Carotid body paraganglioma fine-needle aspiration cytology
Arijit Majumdar, Angshuman Jana, Anirban Jana, Soumali Biswas
Department of Pathology, Dr. BC Roy PGIPS, Kolkata, West Bengal, India
Date of Web Publication 15-May-2014
Dr. Arijit Majumdar
Vill.-Duilya, Charaktala P.O. - Andul, Howrah - 711 302, West Bengal
Carotid body tumor (CBT) is a Paraganglioma arising from the chief cells of the carotid body, which is situated at the bifurcation of the common carotid artery. We describe the fine needle aspiration cytology findings of one such tumor in a 45-year-old man. The aspirate was hemorrhagic with clusters of round to oval cells showing moderate anisokaryosis [anisokaryosis is found to be used in standard textbook of cytology (like Orell, Gray, Bibo, Chiba's text book of cytology) to indicate the varion in size of the nucleus. In hematology 'anisocytosis' is used to indicate the variation in red cell size]. Delicate fibrous strands with spindle cells were observed within these clusters. Based on these cytologic findings and the location of the swelling, a diagnosis of CBT was made. The mass was excised and the diagnosis was confirmed on histopathological examination. Our case report adds to the existing literature on cytologic diagnosis of CBT, further attesting to its safety and accuracy.
Keywords: Carotid body tumor, fine-needle aspiration cytology, paraganglioma
Majumdar A, Jana A, Jana A, Biswas S. Carotid body paraganglioma fine-needle aspiration cytology. J Med Trop 2014;16:45-6
Majumdar A, Jana A, Jana A, Biswas S. Carotid body paraganglioma fine-needle aspiration cytology. J Med Trop [serial online] 2014 [cited 2022 Jan 20];16:45-6. Available from: https://www.jmedtropics.org/text.asp?2014/16/1/45/132581
Carotid body tumors (CBTs) are rare benign slow growing neoplasms also called paragangliomas. They arise from the carotid bodies located in the adventitia at the postero-medial aspect of carotid bifurcation. These carotid bodies have demonstrated a chemoreceptor role by modulating cardiovascular and respiratory functions in response to fluctuations in arterial pH, carbon dioxide and oxygen tension historically treated by excision. [1] CBTs are the most common paragangliomas of the head and neck region. We describe the fine-needle aspiration cytology (FNAC) findings of one such tumor in a 45-year-old man.
A 45-year-old man came to the hospital in outpatient department with the complaints of slowly growing painless swelling in the right upper neck for past 20 years. The swelling was 4 cm × 3 cm in size, anterior to sternocleidomastoid, painless, gradually increasing in size. On examination, it was found to be freely moving horizontally but not above downwards, non-tender. It was not associated with fever, dyspnea, hoarseness of voice, difficulty in degglutition and any other abnormality. The patient was sent for FNAC suspecting the lesion as cervical lymph node swelling.
FNAC was done with a 23G needle. The aspirate was hemorrhagic with clusters of round to oval cells showing moderate anisokaryosis. Delicate fibrous strands with spindle cells were observed within these clusters. The tendency to form small acini is noted at places [Figure 1]. Based on these cytologic findings and the location of the swelling, a diagnosis of CBT (paraganglioma) was made.
Figure 1: FNAC smear showing oval to spindle shaped cells in clusters (LG ×10)
The mass was excised and the diagnosis was confirmed on histopathological examination. Microscopy shows thin encapsulated lesion composed of neoplastic cells arranged in clusters and nests separated by thin vascular septa giving rise to Zelballen pattern. The cells are polygonal with eosinophilic granular cytoplasm, vesicular nucleus and clumped chromatin at places. No mitosis and necrosis is present-features are suggestive of paraganglioma [Figure 2].
Figure 2: Histology- paraganglioma (H and E stain, ×10)
The carotid body is involved with the chemoreceptor control of respiration, blood pressure, and heart rate. Malignant growths in this area are classified as paragangliomas or chemodectomas. Carotid body tumors vary in incidence from 7% to 29% [2] of para-pharyngeal tumors. The incidence increases to 79% at high altitudes. [3] CBT can be unilateral or bilateral and 10% are familial. There is female gender preponderance noted 8.3:1 at high altitude as compared to a modest one of 2:1 at lower altitude. The average age of presentation is between 35 to 50 years. [4] Ours is a case of 45 year male. A history of uncontrolled hypertension, tachycardia, facial flushing or excessive sweating may point toward a catecholamine-secreting tumor. [5] These findings were absent in the patient in our study who presented with an asymptomatic painless mass gradually increasing in size. Differential diagnosis includes parotid neoplasm, branchial cleft cyst, lymphoma, metastatic carcinoma or schwannoma.
Radiological imaging is the mainstay of diagnosis and imaging modalities include Doppler ultrasound, contrast enhanced CT scan, MRI, MRA and carotid angiography. [2]
MRA is exceedingly being utilized in place of carotid arteriography. Carotid angiography is the gold standard for diagnosing these tumors and shows splaying of carotid vessels along with tumor blush called the Lyre's sign. [6] Currently, this invasive modality is used for detection of feeding vessel and pre-operative embolization. [7] Incisional biopsy is contraindicated in these tumors.
FNAC of these tumors can help in pre-operative diagnosis, particularly in those cases which were clinically unsuspected as CBT like this one.
These tumors may be multiple and familial (Hirsch et al. 1980, Grufferman et al. 1980). FNAC may be surely an alternative to multiple angiographies in these cases. [8]
Ours is a case of carotid body paraganglioma primarily diagnosed by fine needle aspiration cytology (FNAC). Though there are many reports of carotid body tumor diagnosed by radiological imaging, the incidence of FNAC is rare. That may be due to close proximity of these tumors to the great vessels and cranial nerves. Moreover, ours case is of a male patient where the literatures prove the female preponderance of the tumor. FNAC coupled with the histopathology can really serve as a diagnostic modality for carotid body paraganglioma. Our case report adds to the existing literature on cytologic diagnosis of CBT, further attesting to its safety and accuracy.
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[Figure 1], [Figure 2]
1 Carotid Body Tumor Diagnosed by On-Site FNA: a Case Report
Puneeta Nagiredla,Santosh Tummidi,Manoj Kumar Patro
Indian Journal of Surgical Oncology. 2019;
Majumdar A
Jana A
Biswas S
Carotid body tumor
fine-needle aspiration cytology
paraganglioma