the abdomen. CBTs are the most common head and neck PGs, comprising 60% of them [2, 3]. Diagnosis of these tumors is often delayed because the clinical manifestations are very subtle and their growth pattern is very slow; hence, they can be present for decades before the patient seeks medical attention. Due to rarity these cases are seldom encountered by surgeons. Comprehensive workup and multispeciality management are required for optimally managing these cases. Here we report a case of CBT with review of literature, discussion of which focuses on the diagnostic and surgical approaches.
Introduction
Case Report
Carotid body is a neural crest origin paraganglionic tissue which is an arterial chemoreceptor organ located at carotid bifurcation. It is responsible for detecting changes in arterial O2, CO2 and pH levels and stimulates respiratory centre in brainstem. CBT is a head and neck paraganglioma. There is a well-known association between
A 50 year old lady, known case of Type II diabetes mellitus and hypertension on injection insulin and oral antihypertensives, presented with complaints of gradually progressive swelling left lateral upper neck of 06 months duration. Neck examination revealed a firm, non-tender swelling measuring 04 9 04 cm, anterior extent 05 cm from midline, posteriorly 2.5 cm below the mastoid tip, inferiorly till the level of hyoid. Superior limit could not be palpated clearly as it was extending deep to mandible. There were no palpable lymph nodes. MRI Neck revealed a well-defined, large globular mass of size 04 9 04 9 3.7 cm, at the carotid bifurcation, causing marked splaying of the external carotid artery (ECA) and internal carotid artery (ICA). Left ICA and ECA were encased over half their circumference by the
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