咽旁间隙肿块

本文报告二例:例一,53岁男性白人,患左颈肿块3×4cm并突出咽左壁1×2cm,颈动脉造影在颈动脉分叉处有一血管性肿块,手术切除为附于迷走神经伸向颅底的血管性肿物,病理检查为迷走神经副神经节瘤,术后左声带外展瘫痪18个月未愈。例二,51岁男性白人,4年前曾经手术切除和病理检查证实为腹膜后非嗜铬性副神经节瘤和低分化平滑肌肉瘤,后又患骶部转移性副神经节瘤(以~(60)钴放疗治愈)、左肺副神经节瘤,今又患左颈肿块(3.5cm)经手术切除病检为颈动脉体瘤。作者指出咽旁间隙肿块大致为三类:神经源性肿瘤、涎腺瘤及其他肿瘤。神经源性肿瘤包括     

头颈部迷走神经副神经节瘤的诊断与治疗

目的探讨头颈部迷走神经副神经节瘤的临床特点、诊断与治疗方法。方法回顾分析我院于2003年1月至2013年12月诊治的8例迷走神经副神经节瘤患者临床资料,结合文献复习,对该病的临床特点、诊断与治疗经验进行探讨。结果 8例患者主要以声嘶和颈部包块为特点,其中7单发,1为多发副神经节瘤,7例为良性副神经节瘤,1例伴有淋巴结转移。散发患者7例,1例为家族性发病。6例肿瘤位于颈动脉分叉和颈静脉孔之间的上颈部或局限于颈静脉孔区,2例为咽旁的巨大肿瘤且其中1例伴有颅内侵犯,1例多发副神经节瘤患者同时伴有颈动脉体瘤。5例患者进行了琥珀酸脱氢酶相关基因筛查,3例患者携带有突变。结论迷走神经副神经节瘤的临床特点与颈动脉体瘤和颈静脉球瘤有相似之处,需加以鉴别。CTA和增强MRI对定性诊断有价值,增强MRI和颞骨CT则能提供较多的手术所需信息。根据肿瘤位置的不同,选择颈侧入路或辅以Fisch A型颞下窝入路切除肿瘤。迷走神经副神经节瘤有一定恶性倾向,需注意全身筛查和随访以及家系检查。     

颞骨副神经节瘤手术治疗的长期疗效

颧骨副神经节瘤,又叫颈静脉球瘤或鼓室球瘤,是中耳最为常见的新生物。该类肿瘤发源于副交感神经系统的副神经节细胞,通常为良性肿瘤,但可呈现出局部浸润性和膨胀性生长,远处转移仅占2％～4％。绝大多数情况下,手术切除瘤体是该类肿瘤的首选治疗方法。只有当肿瘤不能切除或切除不彻底时才考虑放疗。在锁骨副神经节瘤的治疗中,一个重要问题是功能恢复。肿瘤的侵犯与手术均可引起颅神经损伤,特别是晚期病例。手术的疗效不仅与肿瘤的彻底根治有关,而且与手术中出现的功能损伤有关。文章评估颈骨副神经节瘤手术切除的长期疗效,特别是对…     

喉副神经节瘤1例

<正>喉副神经节瘤(laryngeal paragangliomas, LPs)是一种起源于神经节细胞的罕见神经内分泌肿瘤，根据肿瘤的位置其临床症状不同，最典型的症状为发音困难、吞咽困难、喘鸣及异物感。我们报道1例以声嘶为主诉的LPs患者的诊疗过程，并对嗜铬细胞瘤/副神经节瘤(pheochromocytoma/paragangliomas, PPGLs)进行相关文献复习。1 临床资料患者，男，61岁。因声嘶10余年、     

