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Malignant Carotid Paraganglioma: A Case Report
Maani M Archang1, Seung Lee2, Ismail Ziu3
1Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, Los Angeles, USA.
Cureus
|August 14, 2023
Summary
This case study details a rare Shamblin grade III carotid body tumor (CBT) encasing the internal carotid artery (ICA). Successful en bloc resection was achieved without vascular reconstruction due to extensive collateralization.
Area of Science:
- Neuro-oncology
- Vascular Surgery
- Head and Neck Surgery
Background:
- Carotid body tumors (CBTs) are rare neuroendocrine neoplasms.
- Malignant CBTs carry a 2%-12.5% risk and often require complex management.
- Surgical resection is the primary treatment but poses significant risks.
Observation:
- A 40-year-old female presented with a 5-year history of a progressively enlarging neck mass.
- MRI/MRA revealed a Shamblin grade III CBT encasing the internal carotid artery (ICA).
- Absent ICA blood flow in the petrous segment with robust collateral brain supply was noted.
Findings:
- En bloc resection of the CBT, carotid bulb, and common carotid artery (CCA) was performed successfully.
- Ligation of the CCA was achieved without the need for vascular reconstruction.
- The patient's extensive collateral circulation facilitated the complex surgical outcome.
Implications:
- This case highlights the feasibility of radical resection in advanced CBTs with significant vascular involvement.
- It underscores the importance of pre-operative vascular assessment and understanding collateral pathways.
- Management strategies for malignant CBTs, including surgery, embolization, and radiation, are reviewed.
