Natural history of glomus jugulare: a review of 16 tumors managed with primary observation

Abstract

Objective: To characterize clinical disease progression and radiologic growth in a series of observed, previously untreated, glomus jugulare tumors (GJT).

Study design: Retrospective review.

Setting: Tertiary neurotologic referral center.

Subjects and methods: All patients with primary GJTs that were observed without intervention for a minimum of 2 years. Primary outcome measures included progression of cranial neuropathy and/or radiologic growth.

Results: A total of 15 patients (80% female; median age, 69.6 years) with 16 GJTs met inclusion criteria. The most common indications for observation included advanced age (11; 73%) and patient preference (11; 73%). Cranial nerve function remained stable in most subjects over a median clinical follow-up period of 86.4 months. Among the 12 with serial imaging, 5 (42%) GJTs demonstrated radiologic growth, while 7 (58%) remained stable. The median growth rate of the 5 enlarging tumors using the maximum linear dimension was 0.8 mm/y (range, 0.6-1.6 mm/y) or 0.4 cm(3)/y (0.1-0.9 cm(3)/y) using volumetric analysis. There were no deaths attributable to tumor progression or treatment.

Conclusion: In an older subset of patients, we found that a significant number of GJTs do not grow after time of diagnosis and symptoms frequently remain stable for many years. Even with disease progression, most GJTs exhibit indolent growth with slowly progressive cranial neuropathy, affording satisfactory physiologic compensation in most patients. In the absence of brainstem compression or concern for malignancy, observation of GJTs is a viable initial management option for elderly patients.

Keywords: glomus jugulare; jugular paraganglioma; natural history.