Elsevier

Oral Oncology

Volume 41, Issue 1, January 2005, Pages 56-61
Oral Oncology

Carotid body tumors: review of a 20-year experience

https://doi.org/10.1016/j.oraloncology.2004.06.006Get rights and content

Summary

Carotid body tumors (CBT) are a rare entity that should be considered in evaluating every lateral neck mass. The objective of the study was to compare demographic data, complications and evolution of patients treated at our institution.

A retrospective study was made of 66 patients with 69 CBT that were treated at our institution between 1982 and 2002. We reviewed the demographic characteristics, clinical features, surgical approach and complications.

Women significantly predominated (96.9%) with a female:male ratio of 31.2:1. Ages ranged from 18 to 94 (mean = 50.2). Fifty-four per cent of the patients lived at altitudes higher than 2200 m above sea level. The most common chief complaint was a painless neck mass (78.7%). No patient had any malignant tumors or a familial history of CBT. Both sides were similarly affected. There were four tumors grouped in Shamblin’s class I, 24 in class II, and 35 in class III. Six tumors were of undetermined Shamblin’s class as inferred from their medical records. Fifty-three patients received treatment: 46 (86.8%), surgery; 6 (11.3%), radiotherapy; 1 (1.9%), radiotherapy following surgery. Three patients (6.3%) underwent vascular reconstruction. In 23 (49%) patients neurological deficit was observed after surgery. Minor complications occurred in five (10.6%) patients. Median follow-up was 38 months, one patient died from a cause not related to the CBT, and the rest remain disease-free and asymptomatic.

We found an overwhelming predominance of women, which opens the possibility that we are dealing with a different disease in female Latin populations. Most of the tumors were of Shamblin’s class III CBT. Early surgical management is recommended to avoid neurological deficit due to a Shamblin’s class III tumor.

Introduction

Tumors of the carotid body are slowly growing neoplasms originating in the chemoreceptors of the carotid body and correspond to almost half of all paragangliomas.1, 2 Other paragangliomas located in the head and neck region are the jugular, vagal, nasal, orbital, laryngeal, and tympanic tumors.3 The incidence of these tumors has been thought to be increased proportionally with altitude, due to the chronic hypoxic stimulus that induces hyperplasia in the carotid body.4 Diagnosis of these tumors is often delayed because quite frequently the clinical manifestations are nil or very subtle and their growth pattern is very slow; hence, they can be present for decades before the patient seeks medical attention. The aim of this study was to compare the demographic characteristics of our patients, as well as to assess their complications and evolution in our institution.

Section snippets

Material and methods

We made a retrospective review of the clinical records of the patients diagnosed with tumors of the carotid body at the Instituto Nacional de Cancerología (INCan, for its initials in Spanish, Mexico City) from 1982 to 2002. Tumors were classified according to the criteria established by Shamblin et al.5 (class I: tumors as small and easily dissected away from the vessels; class II: tumor partially surrounds the vessels; class III: tumors are large and intimately associated with the carotid

Results

Women predominated significantly, at a ratio of 31.2:1. There were three cases (4.5%) of bilateral disease. Urinary screening of metanephrines and vanillyl mandelic acid was performed in five patients (7.5%), finding them within normal values. The mean hemoglobin and hematocrit values for the total population were 14.4 and 42.6, respectively. Comparison of the mean hemoglobin and hematocrit values of those patients living at altitudes higher than 2200 m above sea level (hemoglobin 14.2,

Discussion

The carotid body is constituted by two types of cells, the chief or paraganglionic cells, derived from the neural crest and members of the diffuse neuroendocrine system, and the sustentacular cells, which have chemoreceptor activity and are scarcely found in paragangliomas. Hence, paraganglionic cells predominate in the histological images of the carotid body tumors, arranged in a pseudoalveolar pattern described as Zellballen formation due to their intimate agglutination aspect.6, 7 These

Conclusion

Tumors of the carotid body are infrequent neoplasms; their surgical treatment is highly dependent on the ability and experience of the surgeon, but offering high possibilities of cure. In this series, the larger number of patients corresponded to women, suggesting that we could be dealing with a different disease in the Latin population. The diagnostic and therapeutic relevance of these tumors reside in making a timely and early diagnosis to propose an early surgical treatment aimed at

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