Malignant Shamblin III Carotid Body Tumors Resected with Use of the Retrocarotid Dissection Technique in 2 Patients

Abstract

Carotid body tumors are rare neoplasms with malignant potential in 6% to 12.5% of cases, and surgical resection is the only cure. We present the cases of 2 female patients who had expanding, painless, right-sided neck masses; computed tomographic angiograms revealed Shamblin III tumors at the carotid bifurcation. Each patient underwent tumor resection with use of the retrocarotid dissection technique. The tumor specimens were histologically consistent with malignancy, and free margins were achieved. The patients remained free of symptoms, local recurrence, and metastasis 44 and 19 months after their respective procedures. These are the first malignant Shamblin III carotid body tumors that we have resected by means of retrocarotid dissection. In addition to our patients' cases, we discuss carotid body tumors and compare the retrocarotid and standard caudocranial resection techniques.

Keywords: Carotid arteries/surgery; body/anatomy & histology/physiology; carotid body tumor/classification/diagnosis/etiology/pathology/surgery; disease-free survival; female; head and neck neoplasms/classification/pathology/surgery; paraganglioma, extra-adrenal/pathology; treatment outcome; vascular surgical procedures.

Fig. 1

Patient 1. Computed tomographic angiogram of the head and neck (3-dimensional reconstruction in right lateral projection) shows a hypervascular mass in the right carotid bifurcation (arrow).

Fig. 2

Patient 1. Intraoperative photographs. A) A cervical incision centered over the carotid bifurcation and parallel and anterior to the sternocleidomastoid muscle was extended to the mastoid region. B) The anterolateral lobe of the tumor was approached in standard caudocranial fashion. C) After release of the posteromedial lobe from the carotid bifurcation, the retrocarotid maneuver enabled posterior luxation of the mass behind the internal carotid artery (ICA), with good views of the subadventitial plane. D) After a metastatic lymph node, the remaining tumor, and approximately 3 cm of the external carotid artery (ECA) were resected, the ECA was reconstructed with use of an interpositional saphenous vein graft (SVG).

Fig. 3

Patient 1. A) Photograph shows the resected 5 × 3 × 2-cm anterolateral lobe (left) and 4 × 3 × 2-cm posteromedial lobe. B) Photomicrograph shows the tumor's composition. Nests of cells are separated by fibrovascular connective tissue; in the nests' centers, chief cells have hyperchromatic nuclei and abundant eosinophilic cytoplasm, and sustentacular cells are at the periphery of the nests (H & E, orig. ×40).

Fig. 4

Patient 1. Twelve months postoperatively, computed tomographic angiogram of the head (axial view) shows a patent internal carotid artery (ICA) and external carotid artery (ECA). IJV = internal jugular vein