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WMJ : Official Publication of the State... Sep 2023Radiation therapy may result in complications, including fibrosis, which can result in pain and difficulty with movement - especially in the neck.
BACKGROUND
Radiation therapy may result in complications, including fibrosis, which can result in pain and difficulty with movement - especially in the neck.
CASE PRESENTATION
A 52-year-old man with right-sided vague neck pain unresponsive to conservative management had a computed tomography scan that showed a vagal paraganglioma in the carotid sheath surrounding the right carotid arteries and internal jugular vein. Following radiation therapy, he noticed a new pain in his right jaw and neck worse with certain movements of the neck. Nonsurgical conservative measures including physical therapy and pharmacological management were unsuccessful. An ultrasound evaluation demonstrated fibrosis beneath the sternocleidomastoid muscle and in proximity to the carotid sheath. After careful trajectory planning using ultrasound imaging, a 25 G needle was introduced real time in proximity to the fibrosis. Using a dexamethasone/saline mixture under real-time ultrasound guidance, adhesions were released. After 3 injections, the patient reported greater than 90% pain relief, which lasted 4 months. Subsequently, he required similar injections approximately every 3 months to achieve greater than 75% pain relief.
CONCLUSIONS
This is a successful demonstration of the utility of ultrasound evaluation and guidance for adhesiolysis following radiation therapy.
Topics: Male; Humans; Middle Aged; Neck Pain; Radiation Fibrosis Syndrome; Ultrasonography; Pain Management; Ultrasonography, Interventional
PubMed: 37768775
DOI: No ID Found -
Il Giornale Di Chirurgia 2014Objectives. Carotid Body Tumor (CBT) is a rare lesion of the neuroendocrine system but it is the most common form of head and neck paraganglioma (PGL). Our objective is...
Objectives. Carotid Body Tumor (CBT) is a rare lesion of the neuroendocrine system but it is the most common form of head and neck paraganglioma (PGL). Our objective is to discuss the optimal management of these lesions to provide the best outcome of patients treated by surgical resection. Patients and Methods. A retrospective evaluation was obtained by review of the records of 20 patients with 26 CBT treated at our institution between 2000 and 2012. Primary tumor characteristics, diagnostic protocols, surgical treatment, short and long-term outcomes were collected and analyzed. Results. A total of 26 CBTs resections were performed on 20 patients; the age range was 21-89 years. There was a female prevalence (14 women-80% and 6 men-20%). Familial cases occurred in 6 patients (30%); of these, 3 patients had bilateral lesions and 1 patient multiple paragangliomas. In all cases no lymph node metastasis was found. All lesions were grouped into three groups according to the latero-lateral diameter: Group I < 3 cm; Group II 3<>5cm; Group III >5cm. All patients were managed by surgical resection of the CBT. There were no operative deaths. Overall we found transitory neurological impairment in 15,3% and permanent neurological deficit in 7,6% of cases. No complications occurred in all resections of Group I tumors. In Group II only 1 resection was followed by dysphonia by recurrent nerve palsy (after vagal nerve en-bloc resection). In Group III only 1 resection was followed by permanent vagus nerve palsy. Conclusions. Surgical removal of the tumor is the only treatment that can ensure a complete eradication of the disease. Family screening is of great importance in patients with hereditary forms. Careful preoperative planning of surgical procedure by integrated diagnostic imaging and a full mastery of the surgical technique can minimize the risk of the most common postoperative complications. Lifelong follow-up is mandatory to make early diagnosis of recurrent disease.
Topics: Adult; Aged; Aged, 80 and over; Carotid Body Tumor; Female; Humans; Male; Middle Aged; Retrospective Studies; Time Factors; Young Adult
PubMed: 24690341
DOI: No ID Found -
Journal of Ultrasound Sep 2021Paragangliomas are a rare form of highly vascularized tumors that originate from paraganglia Baysal (J Med Genet 39: 617-622, 2002). In the head and neck PGL arise...
