Department of Otolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Medicine (Baltimore). 2022 Sep 9;101(36):e30379. doi: 10.1097/MD.0000000000030379.
Carotid body tumor (CBT), also known as carotid body chemoreceptor tumor or nonchromaffin paraganglioma, originates from the chemoreceptor behind the common carotid artery bifurcation in the carotid sheath. Most CBTs are benign. Malignant CBT (MCBT) is extremely rare, and cervical lymph node metastasis (CLNM) is usually regarded as a manifestation of malignant behavior. The association between CLNM, pathological features of the primary lesion, clinical manifestations, and prognosis deserves further investigation. The clinical materials of 133 patients with CBT who underwent total resection of the primary tumor and concomitant selective neck dissection (SND) from February 2002 to June 2018 in a single center were reviewed. Postoperative histopathology confirmed CLNM in 10 cases (10/133); clinical manifestations, pathological and imaging characteristics, and treatment outcome data were reviewed and analyzed. The average patient age was 50.5 years, with a female sex tendency (7/10). The mean and median follow-up periods of all cases were 6.9 years and 7 years, respectively. Nine patients (9/10) survived; one patient died of multiple systemic metastases 10 months after surgery when the tumor metastasized to the bilateral breast and other organs in an orderly manner. None of the patients had local recurrence, but postoperative residual lesions were detected by computer-aided 3-dimensional (3D) visualization computerized tomography in one (1/10). Most CBT cases with CLNM displayed adverse features, especially in patients without distant metastases. Immunohistochemically, the patient with distant metastases was negative for S-100, synaptophysin (Syn), and succinate dehydrogenase B (SDHB) expression. Most patients with CBT with CLNM have a good prognosis. Breast metastasis is an exceedingly rare manifestation of MCBT. Despite some association between clinical biological and histological malignancies in CBT with CLNM, the association seems to be vague in cases involving distant metastasis. The combination of certain immunohistochemical indicators (S-100, Syn, and SDHB) might be valuable for predicting the occurrence of distant metastasis. Computer-aided 3D visualization technology might be helpful for the diagnosis and postoperative follow-up of MCBT. Simultaneous SND can remove potentially metastatic lymph nodes and facilitate diagnosis and treatment.
颈动脉体肿瘤（CBT），也称为颈动脉体化学感受器肿瘤或非嗜铬副神经节瘤，起源于颈总动脉分叉处颈动脉鞘内的化学感受器。大多数 CBT 是良性的。恶性 CBT（MCBT）极为罕见，颈淋巴结转移（CLNM）通常被认为是恶性行为的表现。CLNM、原发灶的病理特征、临床表现和预后之间的关系值得进一步研究。回顾了 2002 年 2 月至 2018 年 6 月在一家中心对 133 例接受原发肿瘤全切术和选择性颈清扫术（SND）的 CBT 患者的临床资料。术后组织病理学证实 10 例（10/133）存在 CLNM；回顾和分析了临床表现、病理和影像学特征以及治疗结果数据。平均患者年龄为 50.5 岁，女性倾向（7/10）。所有病例的平均和中位随访时间分别为 6.9 年和 7 年。9 例（9/10）患者存活；1 例患者术后 10 个月死于双侧乳房和其他器官的多系统转移，肿瘤呈有序转移。无局部复发，但 1 例（1/10）患者在计算机辅助三维（3D）可视化计算机断层扫描中发现术后残留病变。大多数存在 CLNM 的 CBT 病例显示出不良特征，特别是在无远处转移的患者中。免疫组化染色显示远处转移患者 S-100、突触素（Syn）和琥珀酸脱氢酶 B（SDHB）表达阴性。大多数存在 CLNM 的 CBT 患者预后良好。乳腺转移是 MCBT 极为罕见的表现。尽管存在 CBT 中 CLNM 的临床生物学和组织学恶性之间的某些关联，但在涉及远处转移的情况下，这种关联似乎很模糊。某些免疫组化指标（S-100、Syn 和 SDHB）的组合可能对预测远处转移的发生有价值。计算机辅助 3D 可视化技术可能有助于 MCBT 的诊断和术后随访。同时行 SND 可以切除潜在转移的淋巴结，有助于诊断和治疗。
