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Prevention and Research

Carotid body paraganglioma: early diagnosis

Case report, 50 - 52
doi: 10.11138/PER/2013.2.2.050
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Abstract
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Background: paragangliomas (PGLs) are rare neuroendocrine tumors which arise from the extraadrenal chromaffin tissue of the autonomous nervous system, located in the carotid body or glomus (CB). This is a little corpuscle localized at carotid bifurcation; it contributes to the regulation of blood pressure, cardiac and respiratory frequency by giving information to the nervous system bodies located in the brain stem. Istologically, PGLs remind of the CB normal architecture, with clusters cells known as Zellballen, highly vascularized. Rarely secreting vasoactive amines, they come more often to clinical observation as a mass located at the mandibular angle, asymptomatic.
Based on the size and connections with the surrounding vascular structures, they are divided into three groups according to the Shamblin classification.
Case report: 57-year-old patient, smoker. He reports about a year before, presence of vertigo associated with cold sweat and general malaise that lasts about 20 min resolved spontaneously (blood pressure in association with these episodes is high
with maximum values recorded around 180/110 mmHg). He is submitted to a Holter blood pressure investigation, ECD of the neck vessels (TSA), then it was performed a neck MRI. The patient underwent surgery. The final histological examination showed a “paraganglioma composed of nests of chromogranin positive cells with round nuclei and finely dispersed chromatin with abundant eosino - philic, granular cytoplasmic portion”.
Discussion and Conclusions: the PGLs are rare neoplasms, with an incidence of 0.012%. Very rarely (5% of cases) the patients come to medical attention for the appearance of a “pressor amine syndrome” with tachycardia, palpitations, flushing, hypertensive crisis, dizziness, malaise, diarrhea, amino-linked activity consequences of PGLs secreting. According to the Shamblin classification are divided into three groups based on the size and relationships contracted with the surrounding vascular structures (group III belongs to the larger and it forms persistently adhesions to the carotid bifurcation). In most cases, the patients having a PGLs come to medical attention for the appearance of a mass in the lateral region of the neck, at the mandibular angle, often completely asymptomatic. When the tumor reaches considerable size, it may be responsible for nerve deficits (especially for X, XI and XII nerves), dysphagia, neck pain. Early diagnosis of PLGs asymptomatic and small reduces the risk of perioperative lesions of the cranial nerves and carotid arteries. In our case, early identification was made possible by the biological and functional characteristics of the tumor and the consequent clinical manifestations, allowing to carry out the surgery safely for the patient.
Despite the size of PLG taken into account, it was ranked to the Shamblin group I.

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