恶性颈动脉体瘤肺转移一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 李怡 ¹ , 陈其章 ¹ , 雷丰丰 ¹ , 陈泉 ²

1. ;
2. ;

Corresponding author：

李怡, Email: mj7690@163.com

Keywords：

恶性颈动脉体瘤; 肺转移; 临床表现; 影像学特点; 治疗

DOI：

10.7507/1671-6205.202111023

Video：

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目的探讨恶性颈动脉体瘤（malignant carotid body tumor，MCBT）的发病机制、临床表现、影像学特点及治疗。方法回顾 1 例确诊 MCBT 的患者资料并结合相关文献进行复习，以“颈动脉体瘤”、“肺转移”以及“carotid body tumor”、“lung metastasis”和“pulmonary metastasis”为检索词检索中国知网、万方、Pubmed 等数据库，对相关文献进行分析。结果患者女，20 岁，以“头晕、伴咳嗽”为首发症状，胸部 CT 示两肺多发粟粒结节，在外院诊断“肺结核”，抗结核治疗 10 d 因出现胃肠道反应停用。入院查体发现左侧下颌角无痛性肿块，结合颈动脉 CT 血管成像（CT angiography，CTA）和正电子发射计算机体层显像联合计算机体层摄影检查结果，考虑 MCBT。文献复习共纳入 36 篇文献，合计 42 例患者。患者临床表现不典型。颈动脉CTA 病变征象呈“破杯征”，典型“抱球征”消失。手术是主要治疗方法，放射治疗、化学治疗作为辅助手段，基因检测和分子靶向治疗是近年来的研究方向。结论 MCBT 临床上缺乏特征性表现，当 CT 表现为粟粒结节样肺转移瘤时，易误诊为肺结核。应对入院患者进行细致查体，可疑患者行颈动脉 CTA 等检查，诊断后尽早彻底切除肿瘤以改善患者预后。

Citation： 李怡, 陈其章, 雷丰丰, 陈泉. 恶性颈动脉体瘤肺转移一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(6): 436-440. doi: 10.7507/1671-6205.202111023 Copy

