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A paciente foi submetida a cirurgia sob anestesia geral. Segundo Shamblin et al. Pantanowitz et al. Fonte de financiamento: Nenhuma. A carotid body tumor is a rare neoplasm, generally benign, that predominantly affects people between their fourth and fifth decades of life.
It manifests as a pulsatile and generally painless cervical mass with firm consistency, located below the angle of the jaw. It can progress to the extent that it causes localized pain, dysphagia, hiccups, hoarseness and hypersensitive carotid body syndrome.
This article reports the cases of two female patients diagnosed with this tumor who were treated surgically. The first was treated with block resection of the tumor, while the second patient, who had an early stage tumor, was treated with subadventitial resection of the lesion. The carotid body is a structure of elliptical shape, 3 to 4 mm in size, that is located at the bifurcation of the common carotid, at the level of its adventitial layer. They can be asymptomatic or manifest as a slow-growing tumor that is painless and pulsatile, in the side of the neck, close to the angle of the jaw, and occasionally lead to complaints of hoarseness, deglutition problems and symptoms of carotid sinus syndrome.
She had had a surgical biopsy of the left cervical region 4 months previously and referred with a diagnosis of carotid aneurysm.
She stated that she had no history of dysphagia, dysphonia, ischemic attacks or weight loss. During the physical examination, a scar approximately 3 cm long was observed at the anterior margin of the sternocleidomastoid muscle, on the left.
Palpation revealed two ovoid masses, one measuring 3 x 4 cm, on the left, and the other measuring 2 x 2 cm, on the right Figure 1. They were located within the right and left carotid triangles and had an elastic consistency, were painless and pulsatile and were mobile in the lateral direction, but immobile longitudinally. They did not produce thrills or murmurs. Examination of the oral cavity did not find evidence of lesions or adenopathies in other sites.
The neurological examination showed that the cranial pairs were undamaged. The patient was admitted to hospital and underwent examinations with color Doppler ultrasonography and computed tomography Figure 2 , which were suggestive of carotid body tumor and this diagnosis was later confirmed by arteriography Figure 3.
On the left, it could be observed that the external carotid was occluded at the origin. The tomographic examination ruled out signs of invasion of the base of the skull. The patient underwent surgery under general anesthesia.
An incision was made at the anterior margin of the left sternocleidomastoid muscle, revealing a solid tumor adhering to the carotid bifurcation, without involving the vagus or hypoglossal nerves. A ligature of the external carotid at the origin was observed. Since dissection was difficult, en bloc resection of the tumor and carotid bifurcation was performed Figure 4.
A temporary Pruitt-Inahara shunt was used for cerebral protection, with interposition of the internal saphenous with proximal side-to-end anastomosis and distal end-to-end anastomosis Figure 5. Two glands were removed for histopathological analysis. The patient recovered during the postoperative period with no neurological deficits and was discharged on the sixth day.
The histopathological analysis confirmed the diagnosis of carotid body tumor and found the glands to be free of involvement Figure 6. A repeat arteriography conducted 60 days after the procedure did not find evidence of tumor remnants Figure 7.
The patient refused surgery on the contralateral tumor. The second patient was a year-old female from Curitiba, PR, Brazil, who complained of a tumor in the left cervical region. She reported a history of systemic arterial hypertension and hypercholesterolemia, both under control.
She also reported having a meningioma adhering to the superior sagittal sinus, which had not exhibited growth since During physical examination, palpation identified an ovoid, pulsatile, and painless mass in the left carotid trigone. It was of elastic consistency, with no adherence to the deeper planes and was mobile laterally, but immobile in the longitudinal direction.
There was no thrill or murmur. In common with the first case, examination of the oral cavity and a neurological examination did not detect abnormalities. The patient underwent imaging exams during the preoperative period. Color Doppler ultrasonography showed an extremely vascularized tumor with dimensions of 3.
Surgical treatment was chosen. Under general anesthesia, a cervical incision similar to that described in the previous case description was made on the left. A solid mass was found adhering to the carotid bifurcation. Material for histopathological analysis was removed. A Jackson-Pratt drain was used for the first 24 postoperative hours. The patient recovered well during the postoperative period, with no complications, and was discharged on the second postoperative day.
Histopathological analysis confirmed the diagnosis of carotid paraganglioma. According to Shamblin et al. With regard to work-up tests and examinations, color Doppler ultrasonography is the first choice, because it provides information that is suggestive of the diagnosis and important for screening and differential diagnosis. Cervical computed tomography or, better still, magnetic resonance imaging, are the examinations of choice for obtaining data on location, extension, correlation with adjacent structures and vascular nature of the tumor.
Surgery is the treatment of choice, bearing in mind the possibility of malignant transformation, peritumoral invasion and metastasis. The most widely-used technique is subadventitial dissection of the tumor Gordon-Taylor. During the procedure, before dissection, it is very important to identify and fully expose all nerves, avoiding excessive handling. Embolization can be employed in cases of large tumors, which will reduce blood loss and the size of the tumor and improve the results of surgery, but the risk of cerebral embolism cannot be ruled out.
However, it must be remembered that side effects can occur, such as necrosis of the jaw, brain and soft tissues. Financial support: None. National Center for Biotechnology Information , U. Journal List J Vasc Bras v. J Vasc Bras. Author information Article notes Copyright and License information Disclaimer. Received Nov 3; Accepted Feb 5. Copyright notice. This article has been cited by other articles in PMC.
Open in a separate window. Figura 1. Figura 2. Figura 3. Figura 4. Figura 5. Figura 6. Figura 7. Figura 8. Figura 9. Footnotes Fonte de financiamento: Nenhuma. Carotid body tumors: a review of 52 cases. S Afr Med J. Carotid body tumors: a subject review and suggested surgical approach. J Neurosurg. Carotid body tumor chemodectoma. Clinicopathologic analysis of ninety cases. Am J Surg. Ver Invest Clin. Diagnosis and treatment of carotid body paraganglioma: 21 years of experience at a clinical center of Serbia.
World J Surg Oncol. Diagnosis and surgical treatment of the carotid body tumors. J Cardiovasc Surg Torino ; 36 3 — Paragangliomas of the neck: clinical and pathological analysis of cases. Surg Clin North Am. Chung WB. The carotid body tumor. Can J Surg. Carotid body tumor unusual cause of transient ischemic attacks. Carotid body tumors: a review. J Otolaryngol. Paraganglioma cervical bilateral. Arch Otor Fund. Gaylis H, Mieny CJ. The incidence of malignancy in carotid body tumours.
Tumor de corpo carotídeo (paraganglioma): relato de dois casos submetidos a tratamento cirúrgico
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