carotid body tumor
Introduction
Introduction to carotid body tumor Carotid body tumor is a rare chemoreceptor tumor, also known as paraganglioma. In 1743, Vonhaller first noticed that the carotid body was considered to be a small gland. In 1891, Marchond reported carotid body tumors and surgical treatment. He died on the 3rd postoperatively. In 1969, more than 500 cases of carotid body tumors were reported. Most of the carotid body is located at the bifurcation of the common carotid artery. It has an envelope, an indefinite size, about 3.5 mm in diameter, rich in blood vessels and nerves. The blood supply is supplied by a small branch of the common carotid artery. The nerve comes from the cervical sympathetic ganglia, the glossopharyngeal nerve, and the vagus nerve. And the hypoglossal nerve. Carotid body tumors were observed by the naked eye as reddish-brown, round or oval, with lobes and outer envelope. The cells are mainly polygonal, stained with cytoplasmic eosin, containing many vacuoles and microsomes. Occurs in 30 to 40 years old, the malignant variability is 5% to 10%. basic knowledge Sickness ratio: 0.05% Susceptible people: good between 30 and 40 years old Mode of infection: non-infectious Complications: aneurysm neurofibromatosis lymphoma
Cause
Cause of carotid body tumor
It is a chemosensory tissue tumor located in the outer membrane layer of the artery behind the bifurcation of the common carotid artery. The tumor is derived from the non-chromophobic paraganglioma of the paraganglial tissue, so it is also called carotid body paraneoplastic. Chronic hypoxia is associated with a high incidence in the highlands. Long-term chronic hypoxic stimulation causes compensatory hyperplasia of the carotid body, eventually forming a carotid body tumor. Most family history patients have bilateral onset.
Prevention
Carotid body tumor prevention
The treatment is mainly surgery. Because of the slow growth of this tumor, the risk of surgery is large. The smaller ones are feasible for follow-up observation, but the tumor is enlarged, the difficulty and mortality of the surgery are increased, and the carotid body tumor is not sensitive to radiotherapy, although the tumor is reduced. However, it increases the possibility of malignant transformation and makes it difficult to separate tumors during surgery. The main problems of surgical treatment are carotid artery injury, hemorrhage and cranial nerve injury. The problem of common carotid artery ligation should be considered before operation. Intermittent compression, increased brain tolerance, selective angiography can be seen from the external carotid artery branches and new blood vessels distributed in the tumor, embolization of carotid artery branches with ethanol polyethylene particles, can reduce intraoperative bleeding, most Tumors can be removed from the total neck or internal carotid artery. The external carotid artery should be ligated to avoid damage to the IX, X, XI, XII cranial nerves, common carotid artery or internal carotid artery injury, and the common carotid artery can be ligated. The mortality rate is 30% to 50%.
Complication
Carotid body tumor complications Complications Aneurysm Neurofibromas Lymphoma
Occasionally regional lymph nodes or distant metastases. Carotid body tumors are rare and the rate of misdiagnosis is high. Need to enlarge the lymph nodes, aneurysms, sacral cysts, neurofibroma and lymphoma, etc., the most common complications are immune system diseases, fever, sweating, fatigue, ESR, lymph node texture It is uneven, some parts are lighter (cheese-like), some are hard (fibrosis or calcification), and they stick to each other and stick to the skin.
Symptom
Carotid body tumor symptoms Common symptoms Progressive neck mass neck pulsation neck thick head dizziness dysphagia tremor dyspnea Syncope systolic murmur hoarseness
As the tumor grows and expands in different directions, different symptoms may occur. Slow and small tumors are often asymptomatic, or have pain, pressure, and large tumors may have syncope, hoarseness, difficulty swallowing, and breathing. Difficulties and other symptoms, physical examination: the tumor is mostly unilateral, located in the carotid triangle and common carotid bifurcation, the deep side of the breast muscle, no adhesion, the tumor is round or oval, the blood vessels are rich and can be swelled or Noise, tremor, because the tumor is attached to the artery, it can often move left and right and cannot move up and down.
Examine
Carotid body tumor examination
B-ultrasound and CT showed increased density at the carotid bifurcation. Digital subtraction angiography can visualize the arteries. For example, the tumor has a large branch to supply blood, and the mass can be developed.
Carotid angiography is the gold standard for diagnosis. It is usually characterized by cup-like widening at the beginning of the neck and external carotid artery, soft tissue shadow with increased density between the internal and external carotid arteries, and multivessel disease. The nourishing blood vessels are from the external carotid artery. Branch; narrowing of the carotid bifurcation.
Diagnosis
Diagnosis and diagnosis of carotid body tumor
diagnosis
Carotid body tumors are difficult to distinguish from other benign tumors before surgery. They are often based on auxiliary examination and intraoperative findings. Postoperative pathological diagnosis, carotid body tumors are mostly located at the bifurcation of the common carotid artery, and the mass of the tumor is often moved. B ultrasound, CT can increase the density of the carotid bifurcation, the digital subtraction angiography can make the arteries develop, such as the tumor has a larger branch to supply blood, the tumor can be developed.
1. The anterior triangle of the neck, the mass of the carotid bifurcation in the mandibular angle plane, the growth is slow, and there are no symptoms in the body. When the tumor is huge, it may be accompanied by dizziness, headache and symptoms of adjacent nerve compression, such as tongue deviation, hoarseness and hoarseness. Horner's syndrome, etc.
2. The tumor is round, elliptical or lobulated, solid, tough, clear, smooth, can be left and right, but the movement is very small, the tumor is rich in blood sinus, can touch the swelling pulsation of the mass and Tremors, squeaking and systolic murmurs, compression of the proximal common carotid artery, pulsation, tremors and murmurs disappeared.
3. Arteriography shows that the common carotid artery is displaced to the shallow side, and the internal and external carotid arteries are separated. The tumor is rich in blood vessels and communicates with the internal or external carotid artery, which is helpful for diagnosis and surgery.
Differential diagnosis
Should be noted with carotid aneurysms, rib cysts, lymphoma, neurofibroma and other identification. Combined with Fontaine's sign and ultrasound, CT showed increased density of carotid bifurcation. Arterial angiography showed that the common carotid artery was displaced to the superficial side. The internal and external carotid arteries were separated. The tumor was rich in blood vessels and communicated with the internal or external carotid artery. More can be clearly diagnosed. Pay attention to the combination of imaging, B-ultrasound, blood routine, blood, urine and other results.
