A lump/mass on the neck- Carotid body tumour
A lump/ mass on the neck – Carotid body tumour.
Carotid body tumour is a tumour that also known as chondroma. The tumour arises from chemoreceptor cells which lined the bifurcation of the aorta.
The real cause of carotid body tumour is unknown. However 10% of the cases are associated with genetic inheritance ( it is familial with autosomal dominant pattern of inheritance ). The carotid body tumour appears to be multiple and bilateral if it is inherited.
The incidence of carotid body tumour is increasing over time on people who lives in a high altitude region for a long period of time. It is a rare case. It can happen at any age but more common in women than in men around the age 50 – 70 years old.
Patient with carotid body tumour complains of a lump which is slowly grows in size. Patient may also complains of hoarseness in voice, difficulty swallowing ( dysphagia) and choking due to compression of the cranial nerves by the carotid body tumour.
During an examination, there will be a lump on the neck with transmitted pulsation on the carotid triangle region of the neck. There will also be evidence of cranial nerve 7, 9, 10, and 11 palsy or paresis.
Carotid body tumour belongs to a group of tumour known as paraganglioma. Paraganglioma also includes other tumours such as jugular tumour, pahechromocytomas, vagal body tumour and glomus jugulare tumour.
Microscopically it is a cluster of vascular tumour which consists of epitheloid calls that is arranged within a fibrious storma. The tumour also has the ability to secrete hormones such as noradrenaline and adrenaline. However it only happens in rare cases.
Macroscopically, most of the tumour are benign and only 20% are able to metastases to the lymph nodes or bone or undergoing local invasion. Besides that the margin of the carotid body tumour also is well defined and the tumours are multiple or present on both sides of the neck in 10% of cases.
Carotid body tumour can be detected by ultrasound. The ultrasound is able to visualize the nature of carotid bifurcation and able to justify the splaying of the external and internal carotid arteries. ‘Blush in the wine glass appearance of the tumour can also be detected.
CT scan and MRI scan able to evaluate the degree of extent of the carotid body tumour while direct and indirect pharyngoscopy and laryngoscopy able to detect any pharyngeal invasion or cranial nerve involvement. Fine needle aspiration is able to produce cytological report in diagnosis.
Carotid body tumour can be managed, conservatively, surgically or radiological. Conservative or supportive therapy is commonly given to elderly or frail patient.
Surgical therapy involves pre –operative preparation such as a supply of several units of cross matched blood and procedure to embolize the large tumour is performed first. During the operation, an incision along the anterior border of the sternocleidomastoid muscle is performed. Next the bifurcation of the carotid artery is exposed and the external carotid artery is isolated and a shunt is placed to reduce the flow of blood to the tumour from common carotid artery to the internal carotid artery. Blood flow in a distal region is detected by the Doppler scan. A length of saphenous vein will replace a segment of artery if the tumour adheres to the arterial wall. Extension of the tumour to the neck will require the involvement of craniofacial surgeons.
Radiotherapy is used in the case where local invasion has occurred to prevent any local recurrence and to treat any metastases.
The complication of carotid body tumour includes cranial nerve palsies as a result of local invasion and spread of the tumours. Surgical complication includes neurological deficit which affect the cranial nerve such as laryngeal nerve or mandibular branch of cranial nerve 7, 9, 10 that later result in dysphagia or swallowing difficulty or respiratory depression. Most will recover, only 3 % develop stroke.
The prognosis of carotid body tumour is , it is a slowly growing tumour that leads to 30% cases of mortality (death ) due to invasion or metastases and 75% will develop symptoms if untreated. Most will cure after surgery.
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