Endocrine Abstracts

JOINT2040

Introduction: Paraganglioma is a tumor that develops at the expense of the "carotid body", which is a chemoreceptive structure located at the posteromedial aspect of the carotid bifurcation. Bilateral character is rare. We aim to report clinical and paraclinical features and thearpeutic management of bilateral carotid paraganglioma through a case report and literature review.

Observation: A female aged 68, operated for a left breast carcinoma in 2011 followed by radio-chemotherapy, in remission since 2012, consulted for a left latero-cervical swelling evolving for 2 years without signs of compression. The physical examination showed a left subangulo-mandibular swelling of 5cm, firm, painless, mobile laterally, fixed longitudinally and having a pulsatile character on palpation. A second upper right jugulo-carotid swelling of 2cm with the same characteristics was objectified on examination. The rest of the examination was without abnormalities. The cervical ultrasound showed a left formation of tissue nature, hypoechogenic, well-limited hypervascularized on Doppler, measuring 4cm located at the level of the carotid bifurcation suggesting a paraganglioma. Cervical MRI showed a large tumor mass of the left carotid bifurcation in T1 isosignal, in heterogeneous T2 hypersignal with "Flow void" with intense and heterogeneous enhancement responsible for a widening of the carotid bifurcation. MRI showed a second lesion with the same characteristics located at the level of the right carotid bifurcation. The dosage of blood and urine metanephrines returned normal. The paraganglioma was classified stage I on the right and stage II on the left according to the Shamblin classification. The patient was proposed for external radiotherapy given the bilateral nature of the tumor.

Conclusion: Carotid paragangliomas are rare neuroendocrine tumors, most often benign and non-secreting, with a slow progression. Imaging is of considerable assistance to diagnosis. Management is multidisciplinary, only surgical treatment is curative. When it is not possible, radiotherapy to reduce tumor progression may be an alternative to treatment.