鼓室颈静脉球副神经节瘤误诊原因分析

目的 探讨鼓室颈静脉球副神经节瘤的误诊原因及临床诊断和病理特点。方法 回顾性总结1例罕见鼓室颈静脉球副神经节瘤患者的临床资料,并复习相关文献,对鼓室颈静脉球副神经节瘤的临床及病理学特点进行讨论。结果 该例患者CT显示右侧外耳道、乳突气房、乳突窦及鼓室内软组织影,相应骨质吸收、破坏,结合病史,考虑慢性中耳乳突炎伴胆脂瘤形成,右侧颈静脉球高位。行耳后乳突径路切除肿瘤。术后组织病理检测诊断为鼓室颈静脉球副神经节瘤。本患者未作进一步治疗。复习文献,鼓室颈静脉球副神经节瘤较少见,临床及影像学检查无特异性,因缺乏大样本随访研究,预后不详。结论 单纯依靠症状及临床特征,鼓室颈静脉球副神经节瘤容易误诊为分泌性中耳炎或胆脂瘤,CT、MR、 DSA以及详细的组织病理学分析是诊断及鉴别鼓室颈静脉球副神经节瘤的主要方法。     

迷走神经副神经节瘤诊疗分析及文献复习

目的探讨迷走神经副神经节瘤的临床特点,以提高诊断及治疗水平。方法3例迷走神经副神经节瘤术前行影像学与专科检查后,均在全麻下行肿瘤完整切除,结合文献分析其临床表现、鉴别诊断及治疗方案。结果迷走神经副神经节瘤极其罕见,临床症状无特异性,常表现为颈部或咽旁的无痛性肿物,早期无呛咳、声音嘶哑等迷走神经受侵犯症状,术前诊断较困难,易误诊为神经鞘瘤而影响治疗。结论CT、MRI对本病的诊断、手术方案制定有重大意义。正确选择手术径路及掌握手术技巧是手术成功及避免严重并发症的关键。     

鼻腔副神经节瘤

非嗜铭性副神经节瘤发生在头颈部者,多见于颈总动脉分义、颈静脉球和迷走神经的结节状神经节部位。约占人体肿瘤的0.012%。文献中曾有报告发生于鼻腔、喉、气管、肺、纵隔、眼眶、松果体和小肠的个别病例。本文报告1例发生于鼻腔的副神经瘤患者。41岁男性,反复鼻衄2周,2年前有左鼻孔出血史。检查见左侧中鼻甲内侧面有一出血性小息肉。将之切除后作组织学检查,见组织内含有圆形或椭圆形细胞团,呈索状排列于毛细血管邻近,血管丰富。很多细胞的胞浆内含有微小颗粒。网蛋白染色显示瘤细胞     

颈静脉鼓室副神经节瘤

颈静脉鼓室副神经节瘤是发生于颅底的一种血管性肿瘤，侵犯周围组织可出现耳部症状和后组颅神经痹。本文对病命名，分型，临床表现，诊断，治疗等方面进行综述，为头颈颅底外科同道提供参考。     

喉癌——在了解肿瘤生长特点后对手术方法的改良

作者们从1966年起,将行喉切除的700余例喉标本作切片研究,以期对喉癌的生长和播散有较好了解。作者们认为声带固定对标准的垂直半喉切除是禁忌症。对广泛性肿瘤的治疗,可做喉广泛次全切除。手术成功有赖于对扩散型肿瘤和手术时切除缘冰冻切片安全范围的了解。涉及前联合区的广泛性肿瘤常扩散到声门下,侵犯甲状软骨板下缘,通过环甲膜扩散到喉外,乃至肿瘤直接处于颈前皮肤下。为了避免遗留皮下肿瘤,可从该区作一椭圆形皮肤切除,作为喉切除的一     

癌颈廓清术中保留颌下三角区疗效观察（摘要）

根治性颈廓清术切除的范围一般包括颈部的六个三角区内的淋巴组织及邻近的颈内静脉、副神经、胸锁乳突肌、颌下腺等。根据头颈部淋巴系统的解剖特点、喉癌病人的临床观察以及国内外对喉癌颈廓清手术治疗中有关文献报道，我们在1989-1991年间对21例喉癌颈淋巴结转移病人做了喉部分切除、全喉切除及保留颌下三角区组织的颈廓清术。     

