Tariq Rafi, Shakeel Akhtar, Kamaluddin Khan.
Carotid Body Tumour - A Case Report.
J Surg Pak Jan ;6(2):40-1.

Paragangliomas are neuroendocrine neoplasms arising from the chief cells of the paraganglia and are slow growing. A middle aged lady was suffering from a huge carotid body tumour as confirmed by a previous open biopsy and later by CT scan and angiography. She was treated by surgical excision and common carotid artery repair. The recovery and followup were uneventful.

A 50 years old lady was admitted in the ENT ward of Jinnah Postgraduate Medical Centre, Karachi with a history of a slowly progressively growing swelling on the left side of the neck for the last 10 years. The swelling was not associated with pain, tenderness, change of voice or dysphagia. There was only mild ear ache for 6 months and no systemic disease.

Examination revealed a visible swelling on the left upper third of the neck, about 8cm x 4cm in size, non tender, lobulated, firm in consistency and mobile sideways. The overlying skin was non-adherent with a horizontal scar mark. In the inferio-posterior quadrant there was a visible as well as palpable pulsation. No bruit was auscultated. The examination of the nasopharynx showed a smooth rounded bulge situated on the posterior pharyngeal wall, ipsilaterally. There was no loss of gag reflex, shoulder shrugging or tongue movement. An incisional biopsy was taken at a local hospital 5 years earlier, revealing appearance consistent with paraganglioma. CT Scan, the main stay of diagnosis ,showed a large, homogenous mass extending from the left para pharyngeal area to left retromandibular area and downwards into the neck below the carotid bifurcation. The major vessels were engulfed in the mass. Suspecting vascular involvement was indicated digital subtraction angiography which revealed evidence of a large highly vascular tumour, supplied by the external carotid artery just beyond its origin. We found displacement of the common carotid artery as well as the left internal carotid artery. There was a small branch supplying it from the left subclavian artery.

Since the patient had no evidence of flushing or relapsing hypertension, catecholamine levels were not estimated. The patient was offered surgical management. A skin crease neck incision was made, on elevation of the flap and on further dissection, a huge Lobulated firm mass was found. It was completely embracing the common external and internal carotids of left side. It was almost impossible to dissect out the common carotid artery which was stretched over the tumour; thinned out and was torn during dissection. Bulldog clamps were applied on both ends of the common carotid artery for hemostosis. Vagus and hypoglossal nerves were identified and secured, the tumour was then dissected and separated from the left internal and external carotid arteries. A vascular surgeon stitched the common carotid artery end to end using 6 zero proline. It took about forty five minutes for the vessel to be repaired while the clamps were continuously applied during-that time.

The patient was closely observed. She recovered smoothly and uneventfully. There was no neurological or vascular deficit noted even on 6 month followup.

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