Surgical and Histopathological Results in Carotid Body Tumors

Abstract

Objective The possible relationships between the histopathological findings of carotid body tumors and age, gender, tumor diameter, and Shamblin classification were investigated. In addition, preoperative embolization status, development of neurological complications, need for vascular reconstruction, hemoglobin change, and discharge time were examined and the effects of these variables on each other were analyzed.

Methods Between 2008 and 2022, 46 cases who underwent carotid body tumor excision were examined retrospectively. The cases were followed for an average of 81 months postoperatively. Histopathological materials were reexamined and the effect of categorical variables was analyzed.

Results Mean tumor diameter was 3.55 ± 1.26 cm, mean discharge time was 3.91 ± 2.37 days, and mean hemoglobin change was 1.86 ± 1.25. Neurological complications developed in 13% of cases. The amount of hemoglobin change was significantly (p = 0.003) higher in those who developed neurological complications, whereas the tumor diameter and discharge time were found to be insignificantly higher. Surgical complications requiring vascular repair occurred in 10.8% of cases. Tumor diameter (p = 0.017) and hemoglobin change (p = 0.046) were significantly higher in these patients. There were significant correlations between higher Shamblin classification and tumor diameter, discharge time, postoperative hemoglobin value, and number of surgical and neurological complications. No significant difference was found between K_i-67, capsular invasion, mitosis, pleomorphism, prominent nucleoli, mean island diameter, and tendency of islands to merge with categorical variables.

Conclusion As the tumor diameter increases, the operation becomes more difficult and the postoperative complication rate increases. We think that subadventitial and capsular removal of the tumor is effective in preventing recurrence. To reach a histopathological conclusion, a larger series of studies including tumors with high K_i-67 and mitosis rates, large size, and one or more of the criteria for necrosis are needed.

Keywords

carotid body tumors - carotid paragangliomas - histopathological results - neuroendocrine tumors - surgical complications

• References

• 1 Nazari I, Aarabi Moghaddam F, Zamani MM, Salimi J. Clinical characteristics and remedies in 45 Iranians with carotid body tumors. Acta Med Iran 2012; 50 (05) 339-343
• 2 Dimakakos PB, Kotsis TE. Carotid body paraganglioma: review and surgical management. Eur J Plast Surg 2001; 24: 58-65
• 3 Kruger AJ, Walker PJ, Foster WJ, Jenkins JS, Boyne NS, Jenkins J. Important observations made managing carotid body tumors during a 25-year experience. J Vasc Surg 2010; 52 (06) 1518-1523
• 4 Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, Granados-Garcia M, Herrera-Gomez A. Carotid body tumors: review of a 20-year experience. Oral Oncol 2005; 41: 56-61
• 5 Shamblin WR, ReMine WH, Sheps SG, Harrison EG. Jr. Carotid body tumor (chenodectoma). Clinical pathologic analysis of ninety cases. Am J Surg 1971; 122 (06) 732-739
• 6 Ma D, Liu L, Yao H. et al. A retrospective study in management of carotid body tumour. Br J Oral Maxillofac Surg 2009; 47 (06) 461-465
• 7 Kotelis D, Rizos T, Geisbüsch P. et al. Late outcome after surgical management of carotid body tumors from a 20-year single-center experience. Langenbecks Arch Surg 2009; 394 (02) 339-344
• 8 Power AH, Bower TC, Kasperbauer J. et al. Impact of preoperative embolization on outcomes of carotid body tumor resections. J Vasc Surg 2012; 56 (04) 979-989
• 9 Gilbo P, Morris CG, Amdur RJ. et al. Radiotherapy for benign head and neck paragangliomas: a 45-year experience. Cancer 2014; 120 (23) 3738-3743
• 10 Duet M, Sauvaget E, Pételle B. et al. Clinical impact of somatostatin receptor scintigraphy in the management of paragangliomas of the head and neck. J Nucl Med 2003; 44 (11) 1767-1774
• 11 Kawai A, Healey JH, Wilson SC, Huvos AG, Yeh SDJ. Carotid body paraganglioma metastatic to bone: report of two cases. Skeletal Radiol 1998; 27 (02) 103-107
• 12 Westerband A, Hunter GC, Cintora I. et al. Current trends in the detection and management of carotid body tumors. J Vasc Surg 1998; 28 (01) 84-92 , discussion 92–93
• 13 Fruhmann J, Geigl JB, Konstantiniuk P, Cohnert TU. Paraganglioma of the carotid body: treatment strategy and SDH-gene mutations. Eur J Vasc Endovasc Surg 2013; 45 (05) 431-436
• 14 Gad A, Sayed A, Elwan H. et al. Carotid body tumors: a review of 25 years experience in diagnosis and management of 56 tumors. Ann Vasc Dis 2014; 7 (03) 292-299
• 15 Texakalidis P, Charisis N, Giannopoulos S. et al. Role of preoperative embolization in carotid body tumor surgery: a systematic review and meta-analysis. World Neurosurg 2019; 129: 503-513.e2
• 16 Qin RF, Shi LF, Liu YP. et al. Diagnosis and surgical treatment of carotid body tumors: 25 years' experience in China. Int J Oral Maxillofac Implants 2009; 38 (07) 713-718
• 17 Robertson V, Poli F, Hobson B, Saratzis A, Ross Naylor A. A systematic review and meta-analysis of the presentation and surgical management of patients with carotid body tumours. Eur J Vasc Endovasc Surg 2019; 57 (04) 477-486
• 18 Sajid MS, Hamilton G, Baker DM. Joint Vascular Research Group. A multicenter review of carotid body tumour management. Eur J Vasc Endovasc Surg 2007; 34 (02) 127-130
• 19 Makeieff M, Raingeard I, Alric P, Bonafe A, Guerrier B, Marty-Ane Ch. Surgical management of carotid body tumors. Ann Surg Oncol 2008; 15 (08) 2180-2186
• 20 Wang YH, Yang J, Zhong H. et al. Prevalence, characteristics, evaluation, and management of carotid body tumors: systematic analysis based on available evidence. J Vasc Surg 2024
• 21 Erentuğ V, Bozbuğa NU, Sareyyüpoğlu B. et al. The surgical approaches in carotıd body tumors. Turk Gogus Kalp Damar Cerrahisi Derg 2004; 12 (04) 277-279
• 22 Thompson LDR, Gill AJ, Asa SL. et al. Data set for the reporting of pheochromocytoma and paraganglioma: explanations and recommendations of the guidelines from the International Collaboration on Cancer Reporting. Hum Pathol 2021; 110: 83-97
• 23 Kimura N, Takayanagi R, Takizawa N. et al; Phaeochromocytoma Study Group in Japan. Pathological grading for predicting metastasis in phaeochromocytoma and paraganglioma. Endocr Relat Cancer 2014; 21 (03) 405-414
• 24 Koh JM, Ahn SH, Kim H. et al. Validation of pathological grading systems for predicting metastatic potential in pheochromocytoma and paraganglioma. PLoS One 2017; 12 (11) e0187398
• 25 Fishbein L, Del Rivero J, Else T. et al. The North American Neuroendocrine Tumor Society Consensus Guidelines for surveillance and management of metastatic and/or unresectable pheochromocytoma and paraganglioma. Pancreas 2021; 50 (04) 469-493