1.	Turchini J, Cheung VKY, Tischler AS, et al. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology, 2018, 72(1): 97-105.
2.	Ayala-Ramirez M, Feng L, Johnson MM, et al. Clinical risk factors for malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: primary tumor size and primary tumor location as prognostic indicators. J Clin Endocrinol Metab, 2011, 96(3): 717-725.
3.	Ferrante AM, Boscarino G, Crea MA, et al. Cervical paragangliomas: single centre experience with 44 cases. Acta Otorhinolaryngol Ital, 2015, 35(2): 88-92.
4.	Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, et al. Does Shamblin's classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin's classification. Eur Arch Otorhinolaryngol, 2006, 263(2): 171-175.
5.	Fanning JP, Woods FM, Christian HJ, et al. Metastatic carotid body tumor report of a case with review of the literature. JAMA, 1963, 185(1): 49-50.
6.	Pinsker KL, Messinger N, Hurwitz P, et al. Cervical chemodectoma with extensive pulmonary metastases. Chest, 1973, 64(1): 116-118.
7.	Tu H, Bottomley RH. Malignant chemodectoma presenting as a miliary pulmonary infiltrate. Cancer, 1974, 33(1): 244-249.
8.	Merino MJ, LiVolsi VA. Malignant carotid body tumors: report of two cases and review of the literature. Cancer, 1981, 47(6): 1403-1414.
9.	Kabnick EM, Serchuk L, Adler L. Metastatic chemodectoma. J Natl Med Assoc, 1985, 77(9): 750,755-756.
10.	Vuorela AL, Jakobsson M, Anttinen J. Slowly growing pulmonary metastases of malignant cervical chemodectoma. Acta Oncol, 1994, 33(1): 77-78.
11.	Patel SR, Winchester DJ, Benjamin RS. A 15-year experience with chemotherapy of patients with paraganglioma. Cancer, 1995, 76(8): 1476-1480.
12.	Tan KL, Mah PK, Rajasoorya C, et al. Paraganglioma with pulmonary metastases: a case report. Ann Acad Med Singap, 1996, 25(4): 592-595.
13.	Hajnzić TF, Kruslin B, Belicza M. Carotid body paraganglioma in a nine-year-old boy with extensive pulmonary metastases. Med Pediatr Oncol, 1999, 32(5): 399-400.
14.	Pacheco-Ojeda L. Malignant carotid body tumors: report of three cases. Ann Otol Rhinol Laryngol, 2001, 110(1): 36-40.
15.	García Franco C, Heili S, Jiménez Hiscock L, et al. Pulmonary metastases in a bilateral carotid body paraganglioma. Interact Cardiovasc Thorac Surg, 2004, 3(4): 578-580.
16.	Havekes B, Corssmit EP, Jansen JC, et al. Malignant paragangliomas associated with mutations in the succinate dehydrogenase D gene. J Clin Endocrinol Metab, 2007, 92(4): 1245-1248.
17.	Nishijima H, Asakage T, Sugasawa M. Malignant carotid body tumor with systemic metastases. Ann Otol Rhinol Laryngol, 2011, 120(6): 381-385.
18.	Oakes A, Witt B, Adler DG. Metastatic carotid body paraganglioma detected during evaluation for biliary stone disease. Diagn Cytopathol, 2014, 42(10): 868-871.
19.	Lv H, Chen XH, Zhou S, et al. Imaging findings of malignant bilateral carotid body tumors: a case report and review of the literature. Oncol Lett, 2016, 11(4): 2457-2462.
20.	Kumari K, Jain D, Kumar R, et al. Metastatic carotid body paraganglioma of lungs and lymph nodes: unsuspected diagnosis on EBUS TBNA. Diagn Cytopathol, 2017, 45(4): 327-332.
21.	Rubio Maicas C, Dualde Beltrán D, Ferrández Izquierdo A, et al. Malignant carotid paraganglioma: a case report. Radiologia (Engl Ed), 2019, 61(2): 171-176.
22.	Fathalla AE, Elalfy MA. Clinical outcome of carotid body paraganglioma management: a review of 10-year experience. J Oncol, 2020, 2020: 6081273.
