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Unusual location of a cervical paraganglioma between the thyroid gland and the common carotid artery: case report.

Pinto FR, Capelli Fde A, Maeda SA, Pereira EM, Scarpa MB, Brandão LG - Clinics (Sao Paulo) (2008)

View Article: PubMed Central - PubMed

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Paragangliomas are rare tumors derived from the extra-adrenal paraganglionic system, which is composed of cells from the neural crest that are associated with the autonomous nervous system., They have been observed at many sites in the head and neck area, including the carotid body, the jugular-tympanic region, and the vagus nerve., Unlike pheochromocytomas, head and neck paragangliomas are usually non-functioning tumors; in other words, they do not secrete catecholamines, and the primary symptom is a slow growing mass in the neck., Paragangliomas arising within the thyroid gland or the neighboring area are extremely rare, and are believed to derive from the inferior laryngeal paraganglia. – The laryngeal paraganglia was first described in 1963 by Watzka, who showed the presence of this particular tissue in the upper and anterior third of ventricular folds... One year later, Kleinsasser reported the presence of paraganglia in the subglottic larynx and named it the inferior laryngeal glomus; this author also labeled Watzka’s discovery as the superior laryngeal glomus... In anatomical studies of the human larynges, Zak and Lawson demonstrated that the position of the inferior laryngeal paraganglia can vary from patient to patient... They found paraganglionic tissue to lie between the inferior horn of the thyroid cartilage and the cricoid cartilage, to lie between the cricoid and the first tracheal ring, or to be in intimate contact with the medial aspect of the capsule of the thyroid gland... Aberrant positions, such as in front of the cricoid cartilage and over the cricothyroid membrane, have also been described. – The association between the inferior laryngeal paraganglia and the inferior laryngeal nerve and its branches has been well document. – The objective of this paper is to report the diagnosis and treatment of a paraganglioma located in the anterior visceral cervical space, between the thyroid gland and the common carotid artery, which during surgery showed no relationship with the recurrent laryngeal nerve and was easily dissected from the thyroid capsule... In the head and neck, the carotid body is the most frequently described location of such tumors, but several other sites have been described in the literature., Uncommon sites include the laryngeal,– tracheal, and thyroid paragangliomas. –,– The laryngeal paraganglia has been well described in anatomical studies performed by German researchers,, and more recently by Zak and Lawson... Other previous papers have reported paragangliomas located within the thyroid,,–,–, between the gland and the trachea, and even over the thyroid cartilage., All of these locations may be explained by anatomical studies documenting the distribution of cervical paraganglionic tissue... Hence, all patients submitted to a paraganglioma resection must be observed in regular follow-up exams to rule out recurrence or metastasis... However, according to the literature, the ratio of proven cervical malignant paragangliomas is low: it ranges from 2% to 10% for carotid and vagal body tumors, to less than 2% for laryngeal paragangliomas., In conclusion, we have described here an atypical location of a cervical paraganglioma... This tumor probably originated from an ectopic inferior laryngeal paraganglia or perhaps from a novel paraganglionic tissue not yet described... This description supports the idea that the anatomical distribution of human paraganglia is incompletely understood.

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Intra-operative view of the paraganglioma (PG), which is being dissected from the right thyroid lobe (RTL)
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f2-24-le-0034: Intra-operative view of the paraganglioma (PG), which is being dissected from the right thyroid lobe (RTL)

Mentions: The patient was then submitted to a cervicotomy through a traditional thyroidectomy incision. During surgery, a reddish tumor was easily dissected from the postero-lateral aspect of the right thyroid lobe, which was preserved (Figures 2 and 3). The recurrent laryngeal nerve was identified and preserved using standard procedures. No relationship was observed between the tumor and this nerve or any of its branches. No excessive bleeding or other operative or post-operative complications were observed. The histopathological examination as well as a new immunohistochemical test with a panel of antibodies confirmed the diagnosis of paraganglioma (Table 1, Figures 4 and 5). No tumor recurrence or metastasis was detected six months after surgery, and the patient continues to be observed in regular follow-up exams.


