DIAGNOSIS OF CAROTID PARAGANGLIOMA: MULTIDISCIPLINARY ASPECTS

Objective: to enhance the efficiency of diagnosis and treatment of  carotid paragangliomas, by introducing of a multidisciplinary approach into clinical practice.

Material and methods. A total of 15 cases of paragangliomas have been followed up for 10 years. The age of the patients was 18 to 58  years (mean age 38±12 years). Primary multiple sites of chemodectomas were noted in 2 cases. Bilateral involvement was observed in one case. In the other, two unilateral vascular  tumors successively developed with an interval of almost 6 years. A  set of studies was conducted, which embraced ultrasound duplex  scanning (USDS) of the neck vessels, computed tomography (CT), and selective carotid angiography (SCAG) in various  combinations. The investigators made a successive examination of  the symmetrical areas of the face and neck and polypositional  scanning of the zone of interest and studied quantitative parameters, including linear blood flow velocity (LBFV) and  volumetric blood flow velocity. Native and contrast-enhanced X-ray  CT and magnetic resonance imaging (MRI) were carried out. SCAG  was performed as digital subtraction angiography.

Results. USDS can confirm the hypervascular nature of the tumor  and its close relationship with the carotid artery branches and  measure blood flow velocity (LBFVmean, 0.46 m/sec). X-ray CT and  MRI examinations in combination with vessel contrasting make it  possible to accurately determine the localization and topography of  the tumor, its association with the carotid artery system and to type  afferent vessels. SCAG is a highly informative technique that can  identify the afferent vessels of the tumor and its relationship with  the great vessels and, if technically possible, perform selective  microembolization of the afferent tumor vessels, which will further facilitate surgical treatment, reducing the risk of intraoperative bleeding.

Conclusion. The multidisciplinary approach to diagnosing carotid  paragangliomas in the maxillofacial area and neck makes it possible  to determine the type, size, and velocity characteristics, to verify the  diagnosis, and to work out optimal treatment policy. Among the  non-invasive techniques, CT angiography and MR angiography are  most valuable for final diagnosis. Selective angiography of the  branches of the external carotid arteries remains the gold standard  and is the final and most important stage of the study, which make it possible to detail angioarchitectonics, to determine afferent vessels,  and to plan further treatment, including endovascular embolization.  The diagnosis of carotid paragangliomas requires a multidisciplinary  approach with the equal attraction of endovascular diagnosis and  treatment specialists, maxillofacial surgeons, angiologists,  ultrasound and radiology diagnosticians, and pathologists both at the  stages of diagnosis and subsequent treatment. This problem can be effectively solved in a multidisciplinary hospital that has skilled  staff with sufficient clinical experience in diagnosing vascular masses and is equipped with modern equipment, which allows  optimization of further treatment.

1. Isik F.C., Imamoglu M., Erem C., Sari A. Paragangliomas of the head and neck. Med. Princ. Pract. 2007; 16 (3): 209–14.

2. Дружинин Д.С., Пизов Н.В. Каротидная хемодектома: дифференциальная диагностика по данным ультразвукового исследования. Опухоли головы и шеи. 2012; 1: 46–50. [Druzhinin D.S., Pizov N.V. Carotid body tumor: differential diagnosis by ultrasound. Opukholi Golovy i Shei (Head and Neck Tumors, Russian journal). 2012; 1: 46–50 (in Russ.).]

3. Gardner P., Dalsing M., Weisberger E., Sawchuk A., Miyamoto R. Carotid body tumors, inheritance, and a high incidence of associated cervical paragangliomas. Am. J. Surg. 1996; 172: 196–9.

4. Дудицкая Т.К., Матякин Е.Г. Диагностика и хирургическое лечение параганглиом шеи. Актуальные вопросы клинической онкологии. 2003; 5 (1): 48–54. [Duditskaya T.K., Matyakin E.G. Diagnosis and surgical treatment of paragangliomas of the neck. Aktual’nye Voprosy Klinicheskoy Onkologii (Topical Issues of Clinical Оncology, Russian journal). 2003; 5 (1): 48–54 (in Russ.).]

5. Sajid M.S., Hamiltone G., Baker D.M. A multicenter review of carotid body tumor management. Eur. J. Vasc. Endovasc. Surg. 2007; 34: 127–30.

6. Гавриленко А.В., Степанов Р.Р. Диагностика и хирургическое лечение каротидных хемодектом. М.: Галерия; 2005. [Gavrilenko A.V., Stepanov R.R. Diagnosis and surgical treatment of carotid chemodectomas. Moscow: Galeriya; 2005 (in Russ.).]

7. Barnes L., Tse L.L.Y., Hunt J.L. Body paraganglimas. Pathology and genetics of head and neck tumors. Lyon: IARC Press; 2005: 364–5. Available at: http://www.iarc.fr/en/publications/pdfs-online/patgen/bb9/bb9-chap8.pdf (accessed 18 June 2018)

8. Пинский С.Б., Дворниченко В.В., Репета О.Р. Редкое наблюдение множественной злокачественной параганглиомы шеи. Сибирский медицинский журнал. 2009; 3: 131–5. [Pinskiy S.B., Dvornichenko V.V., Repeta O.R. Rare observation of multiple malignant neck paraganglioma. Sibirskiy Meditsinskiy Zhurnal (Siberian Medical Journal, Russian journal). 2009; 3: 131–5 (in Russ.).]

