Paraganglioma of the vagus nerve mimicking as a carotid body tumor

Abstract

A 58-year-old woman presented with a pulsatile swelling in the right neck of 12 years' duration (A). The clinical examination revealed right ptosis, deviation of the tongue to right, and a large pulsatile swelling of 11 ϫ 8 cm in the right neck lifting the right pinna.Cytologic evaluation of a fine needle aspiration specimen at another center showed blood. Computed tomography (CT) imagery demonstrated an intensely enhancing vascular mass lesion with extensive vascular arcades seen in the right parapharyngeal and submandibular region causing splaying of the carotid arteries, suggesting a carotid body tumor (Cover). On exploration, the tumor was arising from the vagus nerve, and this needed to be sacrificed for total excision of the tumor (B). The tumor was hypervascular, with multiple feeding vessels from the external carotid artery. Ligation of the external carotid artery resulted in reduced bleeding from the tumor and its separation from the internal carotid artery (C). Histopathologic examination suggested a vagal paraganglioma. Postoperatively, hoarseness developed and a nasogastric tube was placed for a week.

Pseudo-Lyre Sign

“…(4,5) Furthermore there are reports of a parathyroid carcinoma mimicking a carotid body tumour, and a carotid aneurysm causing splaying of the carotid arteries. (6,7) In this case, a vagal paraganglioma demonstrated the characteristic ‘Lyre Sign’ of a carotid body tumour.…”

A importância da embolização pré-operatória no tratamento do tumor do corpo carotídeo: relato de caso e revisão da literatura

“…Histopathologic analysis recognized it as a vagal paraganglioma. 3 Ultrasonography is a useful diagnostic modality in differential diagnosis of cervical tumors, and can be associated with the color mode to determine its association with the carotid bifurcation. Computed tomography and nuclear magnetic resonance confirmed its extension and relations with adjacent structures, and arteriography allows for a record of arterial anatomy and also to perform preoperative embolization of the tumor.…”

Manejo del paraganglioma del nervio vago en cabeza y cuello

“…evidencia tumor vascularizado que desplaza medial y anteriormente las arterias carótidas (ver Figura 2b), sin ampliar el ángulo de la bifurcación carotídea, como en el caso reportado, mientras que los tumores del cuerpo carotídeo tienen una localización más cercana a la bifurcación y dan una imagen de lira (9,(15)(16)(17)(18). La angiorresonancia se considera el estándar de oro, observándose una masa con apariencia en "sal y pimienta", hipointensa en T1 e hiperintensa en T2, que característicamente aumenta de intensidad a la aplicación del contraste (1,12,16).…”

“…Se debe evitar la toma de biopsia, por su rica vascularización, alto riesgo de sangrado y falsos negativos (7,18). De igual manera, la angiografía se reserva para pacientes en quienes se considere cirugía (19).…”