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Tumor del

Glomus
Carotdeo
Dr. Wagner Romero
R3 Cirugia General
Universidad Central del Ecuador
Hospital de Especialidades
Eugenio Espejo

Mide 3 x 6 mm
Peso: 2mg

Tumor del Glomus Carotideo


Historia

Guild, 1941: Cuerpo yugular,


Mulligan, 1950: Propuso el nombre de
quemodectoma
Lattes, 1950: Paraganglioma (basandose
en la ubicacin anatomica y origen
embrionario)
12

Guild, SR. A hitherto unrecognized structure, the glomus jugularis. Man. Anat. Rec. (Suppl. 2), 79: 28, 1941.
Mulligan, RM. Chemodectoma in the Dog. Am. J. Path. 1950. 26: 680.
Lattes, R. Nonchromaffin paraganglioma of ganglion nodosum, carotid body, and aortic-arch bodies. Cancer,
1950; 3: 667.

Epidemiologia
Paragangliomas

0,8/100.000/ao
30 50 aos
H:M
Benignos
Tumor del Glomus: 65% de todos los
paragangliomas de cabeza y cuello
10%

Malignidad
10% Bilaterales
10% antecedente familiar
Derrick Lin, MD; Sally E Carty, MD, FACS; William F Young, Jr, MD, Msc
Paragangliomas: Epidemiology, Clinical Presentation, Diagnosis, And Histology. Uptodate, Sept 9 th 2013
Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Factores de Riesgo
Sindromes

hereditarios

Mutaciones en los genes codificadores de


la succinato deshirogenasa
MEN2A y 2B
Von Recklinghausen
Von Hippel Lundau
Carney-Stratakis

Derrick Lin, MD; Sally E Carty, MD, FACS; William F Young, Jr, MD, MSc
Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology. UpToDate, Sept 9 th 2013

Factores de Riesgo
Asociacin

hipoxia paraganglioma

Grandes alturas
Prevalencia:

1 de cada 10, 1 de cada 2

bovinos
86 a 96% en mujeres

EPOC

High altitude hypoxia and chemodectomas. Saldana MJ, Salem LE, Travezan R. Hum
Pathol. 1973 Jun;4(2):251-63

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Patologa
Crecimiento

lento
Vascularizados
Benignos
Histologa: Pequeos nidos de clulas
cromafnicas poligonales uniformes
(Zellballen")
Inmunohistoquimica: S-100 positivos

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Patologa
Criterios

de malignidad

Invasin local con el desarrollo de


parlisis de los nervios craneales, la
invasin de la cartida, o infiltracin de
los tejidos blandos en el espacio
parafarngeo; o la destruccin sea en la
base del crneo
MTS linftica
MTS a distancia

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

CLASIFICACION

Clasificacion

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Cuadro Clnico
Hallazgo casual
Al examen fsico

Parte alta del cuello


Pulstiles
Parlisis de los pares craneales inferiores

Tumores en espacio parafaringeo

Masa en pared farngea lateral


Desplazamiento medial de la amigdala y
paladar

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Diagnostico
TC

Desplazamiento de la grasa del espacio


parafaringeo y de la ACI hacia adelante
Muy vascularizados
Realce al contraste

RMN

Aumento de intensidad y vacos de flujo

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Tratamiento
Seleccin

de pacientes

Tamao del tumor


Ubicacin
Edad
Profesion del paciente
Riesgo de lesin neurolgica

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Manejo no Quirurgico
Observacin

Debe ser considerada la primera opcin


Control imagenolgico seriado
RMN anual
Ciruga
Aparicin

rpida de sntomas
Crecimiento del tumor desproporcionado

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Radioterapia
No

erradica el tumor

Tecnica convencional
Radiociruga estereotctica
Radiociruga con bistur gamma

Indicaciones

Ancianos
Shamblin III > 5cm
Mal estado general

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
Mohamad Chaaban, MD; Chief Editor: Arlen D Meyers, MD, MBA. Carotid Body Tumors
Treatment & Management. Jan 14, 2014

Embolizacion
Indicado

en tumores mayores a 4cm

Ayuda a delinear el controno


La infiltracion vascular
Detecta tumores bilaterales

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
Mohamad Chaaban, MD; Chief Editor: Arlen D Meyers, MD, MBA. Carotid Body Tumors
Treatment & Management. Jan 14, 2014

Tratramiento Mdico
Util

en paragangiomas funcionantes
Inhibidores del anlogo de la
somatostatina

Disminucion del tamao tumoral en el


15% de los casos.

No

tiene mucha utilidad en tumores del


glomus carotideo

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Tratamiento Quirrgico
Indicaciones

Factores del tumor


Malignidad

confirmada
Crecimiento rpido
Compresin local

Factores del paciente


Paciente

joven
Lesin unilateral
Riesgo minimo de lesin neurolgica
Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Preparacion Prequirrgica
Si la lesin es grande y muy vascularizada se
debe realizar angiografa
Embolizacin preoperatoria: 24 horas
previos a la ciruga
Estimar el potencial sangrado transquirurgico
En tumores grandes: estudios de oclusion
para demostrar buena circulacin del flujo
carotideo contralateral

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Tcnica: Tumores Benignos


Anestesia

general
Electrocauterio bipolar
Instrumental vascular (clamps, loops,
Fogarty)
Posicion: decubito supino, cuello
extendido y lateralizado en sentido
contralateral

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Tcnica: Tumores Malignos


Informar

al paciente de la posible lesin


cerebrovascular
Estar preparado para resecar y
reconstruir la ACI
Team debe contar con cirujano vascular
Anestesia: general

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14

Complicaciones
Lesin

vascular (Shamblin III)


Lesin neurolgica (X XII, laringeo
superior)

Incapacidad de crear sonidos agudos


Paralisis de cuerdas vocales
Problemas para la deglucion
Dolor en el hombro y debilidad
Sindrome del primer bocado

Mohamad Chaaban, MD; Chief Editor: Arlen D Meyers, MD, MBA. Carotid Body
Tumors Treatment & Management. Jan 14, 2014

Cuidado Postoperatorio
Supervision

de neuropatias craneales
Evaluar habla y deglucion
En caso de lesiones permanentes:

Protesis de aumento palatino


Paralisis de cuerdas vocales:
medializacin
Terapia del habla y deglucion*

Jatin Shahs. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14