Synchronous bilateral carotid body tumor and vagal paraganglioma: a case report and review of literature

We present a case of synchronous bilateral carotid body tumor and vagal paraganglioma in a 49-year-old man who presented with 3 months history of tenderness and palpable neck masses bilaterally. An encapsulated mass which was thought to be a carotid body tumor and an incidental 3 cm x 2 cm, 5 cm x 1 cm, 5 cm mass which seemed to be originated from vagus nerve were dissected from the left side. Pathology revealed carotid body tumor and vagal paraganglioma. Six months after the first operation, the carotid body tumor on the right side was totally excised. A discussion of this case is followed by a review of the literature surrounding this rare clinic and pathological entity.     

Laryngeal paraganglioma

Paraganglioma is an uncommon tumor of the larynx. The diagnosis and management of laryngeal paragangliomas remain problematic for the clinician. A recent experience with this uncommon tumor provides a forum for a discussion of laryngeal paraganglioma.     

Laser surgical treatment of laryngeal paraganglioma

Paragangliomas are rare benign neoplasms arising from the neural crest-derived paraganglia of the autonomic nervous system. In the larynx three different localizations of paraganglia are known. Most laryngeal paragangliomas arise from the supraglottic paraganglia. A review of the literature shows that the treatment of choice for laryngeal paragangliomas is surgical excision. Since the implementation of CO(2) laser surgery into laryngology in 1972, no reports of endoscopic laser surgical excisions of laryngeal paragangliomas have been published so far. We present the case of a 66-year-old female patient who suffered from a large (4 x 4 x 3 cm) left supraglottic paraganglioma. The tumour was completely excised utilizing the CO(2) laser. Histopathology and immunohistochemistry of the tissue presented the typical findings of a laryngeal paraganglioma. The pre- and post-operative management as well as the treatment strategies are discussed. To our knowledge the present case demonstrates for the first time a complete transoral CO(2) laser surgical resection of an advanced laryngeal paraganglioma.     

Subglottic laryngeal paraganglioma

OBJECTIVES: To review the clinical and pathological picture of laryngeal paragangliomas and compare laryngeal paragangliomas with the three other types of laryngeal neuroendocrine neoplasms. STUDY DESIGN: The study presents a case review of a patient with a subglottic laryngeal paraganglioma treated at our institution, with a literature review of the laryngeal neuroendocrine neoplasms. Included is a review of all four neuroendocrine neoplasms, taking a close look at a comparison between laryngeal paragangliomas and atypical carcinoids tumors. All cases of subglottic laryngeal paragangliomas reported in the literature were also compiled and tabulated. METHODS: The patient's record was reviewed for age, symptomatology, workup, and surgical procedures performed. RESULTS: The patient was disease free 36 months after undergoing a tracheostomy for airway control, followed by a cricoid split for complete excision of the tumor. CONCLUSIONS: It is important to differentiate among the four laryngeal neuroendocrine neoplasms, especially between atypical carcinoids and paragangliomas. Each tumor requires different treatments, with the former requiring a more aggressive approach. Paragangliomas must be completely excised to prevent their recurrence, and this approach should be considered a curative treatment. In addition, the immunohistochemical battery is of paramount importance in obtaining the correct pathological diagnosis.     

Treatment of neuroendocrine neoplasms of the larynx.

The best treatment for carcinoid tumor is surgical excision. The mainstay of treatment for atypical carcinoid tumor is wide surgical resection, often with elective neck dissection. Although it is not effective in the management of paragangliomas and carcinoid tumors, primary radiation therapy with adjuvant chemotherapy is the treatment of choice for small cell neuroendocrine carcinoma of the larynx. Management of laryngeal paraganglioma is surgical and may often be accomplished by partial laryngectomy. Most tumors are supraglottic and may be resected via modified lateral pharyngotomy. Preoperative angiography and embolization are occasionally useful.     

