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- Title
Conservative versus aggressive treatment of paragangliomas: What is the best approach?
- Authors
Fink, Daniel; Abdul-Aziz, Dunia; Shargorodsky, Josef; Lee, Linda; Frankenthaler, Robert A.
- Abstract
Objectives: To review the presentation, genetics, and management of paragangliomas and to understand options for diagnosis and treatment. Study Design: Case report and review of the literature. Methods: Retrospective review of a case of multiple, bilateral paragangliomas. Genetic, surgical, radiographic, and histopathologic findings are shown and discussed. Therapeutic modalities are compared and indications for preoperative embolization are reviewed. Surgical approaches for the parapharyngeal space are compared. Results: A 38 year old female presented with neck swelling and dysphagia for four months. Family history was significant for malignant paraganglioma. Radiographic imaging revealed bilateral carotid body tumors (CBT) in addition to a left 3.5cm glomus tumor extending to the skull base. Octreotide scanning confirmed uptake in the parapharyngeal space. Urine metanephrines were normal. Genetic testing was positive for the SDH-D mutation. After embolization, transcervical exploration of the left neck revealed a glomus tumor inseparable from the vagus and superior laryngeal nerves. The glomus tumor and left CBT were successfully resected en bloc. Conclusions: Management of head and neck paragangliomas lacks a discrete protocol; rather, many decisions must be made using the otolaryngologist's critical judgment. The proximity of these masses to vital neurovascular structures brings risk to both observation of these tumors, as well as to intervention. As malignancy can only be established through evidence of distant metastasis, otolaryngologists must also decide when full body imaging is indicated. Genetic testing for SDH-B, SDH-C, and SDH-D can help guide treatment decisions and should be well understood by all otolaryngologists.
- Subjects
CASE studies; PARAGANGLIOMA; NEUROENDOCRINE tumors; RETROSPECTIVE studies; PATIENTS
- Publication
Laryngoscope, 2011, Vol 121, Issue S5, pS287
- ISSN
0023-852X
- Publication type
Article
- DOI
10.1002/lary.22243