Carotid Body Tumor

CAROTID BODY TUMOR

Saad Ismail Al Hashimi ( Steve ), Ph.D.

Medical sonographer at Shift Imaging, Grand Prairie –Alberta-Canada

Abstract

The carotid body is the largest collection of paraganglia in the head and neck and is

found on the medial aspect of the carotid bifurcation bilaterally. Carotid body tumors are rare neoplasm arising from the chemoreceptor cells of the carotid bulb.

This case of carotid body tumor in a 49-year-old male, from East Canada who was

working in Alberta , and who presented with painless, pulsatility, gradually progressive

lateral neck swelling as he mentioned the increased in size in 3 years time.

The diagnosis is suspected on the basis of history, clinical and radiological examination

findings, and a successful surgical excision of the tumor is performed.

This is a brief literature about carotid body tumors in terms of its clinical and imaging presentation, evaluation, and management.

Keywords: Carotid body tumor; Carotid space; Chemodectomas; Neck tumor;

Paraganglioma.

MRI T2, AND T1 at the carotid body tumor at bifurcation

Background

Paraganglioma of the head and neck are rare vascular tumors derived from the

paraganglia tissues originating from the neural crest. They are usually benign and

hypovascularized. Diagnosis is relatively easy in condition to consider it in evaluating every lateral neck mass. (1)

Methods

The author made a retrospective study of the records of 5 patients, 4 patients who

presented with carotid body tumors at a various clinics that I used to work for in Calgary- Alberta and one patient in Shift Imaging- Grand prairie Alberta, during the period between 2011 and 2021. Epidemiologic, etiologic, diagnostic, and therapeutic features were analyzed.

CT SCAN of the carotid body tumor at bifurcation

Results

The average age of our patients was 40.5 years (30–60 years), with female

predominance 3 females and 2 males. The author noted 3 cases of isolated carotid

locations, 1 case of multiple locations, and 1 case at the medial bifurcation segment. A slow-growing neck mass was the main clinical presentation. Other signs were mild

pain, lump feeling, dysphonia, dizziness, headache, and tinnitus. Physical examination showed, in most cases, a neck nontender mass with side to side mobility. 3 of the patients were overweight.

The ultrasound image of the carotid body tumor at the carotid bifurcation

Imaging techniques included 2-D –ultrasound Imaging, Doppler ultrasound, computed tomography (CT), and magnetic resonance. Imaging, Urinary analysis

Urinary analysis for metanephrine was carried out in 1 case. The clinical presentation and imaging results strongly suggested the diagnosis of carotid Paraganglioma in all 5 cases.

Treatment was surgical excision

in 4 cases associated with a preoperative embolization

in 1 case and a postoperative radiotherapy in 1 case. Pathology confirmed the

diagnosis, and a lymph node metastasis was suspected of malignity in 1 case. The

evolution was favorable in 4 patients.

The ultrasound image of the carotid body tumor at the carotid bifurcation is highly vascular

Conclusions

Carotid body tumor requires early diagnosis and an adequate multidisciplinary team.

The diagnosis must be considered in the case of any pulsatility cervical mass. Surgery is the treatment of choice despite its risks especially in large tumors. The therapeutic indication should, ideally, be set in a multidisciplinary consultation.

Symptoms

Many times, a carotid body tumor does not cause symptoms and is found by your

doctor during an exam. You may be able to feel the tumor, but it is not painful. (1, 2)

If the tumor becomes large, it can press on the nerves, blood vessels or organs around it. This may cause throat pain, hoarseness, a numb tongue or make it hard to swallow. (3, 4)

The ultrasound image of the carotid body tumor at the carotid bifurcation

Carotid body tumors are not usually cancerous. But, they can grow quickly and become large. Because of this, the best treatment is often surgery to remove the tumor. In rare cases, radiation therapy is used. (4, 5)

Transcatheter Embolization

A Transcatheter embolization is a procedure that reduces blood supply to the tumor. It is done two or three days before surgery. A catheter will be guided through your groin artery into the blood vessels that feed blood to the tumor. Then, medication and/or a blocking device, such as foam, plastic, metal coil, or glue is used to stop the blood flow to the tumor.(6)

Surgical Removal (Resection)

Most times (60% -70%), the tumor can be removed without the need to repair or remove part of the carotid artery. If the artery does need to be repaired, it may be fixed with a simple suture repair. Sometimes, a more complicated repair is needed, such as creating a patch over a hole made during the tumor removal or replacing a section of the artery with a bypass graft (using another blood vessel to create a new pathway for the blood to flow).(7)

The ultrasound image of the carotid body tumor at the carotid bifurcation

Risks of Treatment

Treatment for carotid body tumors is generally very safe with good outcomes. However, all surgery involves risks. One possible complication is stroke, but this is rare and happens in less than 2% of carotid body tumor removals. The risk is highest for patients who have large tumors and need to have vascular repair or replacement. (8)

If the tumor affects the nerves near the carotid artery, such as the vagus nerve, facial nerve or hypoglossal nerve that controls your tongue, part of the nerve may need to be removed.

The ultrasound image of the carotid body tumor at the carotid bifurcation

This can cause problems with the affected nerve(s). The risk of nerve problems is higher if the tumor is large, but the overall risk of permanent nerve damage is less than 5%. If the tumor is cancerous, there is a less than 5% chance it will spread to other areas of your body (metastatic disease). The risk of having another carotid body tumor after surgery is 5% to 10%. The rate of malignancy is reported to be 6–12.5% of all cases. The 7–9% of the cases is hereditary. None of our five cases were bilateral or hereditary. (9-10-11-12)

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