Paragangliomas are a rare form of highly vascularized tumors that originate from paraganglia Baysal (J Med Genet 39: 617-622, 2002). In the head and neck PGL arise primarily in four distinct areas: vagal, middle ear, and larynx and more frequently carotid bifurcation. Imaging evaluations include sonography, color Doppler, US-elastosonography and contrast-enhanced ultrasound (CEUS). Additionally, Computed Tomography, Magnetic Resonance Imaging (MRI) as well as digital subtraction angiography can be performed Stoeckli et al. (Laryngoscope 112: 143-146, 2002). We present herein a case of a rare bilateral carotid body tumor assessed with multiparametric ultrasound evaluation, including CEUS and US-elastography.
Topics: Angiography, Digital Subtraction; Carotid Body Tumor; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Ultrasonography
PubMed: 33999368
DOI: 10.1007/s40477-021-00581-z -
Journal of Clinical and Diagnostic... Jan 2016We report a large vagal neurilemmoma in the poststyloid compartment of the parapharyngeal space. A 52-year-old man was referred to our hospital with a feeling of...
We report a large vagal neurilemmoma in the poststyloid compartment of the parapharyngeal space. A 52-year-old man was referred to our hospital with a feeling of discomfort in the left upper neck. Computed tomography showed a 30mm x 30mm x 40mm mass with inhomogeneous internal enhancement in the left carotid space. Magnetic resonance imaging revealed a 30mm × 30mm × 40mm heterogeneous mass in the area of the bifurcation of the common carotid artery. We gave a provisional diagnosis of neurilemmoma or vagal paraganglioma in the parapharyngeal space preoperatively based on the results of physical examination and imaging. We selected a transcervical-transmandibular approach. Under general anaesthesia, a tumour originating from the vagus nerve was completely extirpated while protecting the internal and external carotid arteries. Although mild postvagotomy dysphagia and hoarseness were seem for 6 months postoperatively, symptoms resolved and the patient showed a satisfactory course without recurrence after 10 years. Histological examination of the excised specimen showed antoni A and antoni B pattern. Positive immunoreactivity for S-100 protein was identified, but negative results were obtained for neuron-specific enolase, chromogranin and neurofilament. The tumour was diagnosed as neurilemmoma of the vagus nerve.
PubMed: 26894190
DOI: 10.7860/JCDR/2016/13789.7141 -
Journal of Surgical Case Reports Aug 2010This teaching case report represents an unusual example of a neck mass in a previously healthy individual. The presence of a new neck mass is a relatively common head...
This teaching case report represents an unusual example of a neck mass in a previously healthy individual. The presence of a new neck mass is a relatively common head and neck problem and requires a full work up including a complete history and physical examination. With respect to our patient, thorough history taking, physical examinations and specific investigations led to the diagnosis of a malignant and functionally active paraganglioma. Vagal paraganglioma themselves are rare tumours and account for only 5-25% of all paragangliomas in the head and neck region. The presence of a malignant, functionally active, catecholamine-secreting paraganglioma is even rarer and accounts for only 1-3% of all reported glomus vagale tumours. This case report illustrates the need to carefully monitor all neck masses for changes in size, for any distortion to surrounding structures, and their given function.
PubMed: 24946328
DOI: 10.1093/jscr/2010.6.2 -
CA: a Cancer Journal For Clinicians 1985Vagal body tumors (VBTs) are rare tumors of the paraganglion cells of the vagus nerve, usually occurring near the ganglion nodosum. They can be familial, multicentric,...
Vagal body tumors (VBTs) are rare tumors of the paraganglion cells of the vagus nerve, usually occurring near the ganglion nodosum. They can be familial, multicentric, malignant, and sometimes hormonally active. The most accurate diagnosis is made by angiography. Primary treatment is surgical excision. Radiation therapy may play a role in preoperative preparation or in palliation. The prognosis is good when the tumor is found early and completely resected. Lifelong follow-up of patients and their family members is recommended.
Topics: Cranial Nerve Neoplasms; Head and Neck Neoplasms; Humans; Male; Middle Aged; Paraganglioma, Extra-Adrenal; Radiography; Vagus Nerve
PubMed: 2990640
DOI: 10.3322/canjclin.35.4.232 -
AJNR. American Journal of Neuroradiology 2000Tumors of the cranial nerve sheath constitute 5% to 10% of all intracranial neoplasms, yet few articles have described their CT and MR characteristics. We report the...
