Paraganglioma de carótida direita: tratamento cirúrgico de Glomus carotídeo em Hospital Público Universitário do Rio de Janeiro

Abstract

Paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal autonomic paraganglia, small structures mainly composed of neuroendocrine cells derived from the embryonic neural crest, with the ability to secrete catecholamines. Most paragangliomas of parasympathetic origin are located in the neck and skull base, along the branches of the glossopharyngeal and vagus nerves. They most commonly arise from the carotid body, less frequently from jugulotympanic and vagal paraganglia, and rarely from laryngeal paraganglia. Carotid body paragangliomas account for 0.5-0.6% of head and neck tumors and approximately 60% of cervical paragangliomas. These tumors are typically asymptomatic and grow indolently but may progress to larger, symptomatic, and potentially secreting lesions. In this case report, we present a male patient with a painless cervical bulge on the right side. During the diagnostic workup, a neck AngioCT revealed a 5.5 x 4.3 x 1.0 cm mass at the carotid bulb, followed by a urinary catecholamine assessment. The typical location of this rare neoplasm, the carotid bulb, is a critical area that requires detailed preoperative planning with imaging studies, obviating the need for biopsy. However, in this case, a biopsy was performed before the patient was referred to the UFRJ service. The tumor is highly vascularized, and catecholamine assessment is essential to prevent complications from adrenergic release during surgery. In this case, the catecholamine test was negative. The patient underwent resection of the cervical mass, requiring permanent ligation of the external carotid artery. In surgical planning, it is crucial for the team and the patient to be fully informed about the complexity of the procedure, especially the possibility of sacrificing the carotid artery and its branches. The development of a detailed surgical plan should include strategies for cervical revascularization to ensure adequate perfusion and minimize risks. However, in some cases, revascularization may be unnecessary if appropriate tests confirm the competence of the circle of Willis, ensuring effective cerebral circulation.