Abhinay Indrakumar1 , Garima Sarawgi2 , Amritha Prabha3 , Ganesh Subramanya Mandakulutur4 , B. R. Keerthi5 , Hemanth G. N.6 , Urvish Saha7 , Rahul Surapaneni8 , Udayee B. Teja9 , Khyati Melanta10, Shivkumar N. Hadli11
BACKGROUND Carotid body tumour is most common paraganglioma in the neck with an incidence of 1:30000. We wanted to determine the optimal management of carotid body tumour to provide the best outcome in patients. METHODS We conducted a retrospective study of the records of 8 patients who presented with carotid body tumours at the Department of Surgical Oncology, Vydehi Institute of Medical Sciences, Bengaluru, India. Epidemiologic, aetiologic, diagnostic, and therapeutic features were evaluated in this multidisciplinary study. RESULTS The average age of patients was 38 years with 7 females (87.5%) & 1 male (12.5%). The location of tumour was on the left side of neck in all patients. Out of the 8 cases, 7 had only carotid body tumour, and one had history of tympanic paraganglioma. 1 case had hypoacusis due to previous surgery. A slow-growing neck mass was the main clinical presentation. One of the patients had deviated left tonsillar fossa (on ENT examination). CT angiography in 6 cases showed homogenous (5) and heterogenous (1) enhancing lesion with splaying of ECA and ICA (Lyre sign). MR angiography 3 (37.5%) T1 hypointense and T2 isohyperintense enhancing soft tissue mass at carotid bifurcation. The clinical presentation and imaging results strongly suggested the diagnosis of carotid paraganglioma in all cases. Treatment was surgical excision in all cases associated with a preoperative embolization in 2 case and a pre-operative radiotherapy in 1 case. Pathology confirmed the diagnosis. CONCLUSIONS Carotid body tumour (CBT) requires early diagnosis and an adequate multidisciplinary team. A high suspicion of index must be considered in the case of any pulsatile lateral cervical mass. Surgical resection is the treatment of choice for carotid body tumour, other neo-adjuvant therapies such as embolization and radiotherapy may only assist stabilization of the tumour, particularly with cranial extension, bilateral or multifocal tumours. Risks associated with tumour excision are considerable, especially with the Shamblin III group, hence the neo-adjuvant modalities of treatment may be considered in these tumours. The therapeutic indication should, ideally, be set in a multidisciplinary consultation.
