A diagnostic and therapeutic approach to paragangliomas of the larynx.

Abstract

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.

• Authors: K W Sanders, F Abreo, E Rivera, F J Stucker, C A Nathan
• Journal: Archives of otolaryngology--head & neck surgery (Arch Otolaryngol Head Neck Surg) Vol. 127 Issue 5 Pg. 565-9 (May 2001) ISSN: 0886-4470 [Print] United States
• PMID: 11346434 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Algorithms
• Humans
• Laryngeal Neoplasms (diagnosis, therapy)
• Laryngectomy
• Male
• Paraganglioma, Extra-Adrenal (diagnosis, therapy)
• Treatment Outcome