Unusual location of a cervical paraganglioma between the thyroid gland and the common carotid artery: case report.

Pinto FR, Capelli Fde A, Maeda SA, Pereira EM, Scarpa MB, Brandão LG - Clinics (Sao Paulo) (2008)

Intra-operative view of the paraganglioma (PG), which is being dissected from the right thyroid lobe (RTL)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664290&req=5

f2-24-le-0034: Intra-operative view of the paraganglioma (PG), which is being dissected from the right thyroid lobe (RTL)
Mentions: The patient was then submitted to a cervicotomy through a traditional thyroidectomy incision. During surgery, a reddish tumor was easily dissected from the postero-lateral aspect of the right thyroid lobe, which was preserved (Figures 2 and 3). The recurrent laryngeal nerve was identified and preserved using standard procedures. No relationship was observed between the tumor and this nerve or any of its branches. No excessive bleeding or other operative or post-operative complications were observed. The histopathological examination as well as a new immunohistochemical test with a panel of antibodies confirmed the diagnosis of paraganglioma (Table 1, Figures 4 and 5). No tumor recurrence or metastasis was detected six months after surgery, and the patient continues to be observed in regular follow-up exams.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Paragangliomas are rare tumors derived from the extra-adrenal paraganglionic system, which is composed of cells from the neural crest that are associated with the autonomous nervous system., They have been observed at many sites in the head and neck area, including the carotid body, the jugular-tympanic region, and the vagus nerve., Unlike pheochromocytomas, head and neck paragangliomas are usually non-functioning tumors; in other words, they do not secrete catecholamines, and the primary symptom is a slow growing mass in the neck., Paragangliomas arising within the thyroid gland or the neighboring area are extremely rare, and are believed to derive from the inferior laryngeal paraganglia. – The laryngeal paraganglia was first described in 1963 by Watzka, who showed the presence of this particular tissue in the upper and anterior third of ventricular folds... One year later, Kleinsasser reported the presence of paraganglia in the subglottic larynx and named it the inferior laryngeal glomus; this author also labeled Watzka’s discovery as the superior laryngeal glomus... In anatomical studies of the human larynges, Zak and Lawson demonstrated that the position of the inferior laryngeal paraganglia can vary from patient to patient... They found paraganglionic tissue to lie between the inferior horn of the thyroid cartilage and the cricoid cartilage, to lie between the cricoid and the first tracheal ring, or to be in intimate contact with the medial aspect of the capsule of the thyroid gland... Aberrant positions, such as in front of the cricoid cartilage and over the cricothyroid membrane, have also been described. – The association between the inferior laryngeal paraganglia and the inferior laryngeal nerve and its branches has been well document. – The objective of this paper is to report the diagnosis and treatment of a paraganglioma located in the anterior visceral cervical space, between the thyroid gland and the common carotid artery, which during surgery showed no relationship with the recurrent laryngeal nerve and was easily dissected from the thyroid capsule... In the head and neck, the carotid body is the most frequently described location of such tumors, but several other sites have been described in the literature., Uncommon sites include the laryngeal,– tracheal, and thyroid paragangliomas. –,– The laryngeal paraganglia has been well described in anatomical studies performed by German researchers,, and more recently by Zak and Lawson... Other previous papers have reported paragangliomas located within the thyroid,,–,–, between the gland and the trachea, and even over the thyroid cartilage., All of these locations may be explained by anatomical studies documenting the distribution of cervical paraganglionic tissue... Hence, all patients submitted to a paraganglioma resection must be observed in regular follow-up exams to rule out recurrence or metastasis... However, according to the literature, the ratio of proven cervical malignant paragangliomas is low: it ranges from 2% to 10% for carotid and vagal body tumors, to less than 2% for laryngeal paragangliomas., In conclusion, we have described here an atypical location of a cervical paraganglioma... This tumor probably originated from an ectopic inferior laryngeal paraganglia or perhaps from a novel paraganglionic tissue not yet described... This description supports the idea that the anatomical distribution of human paraganglia is incompletely understood.

Show MeSH
Related in: MedlinePlus