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Carotid Body

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  • • Normal carotid body 3-6 mm

    • Nest of chemoreceptor cells of neuroectodermal origin

    • Responds to decrease in Po2, increase in Pco2, decrease in pH, or blood temperature increase

    • Results in increase in blood pressure, heart rate, depth and rate of respiration

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Carotid Sinus

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  • • Baroreceptor

    • Stimulation causes reflex bradycardia and hypotension

    Tumors of carotid body

    • -Cervical chemodectomas

      -Paragangliomas

      -Glomus tumors

      -Nonchromaffin paragangliomas

    • 10% metastatic

    • Histologically, tumors resemble normal carotid body

    • Often extends to local structures

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Epidemiology

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  • • Incidence equal in genders

    • Bilaterality is common when tumor is familial

    • Incidence increased in hypoxic persons (cyanotic heart disease, high altitude)

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Symptoms and Signs

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  • • Slow enlargement of asymptomatic cervical mass

    • Rarely, hypertension secondary to release of catecholamines

    • Rarely, cranial nerve dysfunction from tumor extension

    • Solitary midlateral pulsatile neck mass that is firm and rubbery

    • Mass mobile in horizontal plane not vertical plan

    • 50% bruits

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Imaging Findings

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  • • Duplex scanning is often diagnostic

    Angiography: Characteristic tumor blush at carotid bifurcation, with wide separation of internal and external carotid arteries

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  • • Duplex scanning often diagnostic

    • Angiography shows characteristic tumor blush at carotid bifurcation, with wide separation of internal and external carotid arteries

    • Percutaneous needle or incisional biopsy is dangerous

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  • • Physical exam

    • Cervical US

    • CT scan or MRI

    • Genetic counseling for succinyl dehydrogenase mutation screening (SDH-D and SDH-B)

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  • Preferred treatment: Complete excision and possible arterial reconstruction

    • Radiation therapy and chemotherapy not helpful

    • Preoperative embolization carries risk of stroke and generally not performed

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Complications

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  • • > 40% incidence of cranial nerve dysfunction after resection

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References

Gombos Z. Zhang PJ. Glomus tumor. Archives of Pathology & Laboratory Medicine. 2008;132(9):1448-52.  [PubMed: 18788860]
Boedeker CC. et al. Malignant head and neck paragangliomas in SDHB mutation carriers. Otolaryngology - Head & Neck Surgery. 2007;137(1):126-9.  [PubMed: 17599579]

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