Contribution of radiation therapy of head and neck paragangliomas: About 6 cases presentation

Öz

The neck’s paraganglions are bilateral nodular structures, with the same embryological origin which is the cephalic neural crest. They have a branchiomeric distribution. They have an important secreting function during the embryonic life, and then regress when the adrenal medulla starts functioning. Then only carotid and aortic paraganglions have chemoreceptor, baroreceptor and endocrine proved functions. The paragangliomas are tumors developed at the expense of paraganglions by proliferations of the chief cells (of type I) most of the time. Generally these tumors exhibit a slow growth rate, most often presenting asymptomatically as a space occupying mass lesion witnessed clinically or radiographically. The secreting tumors are very rare (5%). The benignity is the rule but the localization near noble structures makes it a highly risky tumor. This disease is often monofocal but it may also be part of a multifocal disease (6%). Advances in imaging have facilitated the diagnosis and the assessment of this disease. Diagnosis is generally made through a combination of clinical findings and radiographic studies. Surgery is the treatment of choice through total subadventitial resection, and rebuilding of the carotid axis when necessary. Surgery may lead to significant morbidity, resulting from major cranial nerve injury and especially at a late stage in the evolution of the disease. The preoperative embolization can facilitate ablation and reduce morbidity. Precisely, external radiotherapy can de indicated for recurrences, tumoral operating residues, and counter indications.

Anahtar Kelimeler

• Paraganglioma,Radiotherapy,Head and neck,Pheochromocytoma

Baş ve boyun paragangliomalarında radyasyon tedavisinin katkısı: 6 vaka sunumu

Öz

Boynun paraganglionları, sefalik sinir kreti olan aynı embriyolojik kökene sahip iki taraflı nodüler yapılardır. Branşmerik dağılımları var. Embriyonik yaşam boyunca önemli bir salgılama fonksiyonuna sahiptirler ve adrenal medulla çalışmaya başladığında gerilerler. O zaman sadece karotis ve aort paraganglionları kemorekeptör, barorekeptör ve endokrin kanıtlanmış fonksiyonlara sahiptir. Paragangliomalar, çoğu zaman baş hücrelerin çoğalmasıyla (tip I) paraganglionlar pahasına geliştirilen tümörlerdir. Genellikle bu tümörler, klinik veya radyografik olarak tanık olan bir yer kaplayan kitle lezyonu olarak asemptomatik olarak ortaya çıkan yavaş bir büyüme hızı gösterir. Salgılanan tümörler çok nadirdir (% 5). Benignity kural ama asil yapılara yakın lokalizasyon onu oldukça riskli bir tümör yapar. Bu hastalık genellikle monofokaldir, fakat aynı zamanda multifokal bir hastalığın parçası olabilir (% 6). Görüntüleme alanındaki ilerlemeler, bu hastalığın teşhis ve değerlendirmesini kolaylaştırmıştır. Tanı genellikle klinik bulgular ve radyografik incelemelerin bir kombinasyonu ile yapılır. Cerrahi, total subadventitial rezeksiyon ve gerektiğinde karotis ekseninin yeniden inşası ile tercih edilen tedavi yöntemidir. Cerrahi, önemli kranial sinir yaralanmasından kaynaklanan ve özellikle hastalığın evriminde geç bir aşamada ciddi morbiditeye yol açabilir. Preoperatif embolizasyon ablasyonu kolaylaştırabilir ve morbiditeyi azaltabilir. Kesin olarak, dış radyoterapi nüks, tümörlü çalışma artıkları ve karşı endikasyonlar için gösterilebilir.

Anahtar Kelimeler

• Paraganglioma,Radyoterapi,Baş ve boyun,Feokromositoma

Kaynakça

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