9. Матякин Е.Г., Дан В.Н., Шубин А.А., Вельшер Л.З., Дудицкая Т.К. Параганглиомы шеи (хемодектома). М.: Вердана; 2005. [Matyakin E.G., Dan V.N., Shubin A.A., Vel’sher L.Z., Duditskaya T.K. Paragangliomas of the neck (chemodectoma). Moscow: Verdana; 2005 (in Russ.).]

10. Jany P., Qureshi A.A., Verma S., Walker L. Familial carotid body tumors: is there role for genetic screening? J. Laringol. Otol. 2008; 122 (9): 978–82.

11. Rosa M., Sahoo S. Bilateral carotid body tumor: the role of fine-needle aspiration biopsy in the preoperative diagnosis. Diagn. Citopathol. 2008; 36 (3): 178–80.

12. Газимагомедов З.И. Параганглиомы шеи. Креативная кардиология. 2015; 1: 56–65. [Gazimagomedov Z.I. Paragangliomas of the neck. Kreativnaya Kardiologiya (Creative Cardiology, Russian journal). 2015; 1: 56–65 (in Russ.).]

13. Зотиков А.Е., Алексанян В.М., Бадретдинов И.А., Кармазановский Г.Г. Возможности хирургического лечения параганглиомы шеи, распространяющейся до основания черепа. Ангиология и сосудистая хирургия. 2012; 4: 107–11. [Zotikov A.E., Aleksanyan V.M., Badretdinov I.A., Karmazanovskiy G.G. Possibilities of surgical treatment of paraganglioma of the neck, extending to the base of the skull. Angiologiya i Sosudistaya Khirurgiya (Angiology and Vascular Surgery, Russian journal). 2012; 4: 107–11 (in Russ.).]

14. Maxwell J.G., Jones S.W., Wilson E., Kotwall C.A., Hall T., Hamann S. Carotid body tumor excisions: advers outcomes of adding carotid endarterectomy. J. Am. Coll. Surg. 2004; 198 (1): 36–41.

15. Arya S., Rao V., Juvekar S., Dcruz A.K. Carotid body tumors: objective criteria to predict the Shamblin group on MR imaging. Am. J. Neuroradiol. 2008; 29 (7): 1349–54.

16. Georgiadis G.S., Lazarides M.K., Tsalkidis A., Argyropoulou P., Giatromanolaki A. Carotid body tumor in a 13-year-old chaild: case report and review of the literature. J. Vasc. Surg. 2008; 47 (4): 874–88.

17. Ghoreishi M., Akbar-Beigi A., Tahery D., Sehhat S. Fever as the main presenting symptom of a carotid body tumor. Arch. Iran Med. 2008; 11 (2): 214–17.

18. Yoshida K., Maeda K., Suzuki M. Three cases of carotid body tumor– the usefulness of preoperative radiological studies and embolization. Nippon Jibiinkoka Gakkai Kaiho. 2002; 105 (6): 759–62.

19. Knight T.T.Jr., Gonzalez J.A., Rary J.M., Rush D.S. Current concepts for the surgical management of carotid body tumor. Am. J. Surg. 2006; 191 (1): 104–10.

20. Makeieff M., Raingeard I., Alric P., Bonafe A., Guerrier B., Marty-Ane Ch. Surgical management of carotid body tumors. Ann. Surg. Oncol. 2008; 15 (8): 2180–6.

21. Ольшанский М.С., Коротких Н.Г., Есипенко В.В., Петров Б.В., Иванов А.А., Евтеев В.В. и др. Комбинированное эндоваскулярное и хирургическое лечение каротидной параганглиомы. Ангиология и сосудистая хирургия. 2010; 16 (1): 65–9. [Ol’shanskiy M.S., Korotkikh N.G., Esipenko V.V., Petrov B.V., Ivanov A.A., Evteev V.V. et al. Combined endovascular and surgical treatment of carotid body tumor. Angiologiya i Sosudistaya Khirurgiya (Angiology and Vascular Surgery, Russian journal). 2010; 16 (1): 65–9 (in Russ.).]

22. Коротких Н.Г., Ольшанский М.С., Степанов И.В., Лесникова И.Н. Оценка эффективности методов лечения сосудистых аномалий головы и шеи с использованием мультидисциплинарного подхода. Фундаментальные исследования. 2013; 8 (1): 157–61. [Korotkikh N.G., Ol’shansky M.S., Stepanov I.V., Lesnikova I.N. Evaluation of the effectiveness of treatment methods of vascular anomalies of the head and neck using a multidisciplinary approach. Fundamental’nye Issledovaniya (Fundamental Research, Russian journal). 2013; 8 (1): 157–61 (in Russ.).]

23. Shamblin W., Remine W., Sheps S., Harrison E. Carotid body tumor (chemodectoma). Am. J. Surg. 1971; 122: 732–9.