DOI: 10.36347/sjmcr.2023.v11i06.036

Pages: 1186-1187

Paragangliomas are rare, mostly benign, adult neuroendocrine tumors that develop at the expense of the autonomic nervous system along major vascular axes. They are most frequently located in the cervico-facial region, and the diagnosis is usually made by the suggestive clinic and imaging workup. We present the case of Mr C.A., aged 55, without a notable history, who consults for a left laterocervical swelling that has been evolving for four years and gradually enlarging. The examination found a deterioration of the general condition and an evening heat without excessive sweating. Tinnitus such as ringing in the ears and pulsatile earache associated with hearing loss has been reported. The physical examination found ipsilateral facial paralysis, as well as a large swelling of the left parotid region measuring 7cm in long axis, firm, painless, mobile in the horizontal plane and fistulated in the skin, without palpable cervical lymph nodes. Imaging examinations including cervical ultrasound and a cervico-facial tomodensitometry found a hypervascularized deep tissue cervical mass arising at the left carotid bifurcation suggesting a tumor of the left carotid glomus. Initial workup for metastases did not find a second tumor location. The laboratory test for excretion of fractionated urinary metanephrines and normetanephrines in a 24-hour urine sample was negative, ruling out the diagnosis of secreting paraganglioma. Due to the size of the tumor lesion and the potential morbidity of a surgical procedure, surgery was not a therapeutic option. The patient was treated with arterial embolization followed by local radiotherapy. At two years follow up, reduction in tumor volume and regression of neurosensory symptoms.