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A Diagnostic and Therapeutic Approach to Paragangliomas of the Larynx
Kenneth W. Sanders, MD;
Fleurette Abreo, MD;
Edwin Rivera, MD;
Fred J. Stucker, MD;
Cherie-Ann O. Nathan, MD
Arch Otolaryngol Head Neck Surg. 2001;127:565-569.
Background Differentiating paragangliomas from moderately differentiated neuroendocrine
carcinoma in the larynx is a difficult management problem. As the biological
behavior of these 2 entities is different, we developed an algorithm for the
preoperative diagnosis and treatment of this disease.
Design The sample case from which the algorithm was developed consisted of
a 69-year-old man who was transferred to us after tracheostomy and an attempt
at biopsy for airway obstruction secondary to a vascular mass. Biopsy resulted
in substantial bleeding. Flexible laryngoscopy showed a vascular mass of the
supraglottis. A computed tomographic scan showed 2 vascular masses at the
carotid bifurcation and in the larynx. An arteriogram confirmed synchronous
vascular tumors.
Results The arteriogram showed the superior thyroid artery to be the major feeder
vessel to this mass, a situation commonly seen in paragangliomas but not other
neuroendocrine tumors. The presence of synchronous lesions and a vascular
mass based on the superior thyroid artery helped differentiate paraganglioma
from the other neuroendocrine tumors. As the biological behavior of paragangliomas
is relatively benign, we performed a conservative supraglottic laryngectomy
and excision of the carotid body tumor. Histologic diagnosis and immunohistochemical
analysis confirmed the diagnosis of paraganglioma.
Conclusions The vascular nature of neuroendocrine tumors prevents preoperative pathological
diagnosis. Radiologic features demonstrating a vascular mass with a dominant
feeder vessel by the superior or inferior thyroid artery may help in the clinical
diagnosis of paragangliomas of the larynx. Since paragangliomas are rarely
malignant, a conservative surgical procedure should suffice.
From the Departments of Otolaryngology/Head and Neck Surgery (Drs Sanders,
Stucker, and Nathan), Pathology (Dr Abreo), and Radiology (Dr Rivera), Louisiana
State University Health Science Center and Veterans Administration Medical
Center Shreveport, Shreveport.
Corresponding author: Cherie-Ann O. Nathan, MD, Department of Otolaryngology/Head
and Neck Surgery, LSU Health Science Center, 1501 Kings Hwy, PO Box 33932,
Shreveport, LA 71130 (e-mail: cnatha{at}lsuhsc.edu).
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