Carotid body tumors: review of a 20-year experience
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.
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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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