23.	Ding YM, Li LF, Han DM, et al. Head and neck malignant paragangliomas: experience from a single institution. Ear Nose Throat J, 2021, 15: 1455613211052338.
24.	黄席珍. 化学感受器瘤的诊断和治疗. 中华内科杂志, 1978, 17(3): 193-196,241.
25.	徐本义, 李树玲. 恶性颈动脉体瘤合并广泛转移一例. 天津医药肿瘤学附刊, 1979, 6(4): 275.
26.	杨荫清, 李润明. 化学感受器瘤肺转移生存八年1例报告. 西安交通大学学报(医学版), 1981, (S3): 71-73.
27.	高继东, 李积德, 贾乃镛, 等. 恶性颈动脉体瘤合并闭经和泌乳一例. 中华内分泌代谢杂志, 2001, 17(1): 57.
28.	陶英杰, 刘经祖, 金锐. 10例恶性颈动脉体瘤之生物学行为分析. 中国肿瘤临床, 2001, 28(4): 288-289.
29.	汪忠镐, 潘松龄. 颈动脉体瘤的外科治疗. 中国普通外科杂志, 2002, 11(7): 396-398.
30.	马立公. 颈动脉体恶性化学感受器瘤1例报告. 实用放射学杂志, 2003, 19(3): 246-246.
31.	王凤明, 章文成, 张仑, 等. 15例恶性颈动脉体瘤的诊断与治疗. 中国肿瘤临床, 2007, 34(20): 1185-1187.
32.	孙艳秋, 鲍海华, 赵希鹏, 等. CTA及MRA对颈动脉体瘤的诊断价值. 实用放射学杂志, 2008, 24(4): 462-464.
33.	张文超, 张仑, 王旭东, 等. 左上颈无痛性肿物明显增大. 中国肿瘤临床, 2007, 34(15): 883-886.
34.	沈碧霞, 陆建平, 金爱国, 等. 恶性颈动脉体瘤肝肺转移1例. 中国医学影像技术, 2011, 27(2): 436.
35.	黄群. 颈动脉体瘤恶变多器官转移1例及文献复习. 中国医药指南, 2012, 10(5): 235-236.
36.	张超, 罗涛, 宁雅婵, 等. 9例颈动脉体瘤的诊治. 中华胸心血管外科杂志, 2012, 28(11): 685-687.
37.	黄德亮, 马玥莹, 刘良发, 等. 颈动脉体瘤36例手术治疗体会. 中华耳鼻咽喉头颈外科杂志, 2013, 48(12): 1006-1010.
38.	洪亚然, 黄行志, 沈丽达. 恶性颈动脉体副神经节瘤1例报道并文献复习. 昆明医科大学学报, 2014, 35(2): 134-135.
39.	钱芳芳, 田建辉. 治疗晚期颈动脉体瘤的经验介绍. 名医传承中国民间疗法, 2019, 27(17): 14-16.
40.	魏松锋, 李亦工, 郑向前, 等. 颈动脉体瘤相关致病基因与其临床病理特征关系的初步研究. 现代肿瘤医学, 2012, 20(4): 702-707.
41.	Melachuri S, Valappil B, Snyderman C. Variations in surgical outcomes of carotid body tumors by surgical specialty. Laryngoscope, 2021, 131(1): E190-E195.
42.	Ferreira J, Canedo A, Braga S, et al. Carotid body tumours resection with ultrasound dissector. Chin Med J (Engl), 2013, 126(3): 586-588.
43.	中华医学会内分泌学分会. 嗜铬细胞瘤和副神经节瘤诊断治疗专家共识(2020 版). 中华内分泌代谢杂志, 2020, 36(9): 737-750.
44.	Mhatre AN, Li Y, Feng L, et al. SDHB, SDHC, and SDHD mutation screen in sporadic and familial head and neck paragangliomas. Clin Genet, 2004, 66(5): 461-466.
45.	Assadipour Y, SadowskiSM, Alimchandani M, et al. SDHB mutation status and tumor size but not tumor grade are important predictors of clinical outcome in pheochromocytoma and abdominal paraganglioma. Surgery, 2017, 161(1): 230-239.
46.	化召辉, 蔡高坡, 张林枫, 等. 颈动脉体瘤线粒体琥珀酸脱氢酶基因突变与临床病理特征的关系及其对患者预后的预测价值. 中华实验外科杂志, 2020, 37(1): 124-127.
47.	Hu K, Persky MS. Treatment of head and neck paragangliomas. Cancer Control, 2016, 23(3): 228-241.
48.	Fatima N, Pollom E, Soltys S, et al. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev, 2021, 44(2): 741-752.
49.	Williams MD, Tischler AS. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Paragangliomas. Head Neck Pathol, 2017, 11(1): 88-95.
50.	Lam AK. Update on Adrenal Tumours in 2017 World Health Organization (WHO) of Endocrine Tumours. Endocr Pathol, 2017, 28(3): 213-227.
51.	Chen YJ, Li YZ, Liu JL, et al. The clinical characteristics and outcomes of carotid body tumors in Chinese patients: A STROBE-compliant observational study. Medicine(Baltimore), 2020, 99(3): e18824.
52.	赵立威, 陈为军, 刘亚飞, 等. 肺转移瘤CT误诊为肺结核病例分析. 临床误诊误治, 2019, 32(7): 16-19.
53.	张艳, 杨颍, 高硕辰, 等. 超声、CT对颈动脉体瘤的诊断价值. 中国实用医刊, 2018, 45(4): 4-6.
54.	翟雪佳, 于顺利, 樊青霞, 等. 转移性嗜铬细胞瘤和副神经节瘤的治疗现状及进展. 中华泌尿外科杂志, 2019, 40(12): 949-951.
55.	Roman-Gonzalez A, Zhou S, Ayala-Ramirez M, et al. Impact of surgical resection of the primary tumor on overall survival in patients with metastatic pheochromocytoma or sympathetic paraganglioma. Ann Surg, 2018, 268(1): 172-178.
56.	Hescot S, Curras-Freixes M, Deutschbein T, et al. Prognosis of malignant pheochromocytoma and paraganglioma (MAPP-Prono Study): a european network for the study of adrenal tumors retrospective study. J Clin Endocrinol Metab, 2019, 104(6): 2367-2374.

