Carotid Body Paraganglioma with Prominent Lymphocytic Infiltration Mimicking Metastatic Lymph Node: A Case Report

Abstract

Carotid body paraganglioma is a neuroendocrine neoplasm of the mandibular region. Due to its prominent stromal alternations, carotid body paraganglioma is a great emulator of other neoplasms in the head and neck region especially in metastatic tumors and its definite diagnosis is a great challenge. To the best of our knowledge, the most frequently reported variant is sclerosing and paraganglioma with a prominent lymphoplasmacytic infiltration is extremely rare. We report a rare case of a carotid body lymphoplasmacytic paraganglioma presented as a single asymptomatic mass of the right mandibular region in a 45-year-old woman. In order to exclude other possibilities, the use of immunohistochemistry is essential which shows a strong positive immunoreaction for chromogranin and synaptophysin. Surgical resection is the treatment of choice which is replaced with radiotherapy in contraindications. Overall, the tumor has a favorable clinical outcome.

Keywords: Carotid body tumor; Head and neck neoplasms; Neuroendocrine tumor.

Fig. 1

A: Macroscopic examination show an encaspulated tan nodular mass resembling lymphoid tissue. B: Macroscopic examination show an encapsuated tan nodular mass resembling lymphoid tissue

Fig. 2

A (hematoxylin-eosin, magnification 400X), B (hematoxylin-eosin, magnification 100X), section shows nests of the cells with eosinophilic cytoplasm surrounded by sustentacular cells in a dense lymphoplasmacytic stroma

Fig. 3

Positive immunoreaction for chromogranin (A), synaptophysin (B), and S100 protein in peripheral sustanticular cells (C) with negative reaction for cytokeratin markers (D)