Paraganglioma carotídeo y vagal

Abstract

Introduction: Carotid body paragangliomas are rare, benign, highly vascularized and slow-growing tumors. Two percent of patients with carotid body paragangliomas may simultaneously present with paragangliomas in different head or neck areas (vagal or jugulotympanic). The latest developments in medicine have allowed for earlier diagnosis and a better therapeutic approach to this condition. Description of the case: 59-year-old woman with a progressively growing right laterocervical tumor, about 6 cm in size and painless. Her ENT examination was otherwise normal. A cervical CT scan with intravenous contrast showed a hypervascularized, bilobulated right mass that displaced and compressed the ipsilateral carotid arteries and internal jugular vein. The image was compatible with a carotid body paraganglioma. A cerebral arteriogram with balloon test occlusion showed two highly vascularized masses in the right carotid bifurcation that could correspond to a coexisting glomus vagale. The patient tolerated well the BTO for 20 minutes, with no neurological deficit. Embolization 24 hours before surgery and removal of both masses by right lateral cervicotomy, cutting the vagus nerve and preserving the ipsilateral carotid arteries and internal jugular vein. The pathological anatomy study confirmed that it was a carotid and vagal paraganglioma. Evolution: There were no postoperative complications. At the one-month follow-up visit, the patient was asymptomatic and showed no signs of recurrence. Conclusions: Head and neck paragangliomas can be multicentric. Individualized treatment is recommended given the variability of this condition.