Malignant Paragangli-oma of Glomus Caroticum

Overview

In 1993, a young man was admitted to the University ENT Department, Charles University, Hradec Králové, with a progressive right-sided neck swelling. The ultrasound examina-tion of the neck disclosed a solid highly vascularised formation of 6x4x3 cm size, pressingthe carotid bifurcation. Additional CT examination and carotid angiography confirmed a vascularised tumor in the carotid bifurcation, with vessel supply from the carotid bifurcation and multiple branches of the external carotid artery. Based on these examinations the diagnosis of a paraganglioma was established and after a preoperative partial embolisation the tumor was completely removed in collaboration with a vessel surgeon; due to the injury of the external carotid artery a suture of the vessel was necessary. The histological examination confirmed the diagnosis. A centrál left-sided hemiparesis after the operation was successfully rehabilitated and the patient was further dispen-sed at our department.Since winter 1996 multiple indolent prominating resistances in the occipital region and the forehead on the right side consequently appeared; since summer 1997 further indolent slowly growing resistance below the clavicule on the right side came forward. After CT scanning and biopsy from the calve distant metastases of a paraganglioma were verified. The skeleton scintigraphy further revealed multiple metastases to the bones of calve, ribs of both sides of the thorax, spinal column and pelvis. The patient then underwent a palliative chemotherapy, surgical stabilization of the spině and radiotherapy of backbone metastases in June 1998. The patient is alive till present (2003) with signs of slowly progressive malignant disease, his quality of life is self-evaluated as good. In conclusion we would like to suggest that the patients after a surgical therapy of paraganglioma should be long term followed-up. The primary histological examination námely cannot always answer the question of the biological behavior of the tumor. Only the further follow-up of the patient can guarantee a timely disclosure of possible signs of malignant tumor activity and statě the definitivě diagnosis.

Key words:
tumor of glomus caroticum, malignant paraganglioma, follow-up.