PubMed · 13879116
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S CHODKOWSKA, L PAWLICKA. [Pulmonary chemodectoma].. https://pubmed.ncbi.nlm.nih.gov/13879116/
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BACKGROUND: Carotid body tumors (CBT) are rare, infrequently malignant vascular neoplasms that are near the carotid bifurcation. Surgical excision is the treatment of choice, but individual surgeons or an institution cannot accumulate sufficient expertise to evaluate their outcomes with confidence. Our purpose was to report outcomes of surgical procedures for CBT from a nationwide dataset. STUDY DESIGN: Data were retrieved from the Nationwide Inpatient Sample from nonfederal hospital discharge abstracts. Data were queried for ICD-9-CM code 39.8, operations on the carotid body and vascular bodies, and code 38.2, carotid endarterectomy. Outcomes analyzed were length of stay, charges, and in-hospital mortality. RESULTS: An estmated 4,601 operations were identified, 3,746 for CBT surgical procedures only, and in 855 a carotid endarterectomy was also performed. Overall morbidity was 3.3%. Mortality with CBT alone was 2.0% but was 8.8% if carotid endarterectomy was also performed. CBT surgical procedures are most commonly performed in western states where higher elevations are found. Women constituted 59% of the population; mortality for women was higher than for men (12.4% versus 7.9%). Mortality in urban teaching hospitals was 2.1% and in nonteaching hospitals 4.9%. CONCLUSIONS: CBT surgical procedures are rare but are performed across a broad age spectrum. Mortality rate is low for patients having CBT alone but rises when CE is added. Women are more commonly affected and fare less well. Addition of CE to CBT surgical procedures and the resulting poor outcomes have not been previously described. Consideration should be given to referral of CBT patients to hospitals where mortality rates are low.
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The most common sites of paragangliomas occurring in the head and neck region are the carotid body and vagal glomus. The clinical course of carotid body paragangliomas is characterized by two modes of development: locoregional growth and distant metastatic dissemination. Few cases of malignant carotid body paraganglioma have been reported in the literature. We report a case managed in the ENT Department of Grenoble university hospital in 1993. A 53-year-old woman presented a bilateral functional (dopamine secretion) carotid tumor, stage II on the right side and stage I on the left side according to the Shamblin classification. Two successive excisions with complete resection were performed without complication. Two years after the second surgical excision, bone and liver metastases were diagnosed and visualized with a Ostreoscan scintigraphy. Clinical course was rapidly unfavorable and the patient died a few weeks later. Malignant forms of carotid paraganglioma are very uncommon and there is no cellular or histological appearance significantly contributing to the diagnosis of malignancy. Clinical findings are the most reliable criteria for malignancy, with the development of distant metastases usually after about 9 years. Long follow-up is essential. Histology in needed to establish the diagnosis of metastasis. A histology specimen may not be possible for a functional paraganglioma. In this case scintigraphy can provide the diagnosis. Malignant forms are more frequent in case of functional paraganglioma, more particularly in case of dopamine secretion.