1. Turchini J, Cheung VKY, Tischler AS, et al. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology, 2018, 72(1): 97-105.
2. Ayala-Ramirez M, Feng L, Johnson MM, et al. Clinical risk factors for malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: primary tumor size and primary tumor location as prognostic indicators. J Clin Endocrinol Metab, 2011, 96(3): 717-725.
3. Ferrante AM, Boscarino G, Crea MA, et al. Cervical paragangliomas: single centre experience with 44 cases. Acta Otorhinolaryngol Ital, 2015, 35(2): 88-92.
4. Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, et al. Does Shamblin's classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin's classification. Eur Arch Otorhinolaryngol, 2006, 263(2): 171-175.
5. Fanning JP, Woods FM, Christian HJ, et al. Metastatic carotid body tumor report of a case with review of the literature. JAMA, 1963, 185(1): 49-50.
6. Pinsker KL, Messinger N, Hurwitz P, et al. Cervical chemodectoma with extensive pulmonary metastases. Chest, 1973, 64(1): 116-118.
7. Tu H, Bottomley RH. Malignant chemodectoma presenting as a miliary pulmonary infiltrate. Cancer, 1974, 33(1): 244-249.
8. Merino MJ, LiVolsi VA. Malignant carotid body tumors: report of two cases and review of the literature. Cancer, 1981, 47(6): 1403-1414.
9. Kabnick EM, Serchuk L, Adler L. Metastatic chemodectoma. J Natl Med Assoc, 1985, 77(9): 750,755-756.
10. Vuorela AL, Jakobsson M, Anttinen J. Slowly growing pulmonary metastases of malignant cervical chemodectoma. Acta Oncol, 1994, 33(1): 77-78.
11. Patel SR, Winchester DJ, Benjamin RS. A 15-year experience with chemotherapy of patients with paraganglioma. Cancer, 1995, 76(8): 1476-1480.
12. Tan KL, Mah PK, Rajasoorya C, et al. Paraganglioma with pulmonary metastases: a case report. Ann Acad Med Singap, 1996, 25(4): 592-595.
13. Hajnzić TF, Kruslin B, Belicza M. Carotid body paraganglioma in a nine-year-old boy with extensive pulmonary metastases. Med Pediatr Oncol, 1999, 32(5): 399-400.
14. Pacheco-Ojeda L. Malignant carotid body tumors: report of three cases. Ann Otol Rhinol Laryngol, 2001, 110(1): 36-40.
15. García Franco C, Heili S, Jiménez Hiscock L, et al. Pulmonary metastases in a bilateral carotid body paraganglioma. Interact Cardiovasc Thorac Surg, 2004, 3(4): 578-580.
16. Havekes B, Corssmit EP, Jansen JC, et al. Malignant paragangliomas associated with mutations in the succinate dehydrogenase D gene. J Clin Endocrinol Metab, 2007, 92(4): 1245-1248.
17. Nishijima H, Asakage T, Sugasawa M. Malignant carotid body tumor with systemic metastases. Ann Otol Rhinol Laryngol, 2011, 120(6): 381-385.
18. Oakes A, Witt B, Adler DG. Metastatic carotid body paraganglioma detected during evaluation for biliary stone disease. Diagn Cytopathol, 2014, 42(10): 868-871.
19. Lv H, Chen XH, Zhou S, et al. Imaging findings of malignant bilateral carotid body tumors: a case report and review of the literature. Oncol Lett, 2016, 11(4): 2457-2462.
20. Kumari K, Jain D, Kumar R, et al. Metastatic carotid body paraganglioma of lungs and lymph nodes: unsuspected diagnosis on EBUS TBNA. Diagn Cytopathol, 2017, 45(4): 327-332.
21. Rubio Maicas C, Dualde Beltrán D, Ferrández Izquierdo A, et al. Malignant carotid paraganglioma: a case report. Radiologia (Engl Ed), 2019, 61(2): 171-176.
22. Fathalla AE, Elalfy MA. Clinical outcome of carotid body paraganglioma management: a review of 10-year experience. J Oncol, 2020, 2020: 6081273.
23. Ding YM, Li LF, Han DM, et al. Head and neck malignant paragangliomas: experience from a single institution. Ear Nose Throat J, 2021, 15: 1455613211052338.
