Introduction: We report a case of paraganglioma of glomus caroticum with lung metastases treated with 150 mCi 131I-MIBG.
Case: A 25-year-old woman was referred to our department for cachexia. She had low BMI (18) normotension, mild normochromic normocytic anemia with a mass under left mandibula. Radiologic imaging of neck revealed that 24×36×45 mm diameter mass surrounding of carotis externa and interna at the level of bifurcation. She underwent surgical operation. Pathological examination revealed that the tumor was paraganglioma with index of Ki-67 23%. Further endocrine evaluation showed increased urinary normetanephrine (607 microgram/dl (normal: 88444) and dopamine 405 microgram/dl (normal: 65400). Radiological scan of thorax, abdomen and cervical region were performed for evaluation of metastases. Bilateral,small lung nodules were shown in thorax CT. 131I-MIBG scintigraphy was positive only on the right side of neck and octreotide scan was negative. Lung biopsy was performed for pathological confirmation of metastases. Pathological examination revealed that the lung tumors were paraganglioma with index of Ki-67 23%. 131I-MIBG therapy was performed with 150 mCi. Post-therapeutic MIBG scan was showing no uptake in the lung. No further elevation of urinary cathecolamine metabolites was observed during follow-up. Mass size and clinical findings were stable.
Conclusion: Paragangliomas are very rare tumours in the head and neck but should be considered in the differential diagnosis of neck masses. As these tumours can form part of a familial syndrome, long-term follow-up is necessary.