Paragangliomas are rare
tumors and very few cases of malignant vagal
paraganglioma with synchronous
carotid body paraganglioma have been reported. We report a case of a 20-year old male who presented with slow growing bilateral neck masses of eight years duration. He had symptoms of
dysphagia to solids, occasional
mouth breathing and
hoarseness of voice. Fine needle aspiration cytology (FNAC) performed where he lived showed a
sinus histiocytosis and he was administered anti-tubercular treatment for six months without any improvement in his symptoms. His physical examination revealed pulsatile, soft to firm, non-tender swellings over the anterolateral neck confined to the upper-mid jugulo-diagastric region on both sides. Direct laryngoscopy examination revealed a bulge on the posterior pharyngeal wall and another over the right lateral pharyngeal wall. Magnetic resonance imaging (MRI), 99mTc-labeled
octreotide scan and angiography diagnosed the swellings as
carotid body paraganglioma, stage III on the right side with left-sided vagal malignant
paraganglioma. Surgery was ruled out as a high morbidity with additional risk to life was expected due to the highly vascular nature of the
tumor. The patient was treated with
radiation therapy by image guided radiation to a dose of 5040cGy in 28 fractions. At a follow-up at 16 months, the
tumors have regressed bilaterally and the patient can take solids with ease.