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Year : 2017  |  Volume : 32  |  Issue : 3  |  Page : 241-242  

Glomus tumor of the larynx: A rare synchronous paraganglioma in a patient with bilateral carotid body tumor detected on 68Ga-DOTANOC PET/CT


1 Department of Nuclear Medicine, All Institute of Medical Sciences, New Delhi, India
2 Department of Otorhinolaryngology, All Institute of Medical Sciences, New Delhi, India
3 Department of Nuclear Medicine, Eastern Diagnostics, Kolkata, West Bengal, India

Date of Web Publication13-Jun-2017

Correspondence Address:
Shamim Ahmed Shamim
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_163_16

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   Abstract 

Paragangliomas are neoplasms arising from extra-adrenal chromaffin tissue. They frequently cause symptoms by overproduction of catecholamines with known predilection to multicentricity. We describe the case of a patient with bilateral carotid body tumor who underwent a baseline 68 Gallium labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-Octreotide

Keywords: 68Ga-DOTANOC, glomus tumor, paragangliomas, PET-CT


How to cite this article:
Tripathy S, Mukherjee A, Singh CA, Jat B, Bal C, Shamim SA. Glomus tumor of the larynx: A rare synchronous paraganglioma in a patient with bilateral carotid body tumor detected on 68Ga-DOTANOC PET/CT. Indian J Nucl Med 2017;32:241-2

How to cite this URL:
Tripathy S, Mukherjee A, Singh CA, Jat B, Bal C, Shamim SA. Glomus tumor of the larynx: A rare synchronous paraganglioma in a patient with bilateral carotid body tumor detected on 68Ga-DOTANOC PET/CT. Indian J Nucl Med [serial online] 2017 [cited 2017 Sep 26];32:241-2. Available from: http://www.ijnm.in/text.asp?2017/32/3/241/207877

A 33-year-old patient presented with bilateral neck swelling progressively increasing in size over a period of 6 months. Based on the physical examination, a preliminary diagnosis of bilateral carotid body tumor was made. Twenty-four hour urinary catecholamine estimation was within normal limit (metanephrine: 60 mcg/24 h, norepinephrine: 50 mcg/24 h, normetanephrine: 200 mcg/24 h, VMA: 5 mg/24 h). He was referred for further evaluation with 68Gallium 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid-1-NaI3-Octreotide (68Ga-DOTANOC) positron emission tomography/computed tomography (PET/CT). A contrast-enhanced CT fused with PET was performed which revealed DOTANOC avid hyperenhancing soft tissue density mass of size 2.4 × 1.6 × 3 cm in the right neck at the level of carotid artery bifurcation splaying the internal and external carotid artery and closely abutting the internal jugular vein and of size 4 × 3.5 × 5.2 cm in the left neck with same features [Figure 1]a and [Figure 1]b; solid arrow]. Incidentally, another DOTANOC avid hyperenhancing soft tissue density mass lesion measuring 10 × 8 mm was found just above the anterior commissure of larynx [Figure 1]c and [Figure 1]d; solid arrow]. To further confirm the radiotracer uptake in the larynx, fibreoptic laryngoscopy was done which demonstrated hyperaemic small mucosa covered swelling at the anterior most part of left false cord [Figure 2]. Subsequent histopathological evaluation revealed feature of glomus tumor of the larynx.
Figure 1: DOTANOC PET/CT revealed DOTANOC avid hypernehancing soft tisuue density mass in the bilateral neck at the level of carotid artery bifurcation splaying the internal and external carotid artery (Figure 1 A , B solid arrow). Incidentally another DOTANOC avid hyperenhancing soft tissue density mass lesion found just above the anterior commissure of larynx (Figure 1 C, D solid arrow).

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Figure 2: fibre optic laryngoscopy demonstrated hyperemic small mucosa covered swelling at the anterior most part of left false cord

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Carotid body tumors are the most common head and neck paragangliomas,[1] whereas paragangliomas of the larynx are rare, and unlike other tumors of the larynx, they are more common in females (female/male ratio: 3/1) with a mean age of 44 years.[2],[3] Somatostatin receptor PET/CT using 68Ga labelled octreotide analogues has a very high sensitivity and specificity in the evaluation of patients with pheochromocytomas and paragangliomas with a significant impact on patient management,[4],[5] especially in patients with head and neck paragangliomas.[6] In a study by Naswa et al.[7] on five patients with CBTs using 68Ga- DOTANOC PETCT, additional lesions were detected in three patients. Although detection of additional parganliomas and pheochromocytomas [8] has been described with this tracer, association of glomus tumor of the larynx has never been reported with bilateral carotid body tumour. This case therefore further confirms the importance of pre-operative work-up of patients with head and neck paragangliomas using 68Ga-DOTANOC PET/CT since these undetected lesions could serve as nidus for tumor recurrence and patient debility.

Financial support and sponsorship

Nil.

Conflicts of Interest

The authors declare no conflicts of interest.

 
   References Top

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Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, et al. Paragangliomas of the head and neck. Oral Oncol 2004;40:563-75.  Back to cited text no. 1
    
2.
Kaytaz A, Karaman E, Edizer DT, Haciyev Y, Oz B. Laryngeal paraganglioma: Report of an unusual entity. Ear Nose Throat J 2010;89:550-2.  Back to cited text no. 2
    
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Aslam N, Qazi ZU, Ahmad AH, Khan RU. Malignant glomus tumour of larynx:First case report and literature review. J Laryngol Otol 2012;126:743-6.  Back to cited text no. 3
    
4.
Naswa N, Sharma P, Nazar AH, Agarwal KK, Kumar R, Amini AC, et al. Prospective evaluation of 68 Ga-DOTA-NOC PET-CT in phaeochromocytoma and paraganglioma: Preliminary results from a single centre study. Eur Radiol 2012;22:710-9.  Back to cited text no. 4
    
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Kroiss A, Shulkin BL, Uprimny C, Frech A, Gasser RW, Url C, et al. (68) Ga-DOTATOC PET/CT provides accurate tumour extent in patients with extraadrenal paraganglioma compared to (123)I-MIBG SPECT/CT. Eur J Nucl Med Mol Imaging 2015;42: 33-41.  Back to cited text no. 5
    
6.
Sharma P, Thakar A, Suman K C S, Dhull VS, Singh H, Naswa N, et al. 68 Ga-DOTANOC PET/CT for baseline evaluation of patients with head and neck paraganglioma. J Nucl Med 2013;54:841-7.  Back to cited text no. 6
    
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Naswa N, Kumar A, Sharma P, Bal C, Malhotra A, Kumar R. Imaging carotid body chemodectomas with 68Ga-DOTA-NOC PET-CT. Br J Radiol 2012;85:1140-5.  Back to cited text no. 7
    
8.
Naswa N, Karunanithi S, Sharma P, Soundararajan R, Bal C, Kumar R, et al. Pre-operative 68Ga-DOTANOC somatostatin receptor PET/CT imaging demonstrating multiple synchronous lesions in a patient with head and neck paraganglioma. Rev Esp Med Nucl Imagen Mol 2014;33:374-7.  Back to cited text no. 8
    


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  [Figure 1], [Figure 2]



 

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