Einseitige Zungenatrophie und Artikulationsschwierigkeiten

A 24-year-old female complained of difficulty articulating and chewing of 2 more than weeks’ standing. She reported that her tongue felt “heavy and inert”. Clinically, right-sided atrophy of the tongue and deflection of the tongue to the right were observed. Tone audiogram demonstrated normal hearing on both sides and tympanometry was also normal. On CT, a bone-destroying process was seen in the area of the right lateral skull base, which reached as far as the internal carotid artery. MRI demonstrated atrophy of the right tongue musculature with fatty degeneration, as well as an oval, smoothly edged lesion which showed marked contrast-medium uptake with a “salt and pepper” configuration in the region of the right jugular foramen. The diagnosis was hypoglossal paresis due to ipsilateral jugular paraganglioma (Fisch classification C1). Following embolization of the feeding vessels of the paraganglioma, the tumor was completely resected, including the hypoglossal nerve which ran through the tumor. Postoperative dysfunction of the vagus and facial nerves became unsymptomatic with time as a result of logopedic therapy.     

Laryngeal paraganglioma and pregnancy.

Paraganglioma is an uncommon tumor of the larynx. We present a 30-year-old woman with a paraganglioma which took a heretofore not described clinical course. The first clinical sign was persistent hoarseness, when she was 26 weeks pregnant. A histological examination of a piece of the reddish, racemose tumor removed during microlaryngoscopy revealed only some slight nonspecific inflammatory changes. The patient remained free of symptoms following this operative procedure until 3 years later when she presented with a recurrence of hoarseness and a laryngeal tumor and was 25 weeks pregnant. Histology showed a laryngeal paraganglioma in the same supraglottic localization as before. Histological studies failed to confirm the obvious suspicion that the episodic growth of the paraganglioma may have been induced by estrogen or gestagen. To date, 6 years after the removal of the tumor, there has been no recurrence.     

Primary paraganglioma in the facial nerve canal

Objective

To describe primary paraganglioma in the facial nerve canal and discuss the characteristics of facial nerve paraganglioma in contrast with other tumors.

Case report

A 23-year-old man developed gradually progressive right facial palsy as the initial symptom. One year later, he exhibited hearing loss without tinnitus in his right ear. CT demonstrated an enlarged facial nerve canal with irregular bony erosion of the circumference. MRI showed a well-enhanced heterogeneous mass with hypo-intensity spots inside it. During surgery, a blood-rich tumor was observed along the facial nerve: however, extensive bleeding interfered with tumor removal. The surgical specimen demonstrated paraganglioma. The tumor was completely removed in the second surgery in combination with arterial embolization. Facial nerve function was reconstructed with a free muscle flap more than one year following resection.

Conclusion

Because paraganglioma is a blood-rich tumor, it is important to perform angiography and embolization. If preoperative facial nerve palsy is demonstrated, careful management of facial nerve function is needed. Paraganglioma must be considered in the differential diagnosis of a facial nerve tumor.     

Laryngeal paraganglioma: update on diagnosis and treatment

Sixty-one cases of laryngeal paraganglioma have been reported in the world literature. Histologic and clinical similarities between this neuroendocrine neoplasm and other organoid laryngeal tumors have led to uncertainty regarding the malignant potential and prognosis of this entity. Immunohistochemical assays have identified biogenic amines and hormonal peptides in these tumors which may prove useful as diagnostic markers. Computer tomography (CT) scanning demonstrates an enhancing lesion and can determine the location and extent of the tumor. The generally small size and constant blood supply of the laryngeal paraganglioma make preoperative angiography unnecessary. Accordingly, intraoperative ligation of the arterial blood supply negates the need for embolization. Partial laryngectomy remains the mainstay of treatment. A case is reported of a patient with a paraganglioma of the larynx who was unsuccessfully treated by laser excision and required surgical resection.