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Case Reports
. 2010 Jun 30;2(2):e21.
doi: 10.4081/rt.2010.e21.

Synchronous malignant vagal paraganglioma with contralateral carotid body paraganglioma treated by radiation therapy

Tejinder Kataria  1 , Shyam Singh Bisht, Swarupa Mitra, Ashu Abhishek, Suryaprakash Potharaju, Devlina Chakarvarty
Affiliations
Case Reports

Synchronous malignant vagal paraganglioma with contralateral carotid body paraganglioma treated by radiation therapy

Tejinder Kataria et al. Rare Tumors. .

Abstract

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.

Keywords: bilateral paraganglioma; malignant vagal paraganglioma; radiotherapy..

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Conflict of interest statement

Conflict of interest: the authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Pre-treatment neck MRI showing splaying of ICA, ECA on the right side by CBP where as the vessels are pushed anteriorly on the left side by vagal paraganglioma.
Figure 2
Figure 2
Pre-treatment 99mTc-labeled octreotide scan.
Figure 3
Figure 3
Irradiation portals with dose distribution showing 8 isocentrically placed beams and coverage of PTV by 95% isodose (color wash).
Figure 4
Figure 4
Neck MRI nine months post treatment.
See this image and copyright information in PMC

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