BACKGROUND AND PURPOSE
Tumors of the cranial nerve sheath constitute 5% to 10% of all intracranial neoplasms, yet few articles have described their CT and MR characteristics. We report the imaging findings in a relatively large series of schwannomas of the jugular foramen, contrasting them with other disease entities, especially vestibular schwannomas and tumors of the glomus jugulare.
METHODS
CT and/or MR studies of eight patients who underwent surgery for histologically proved schwannomas were reviewed retrospectively. One additional patient with an assumed schwannoma of the jugular foramen, who did not have surgery, was also included.
RESULTS
Surgical findings showed schwannomas of the glossopharyngeal nerve in seven patients and tumor involvement of both the glossopharyngeal and vagal nerves in one patient. All tumors were partially located within the jugular foramen. Growth extending within the temporal bone was typical. Tumor extended into the posterior cranial fossa in all nine patients and produced mass effect on the brain stem and/or cerebellum in seven patients; in five patients, tumor extended below the skull base. On unenhanced CT scans, tumors were isodense with brain in six patients and hypodense in two. In seven patients, CT scans with bone algorithm showed an enlarged jugular foramen with sharply rounded bone borders and a sclerotic rim. On MR images, T1 signal from tumor was low and T2 signal was high relative to white matter in all patients. Contrast enhancement on CT and/or MR studies was strong in eight patients and moderate in one.
CONCLUSION
Schwannoma of the jugular foramen is characteristically a sharply demarcated, contrast-enhancing tumor, typically centered on or based in an enlarged jugular foramen with sharply rounded bone borders and a sclerotic rim. Intraosseous extension may be marked.
Topics: Adult; Algorithms; Cranial Nerve Neoplasms; Female; Glomus Jugulare Tumor; Glossopharyngeal Nerve Diseases; Humans; Jugular Veins; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Neurilemmoma; Retrospective Studies; Skull Base Neoplasms; Tomography, X-Ray Computed; Vagus Nerve Diseases
PubMed: 10871029
DOI: No ID Found -
Case Reports in Otolaryngology 2017A 70-year-old female presented with a neck mass and sporadic dry cough, often leading to fits of coughing severe enough to cause vomiting. The patient reported that...
A 70-year-old female presented with a neck mass and sporadic dry cough, often leading to fits of coughing severe enough to cause vomiting. The patient reported that touching the mass triggered the cough. On examination, a 2.5 cm right-sided level two neck mass deep to the sternocleidomastoid was present. Palpation of the mass immediately triggered coughing. Cross-sectional imaging proposed vagal paraganglioma as the chief differential, which was confirmed following surgical excision. The patient reported complete resolution of her severe dry cough after surgery. Vagal paragangliomas are rare neuroendocrine tumors arising from the neural crest-derived paraganglionic tissue surrounding the vagus nerve, typically presenting as a neck mass associated with hoarseness or pulsatile tinnitus. To the best of our knowledge this is a unique description in the English literature. This case is presented to aid physicians should they encounter a neck mass associated with cough. Vagal paraganglioma, although rare, should be part of the differential in such a presentation.
PubMed: 28717527
DOI: 10.1155/2017/7603814 -
Journal of Postgraduate Medicine Jan 1991Paragangliomas are rare tumours of the head and neck and are a diagnostic challenge. Two cases of paragangliomas arising from the vagus are being reported. In the first...
Paragangliomas are rare tumours of the head and neck and are a diagnostic challenge. Two cases of paragangliomas arising from the vagus are being reported. In the first case, an angiogram raised the possibility of intravagal tumour and exploration followed by biopsy confirmed the diagnosis. In the second case, it was a diagnostic surprise where exploration was done on a clinical suspicion of parotid swelling and on the table, the swelling was found to arise from the vagus nerve pushing the parotid gland laterally.
Topics: Adult; Cranial Nerve Neoplasms; Humans; Male; Middle Aged; Paraganglioma; Vagus Nerve
PubMed: 1941697
DOI: No ID Found -
Acta Otorhinolaryngologica Italica :... Oct 2014The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate...
The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.
Topics: Adenoma, Pleomorphic; Adult; Aged; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neurilemmoma; Paraganglioma; Pharynx; Retrospective Studies; Surgical Procedures, Operative
PubMed: 25709146
DOI: No ID Found