24. 黄席珍. 化学感受器瘤的诊断和治疗. 中华内科杂志, 1978, 17(3): 193-196,241.
25. 徐本义, 李树玲. 恶性颈动脉体瘤合并广泛转移一例. 天津医药肿瘤学附刊, 1979, 6(4): 275.
26. 杨荫清, 李润明. 化学感受器瘤肺转移生存八年1例报告. 西安交通大学学报(医学版), 1981, (S3): 71-73.
27. 高继东, 李积德, 贾乃镛, 等. 恶性颈动脉体瘤合并闭经和泌乳一例. 中华内分泌代谢杂志, 2001, 17(1): 57.
28. 陶英杰, 刘经祖, 金锐. 10例恶性颈动脉体瘤之生物学行为分析. 中国肿瘤临床, 2001, 28(4): 288-289.
29. 汪忠镐, 潘松龄. 颈动脉体瘤的外科治疗. 中国普通外科杂志, 2002, 11(7): 396-398.
30. 马立公. 颈动脉体恶性化学感受器瘤1例报告. 实用放射学杂志, 2003, 19(3): 246-246.
31. 王凤明, 章文成, 张仑, 等. 15例恶性颈动脉体瘤的诊断与治疗. 中国肿瘤临床, 2007, 34(20): 1185-1187.
32. 孙艳秋, 鲍海华, 赵希鹏, 等. CTA及MRA对颈动脉体瘤的诊断价值. 实用放射学杂志, 2008, 24(4): 462-464.
33. 张文超, 张仑, 王旭东, 等. 左上颈无痛性肿物明显增大. 中国肿瘤临床, 2007, 34(15): 883-886.
34. 沈碧霞, 陆建平, 金爱国, 等. 恶性颈动脉体瘤肝肺转移1例. 中国医学影像技术, 2011, 27(2): 436.
35. 黄群. 颈动脉体瘤恶变多器官转移1例及文献复习. 中国医药指南, 2012, 10(5): 235-236.
36. 张超, 罗涛, 宁雅婵, 等. 9例颈动脉体瘤的诊治. 中华胸心血管外科杂志, 2012, 28(11): 685-687.
37. 黄德亮, 马玥莹, 刘良发, 等. 颈动脉体瘤36例手术治疗体会. 中华耳鼻咽喉头颈外科杂志, 2013, 48(12): 1006-1010.
38. 洪亚然, 黄行志, 沈丽达. 恶性颈动脉体副神经节瘤1例报道并文献复习. 昆明医科大学学报, 2014, 35(2): 134-135.
39. 钱芳芳, 田建辉. 治疗晚期颈动脉体瘤的经验介绍. 名医传承中国民间疗法, 2019, 27(17): 14-16.
40. 魏松锋, 李亦工, 郑向前, 等. 颈动脉体瘤相关致病基因与其临床病理特征关系的初步研究. 现代肿瘤医学, 2012, 20(4): 702-707.
41. Melachuri S, Valappil B, Snyderman C. Variations in surgical outcomes of carotid body tumors by surgical specialty. Laryngoscope, 2021, 131(1): E190-E195.
42. Ferreira J, Canedo A, Braga S, et al. Carotid body tumours resection with ultrasound dissector. Chin Med J (Engl), 2013, 126(3): 586-588.
43. 中华医学会内分泌学分会. 嗜铬细胞瘤和副神经节瘤诊断治疗专家共识(2020 版). 中华内分泌代谢杂志, 2020, 36(9): 737-750.
44. Mhatre AN, Li Y, Feng L, et al. SDHB, SDHC, and SDHD mutation screen in sporadic and familial head and neck paragangliomas. Clin Genet, 2004, 66(5): 461-466.
45. Assadipour Y, SadowskiSM, Alimchandani M, et al. SDHB mutation status and tumor size but not tumor grade are important predictors of clinical outcome in pheochromocytoma and abdominal paraganglioma. Surgery, 2017, 161(1): 230-239.
46. 化召辉, 蔡高坡, 张林枫, 等. 颈动脉体瘤线粒体琥珀酸脱氢酶基因突变与临床病理特征的关系及其对患者预后的预测价值. 中华实验外科杂志, 2020, 37(1): 124-127.
47. Hu K, Persky MS. Treatment of head and neck paragangliomas. Cancer Control, 2016, 23(3): 228-241.
48. Fatima N, Pollom E, Soltys S, et al. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev, 2021, 44(2): 741-752.
49. Williams MD, Tischler AS. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Paragangliomas. Head Neck Pathol, 2017, 11(1): 88-95.
50. Lam AK. Update on Adrenal Tumours in 2017 World Health Organization (WHO) of Endocrine Tumours. Endocr Pathol, 2017, 28(3): 213-227.
51. Chen YJ, Li YZ, Liu JL, et al. The clinical characteristics and outcomes of carotid body tumors in Chinese patients: A STROBE-compliant observational study. Medicine(Baltimore), 2020, 99(3): e18824.
52. 赵立威, 陈为军, 刘亚飞, 等. 肺转移瘤CT误诊为肺结核病例分析. 临床误诊误治, 2019, 32(7): 16-19.
53. 张艳, 杨颍, 高硕辰, 等. 超声、CT对颈动脉体瘤的诊断价值. 中国实用医刊, 2018, 45(4): 4-6.
54. 翟雪佳, 于顺利, 樊青霞, 等. 转移性嗜铬细胞瘤和副神经节瘤的治疗现状及进展. 中华泌尿外科杂志, 2019, 40(12): 949-951.
55. Roman-Gonzalez A, Zhou S, Ayala-Ramirez M, et al. Impact of surgical resection of the primary tumor on overall survival in patients with metastatic pheochromocytoma or sympathetic paraganglioma. Ann Surg, 2018, 268(1): 172-178.
56. Hescot S, Curras-Freixes M, Deutschbein T, et al. Prognosis of malignant pheochromocytoma and paraganglioma (MAPP-Prono Study): a european network for the study of adrenal tumors retrospective study. J Clin Endocrinol Metab, 2019, 104(6): 2367-2374.

Chinese Journal of Respiratory and Critical Care Medicine

恶性颈动脉体瘤肺转移一例并文献复习

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