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Carotid Body Tumor - Summary

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We're in the neoplastic category of carotid space

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lesions and we looked at the benign tumors of

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which paragangliomas are the most common.

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And within the paragangliomas,

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The carotid body tumor is the most common of

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the paragangliomas in the carotid space.

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The carotid body itself is a small organ that

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is located in the adventitia of the carotid bifurcation.

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And it is the tissue that controls heart rate,

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blood pressure and respiratory rate.

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The normal carotid body measures about 2 to 6 mm in size.

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But the size of the carotid body does

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get larger at higher altitudes.

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So if you're like me living in Evergreen, Colorado,

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with an altitude of about 8200ft,

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you do see larger normal carotid bodies

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in individuals in my neighborhood.

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This is thought to be stimulated by hypoxia.

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And in point of fact.

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When I measure my O2 saturation.

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I'm usually at about 94% at that altitude.

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Carotid body tumors occur in older individuals.

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50 to 70 years of age.

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And they are more common in women than in men.

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These represent the most common of the

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paragangliomas of the head and neck, 50% to 60%.

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The next most common will be your glomus tumors.

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And the third most common,

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representing about five to 10%,

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are the glomus jugulare tumors.

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There is a familial form that leads to bilateral and

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multiple paragangliomas, and when that occurs,

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they will be present in about 32%.

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The right side is more commonly involved than

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the left side with carotid body tumors.

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And as I mentioned,

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usually these patients present with a neck mass,

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if they present at all.

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Some of them are asymptomatic.

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They just feel a fullness in the neck.

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It's not as if they're seeing changes in their heart

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rate or their blood pressure or the respiratory

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rate. That is really not the symptoms that we see.

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What we see is a patient who has a neck mass which

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might be somewhat painful. There is a staging,

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if you will,

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for carotid body tumors, and this relates to the

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ease at which they are able to be removed.

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So group one are tumors that are minimally attached

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to the vessels and therefore easily resectable, less

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than 180 degrees of circumferential involvement.

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So normally you have that carotid tumor sitting

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right at the carotid bifurcation.

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It may circumferentially involve either the

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external or the internal carotid artery.

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We're most concerned with the internal carotid

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artery because that cannot be sacrificed.

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Group two are those that partially surround the

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vessel and are more adherent to the adventitia of

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the vessel. These are difficult to dissect,

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but they can be completely removed from

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the carotid artery. And these are

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ones that generally have circumferential

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involvement of between 180 to 270 degrees.

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The final grouping are the ones that are most

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difficult to remove from the carotid arteries.

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These are adherent to the entire circumference

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of the carotid bifurcation,

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or at least nearly the entire circumference.

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Surgical dissection is impossible.

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It often requires sacrifice of the internal

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carotid artery with vessel replacement.

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And usually they will do something analogous to

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a temporary balloon occlusion test to see how

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symptomatic the patient would be if that internal

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carotid artery had to be sacrificed.

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So greater than 270 degrees involvement is a key to

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determining whether this is a tumor that will be

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able to be removed from the carotid artery.

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This 270 degrees of involvement reflects back on a

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paper I wrote back early in my career about the

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malignancies that involve the carotid sheath.

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And again, it's the same criterion.

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And that is that if a malignancy involves greater

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than 270 degrees of the circumference of the

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internal carotid artery, it is unlikely

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to be salvageable. In other words,

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that carotid artery is going to have to go out

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in the surgical specimen with the tumor.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Neuro

Neoplastic

MRI

Head and Neck

CT

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