Carotid hemodektoma – a tumor from fabric of the carotid glomus which is settling down in the field of bifurcation of a carotid. Proceeds it is good-quality more often, the infiltrative growth and metastasis are less often observed. The poor clinical symptomatology is characteristic, existence of opukholevidny education in a neck can be the only manifestation of a carotid hemodektoma. Unpleasant feelings during the swallowing and turns of the head are possible, dizziness, a headache, change of a voice and short-term unconscious states when pressing on a tumor. The diagnosis is established on the basis of the complaints given survey, results of ultrasonography, KT, MPT and other researches. Treatment is quick.
Carotid hemodektoma – the new growth coming from neuroendocrine cages, which is localized on the side surface of a neck in the field of division of the general carotid. Treats group of tumors of APUD-system. It is diagnosed seldom. Malignization signs, according to various data, come to light in 6-25% of cases. Lack of correlation between morphological structure of cages of a carotid hemodektoma and its clinical manifestations is noted. Perhaps favorable current in the presence of histologic signs of a zlokachestvennost. As the main criterion of a malignization consider features of symptomatology (rapid growth, a retsidivirovaniye and metastasis).
The reasons of development of a carotid hemodektoma are unknown. Pathology can arise at any age, however affects patients of 20-60 years more often. Female patients prevail. Usually the tumor is found on the one hand, more rare happens bilateral. The disease can come to light at close relatives. For good-quality carotid hemodekty slow progressing is characteristic, cases when similar tumors existed within 30 and more years are described. At an ozlokachestvleniye the forecast uncertain – one patients live years and even decades, others perish in several years from multiple metastasises. Treatment is performed by experts in the field of oncology, vascular surgery and neurosurgery.
Pathological anatomy of a carotid hemodektoma
The carotid hemodektoma represents friable and soft, dense round or oval opukholevidny education from 0,5 to 5 in size and more centimeters are more rare. Comes from carotid gland (a sleepy glomus) – a paragangliya which cages presumably participate in regulation of blood pressure and carbohydrate exchange. Settles down in the field of bifurcation of a carotid. Distinguish four options of relationship between a carotid and carotid hemodektomy: the tumor is localized between internal and external branches of a carotid; surrounds an internal branch of a carotid; surrounds an external branch of a carotid; covers a zone of bifurcation and both branches of a carotid.
The carotid hemodektoma often "moves apart" carotid branches, increasing the angle of bifurcation. Infiltration an adventition of an adjacent part of a vessel is observed that complicates operational office of a tumor and significantly increases risk of surgical intervention. The carotid hemodektoma densely adjoins to the hypoglossal, yazykoglotochny and wandering nerve, however germination a paranevriya is absent. Tumors of the big size extend in zachelyustny space. Huge new growths can rise to the basis of a skull and go down in a sredosteniye.
Malignant carotid hemodektoma grow into muscular tissue of a wall of a carotid. Over time the vessel loses elasticity and turns into a rigid tube. Germination of nearby anatomical structures, metastasis in bones, regionarny lymph nodes and the remote bodies is possible. When progressing process the conglomerate including adjacent nerves, an internal jugular vein, a throat and - a clavicular and mastoidal muscle is formed. Color good-quality carotid hemodekty on a section pinkish-brown, malignant – with a grayish shade. In the course of the microscopic research large roundish or polygonal cages are found. Cages connect in the balls lying in Strom. At a malignization the cellular atipiya comes to light.
Symptoms of a carotid hemodektoma
At three of four patients the disease for years proceeds asymptomatically or malosimptomno. Detection of opukholevidny education on the side surface of a neck or increase in the size of the existing tumor becomes long ago a reason for the address to the oncologist. More rare patients from carotid hemodektomy show complaints to unpleasant feelings during the swallowing or turns of the head, morbidity when pressing, the pains irradiating in the head, a face and an ear. The headaches and dizzinesses caused by reduction of a gleam of a carotid can be observed. With a growth of a carotid hemodektoma there are progressing neurologic violations because of a sdavleniye of nearby nerves.
At some patients in the anamnesis falling of arterial pressure and short-term unconscious states come to light when pressing on a tumor. The voice osiplost, sudden attacks of weakness, urezheny ChSS and lability of arterial pressure are possible. Sometimes at patients from carotid hemodektomy mental disorders as an onkofobiya develop. At a palpation the soft or dense opukholevidny education which is usually located above a corner of the lower jaw is defined. The top pole of knot can not be probed. Because of close connection with a carotid there can be a feeling of a pulsation of a tumor.
Diagnostics of a carotid hemodektoma
The diagnosis is established on the basis of the anamnesis, complaints, the yielded external survey and results of tool researches. Patients with suspicion on a carotid hemodektoma are directed to the ultrasonic duplex scanning of vessels allowing to estimate structure, the size and degree of a vaskulyarization of a new growth, and also to define features of an arrangement of a tumor in relation to bifurcation and branches of a carotid. Multispiral KT is informative when determining relationship between carotid hemodektomy and the next anatomical structures, can be used for performing differential diagnostics with some other diseases.
MRT with contrasting allows to obtain information on an arrangement and structure of a carotid hemodektoma, its communication with nearby bodies and a condition of regionarny lymph nodes. At the final stage appoint a selective carotid angiography for definition of features of blood supply of a new growth. If necessary this procedure can be also used in the medical purposes – for an embolization of the vessels feeding a carotid hemodektoma. The final diagnosis is exposed taking into account results of a cytologic research of the sample of fabrics received in the course of a punktsionny biopsy.
Differential diagnostics of a carotid hemodektoma is performed with new growths of a thyroid gland, salivary glands, nerves, fastion, muscles and hypodermic fatty cellulose, with carotid aneurism, with nonspecific lymphadenitis at chronic diseases of an oral cavity and ENT organs, with specific lymphadenitis at tuberculosis and syphilis, and also with metastatic damage of lymph nodes of a neck.
Treatment of a carotid hemodektoma
Medical tactics is defined depending on features of a clinical course of disease. In the absence of rapid growth and signs of a zlokachestvennost surgical intervention is not shown even with major cosmetic defect as because of close connection of a carotid hemodektoma with large vessels any operation is accompanied by high risk for the patient. At the compression of bodies of a neck and chronic violations of brain blood circulation caused by pressure upon arteries and change of provision of branches of a carotid carry out removal of a new growth. Vessels keep, accurately allocating them from tumoral weight.
In case allocation of a vessel is complicated, make bandaging of an external carotid. At close cohesion of a good-quality carotid hemodektoma with a carotid perhaps partial vylushchivaniye of a tumor with preservation of a part of the capsule adjacent to vessels. At malignant process carry out removal of a tumor, a resection of bifurcation and branches of a carotid and replacement of the struck vessels with a transplant. At good-quality new growths nearby nerves, as a rule, manage to be kept. At malignant carotid hemodektoma nerves excise together with the changed fabrics.
To have an opportunity to control blood supply of a brain, surgical interventions usually carry out under local anesthesia. At large new growths use an intubatsionny anesthesia. Considering risk of development of massive bleeding, operations are performed after preparation of enough blood, blood substitutes and antishock medicines. The radiotheraphy and chemotherapy at treatment carotid hemodekty are not used because of inefficiency.
The forecast at good-quality new growths depends on prevalence of a tumor, its communication with nearby anatomical structures and some other factors. Malignant carotid hemodektoma are considered as predictively adverse. Life expectancy is defined by degree of aggression of local growth of a new growth and speed of emergence of the remote metastasises. The lethal outcome can come within several years or decades after diagnosis.