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Objective: To investigate head and neck paraganglioma cases treated at a tertiary center from 2007 to 2023. The research includes a thorough examination of published studies that have focused on long-term outcomes. The additional goal is to contribute to the existing knowledge on head and neck paraganglioma, with a particular emphasis on refining diagnostic algorithms, treatment selection, and follow-up procedures. Methods: A total of 44 patients were retrospectively analyzed, and 39 were included. Demographic information, symptoms, radiological examination results, types, stages, and postoperative complications were recorded. A review was conducted to select articles that reported single-center experiences with large cohorts, long follow-ups, and different treatment modalities since 2010. Results: The mean age of the patients was 54 years, and the female/male ratio was 3.55:1. Among the 39 cases examined, 18 and 19 were identified as cervical paraganglioma and 19 as temporal bone paraganglioma. All patients initially underwent surgical resection. The mean follow-up duration was 5.42 years. Four residual cases and two recurrences were identified postoperatively, and a Gamma Knife was used as additional treatment. Subsequently, 17 articles were selected and summarized, and then a flowchart was prepared showing the possible options for diagnosis, treatment, and follow-up. Conclusions: Preoperative staging is essential for surgical planning and predicting potential intraoperative complications. Based on our findings and review of the articles, we have prepared a flowchart that includes all possibilities depending on the tumor stage to help in the diagnosis, treatment, and follow-up of head and neck paragangliomas. [ABSTRACT FROM AUTHOR]

Introduction and aim. Glomus tumors represent benign neoplastic proliferations of the glomus body, an integral thermoregulatory component within the cutaneous microvasculature. Although they can manifest at various anatomical sites, they are predominantly observed in the subungual region. The tumors present as painful, firm, purplish, solitary nodules of the extremities, especially in the nail bed. They may be solitary or multiple; solitary lesions are encapsulated and most commonly subungual, while multiple tumors are unencapsulated and rarely subungual. Description of the case. Here, we present a case of multiple glomus tumors of the right hand in an 18-year-old female who presented with complaints of painful bluish discoloration of the right little finger for six years and progressive asymptomatic nodules on the right index finger for six months. A clinical examination revealed acute tenderness in both fingers. Love's pin test and Hildreth's test were positive. Excision of all lesions was done and sent for histopathology, which confirmed the diagnosis. The patient was symptom-free immediately following surgery. No nail deformities were noticed, and there was no recurrence of symptoms after one year of follow-up. Conclusion. The transungual approach is a safe and effective minimally invasive surgical technique for the treatment of symptomatic nail bed glomus tumors. It offers high success rates, promising cosmetic outcomes, and minimal complications. However, careful patient selection and meticulous surgical technique are essential to avoid potential nail deformities. [ABSTRACT FROM AUTHOR]

Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare voice changes after Carotid endarterectomy (CEA) and Glomus body tumor resection with objective instrumental and acoustic assessments. Material and Methods: A total of 14 patients underwent CEA or glomus carotid tumor resection at our institution between 2009 and 2013. Among the 14 patients, two patients were excluded due to vocal cord paralysis. This study was applied to 12 patients. Patients were called retrospectively, and objective and subjective voice parameters were measured and compared. Voice handicap index was used to measure subjective voice parameters. Objective voice analysis was performed for patients by using Multi-dimensional voice programming (MDVP), a computer-aided program. Results: A total of 12 patients were included in the study. Five patients underwent carotid endarterectomy. Glomus tumor resection was performed on seven patients. Of the patients who underwent carotid endarterectomy, four were male and one was female. Three of the patients who underwent glomus tumor resection were male and four were female. Voice handicap index (VHI) showed that two patients who underwent glomus tumor resection experienced moderate problems and the patients who underwent CEA had no obvious problems. Patients who underwent glomus carotid tumor resection obtained higher values in all MDVP parameters than those who underwent CEA. Conclusion: Despite the small number of patients, it can be said that glomus tumor resection in neck surgery, that is, tumor surgery, causes more voice changes than carotid endarterectomy operations. The elevated objective sound parameters found in this study necessitate that patients should be informed regarding the potential of developing postoperative dysphonia, especially those who rely on their voice as their profession (e.g. sound artists, teachers, politicians). [ABSTRACT FROM AUTHOR]

Purpose: Ultrasonography (US) and magnetic resonance imaging (MRI), which has better resolution, have been suggested as appropriate diagnostic tools for digits; however, comparative studies of both modalities are scarce. This study compared the diagnostic performance of high-resolution US and MRI in characterizing subungual glomus tumors. Methods: We retrospectively analyzed the data of consecutive patients who were examined with high-resolution US and MRI before surgical exploration for subungual tumors from January 2017 to April 2020. The patients' clinical data and radiological findings were collected. Historical reports for diagnostic confirmation and measurements of mass size were reviewed. We conducted the McNemar test and evaluated the degree of agreement between the size measurements made using both techniques. Results: Overall, 22 patients (age range, 19-72 years) underwent surgical exploration and had subungual glomus tumors. The mean duration from initial symptom presentation to diagnosis was 7 years (range, 5-30) years. Only nine patients (40.9%) presented with the symptomatic triad of pain, cold sensitivity, and tenderness. MRI detected lesions in 19 cases (86.4%); three cases (13.6%) were undetected. Contrastingly, US was able to detect all lesions. Nine patients (40.9%) had visibly rich blood flow in tumor tissues on Doppler US. MRI and US showed bone erosion in eight and 15 cases, respectively. Conclusion: The detection rate of high-resolution US for subungual glomus tumors was as high as that of MRI. US can be applied easily and quickly and can be more useful as a primary diagnostic tool. [ABSTRACT FROM AUTHOR]

Objective1) Perform a meta-analysis of the available data on the outcomes of stereotactic radiosurgery (SRS) for the treatment of temporal bone glomus tumors (GT), and 2) evaluate the collective outcomes of SRS treatment with respect to tumor control.Data sourcesA thorough literature search of the published English-language literature from 2011 to 2016 was performed in PubMed, Ovid, and Cochrane databases using the keywords ("Gamma Knife" or "CyberKnife" or "linear accelerator" or "radiosurgery") and ("glomus jugulare" or "jugular paraganglioma" or "glomus tympanicum").Study selectionStudies reporting outcomes of SRS for temporal bone GT were included.Data extractionOf 45 articles found, 15 studies met our inclusion and exclusion criteria and were selected for qualitative and quantitative analyses totaling 511 patients.Data synthesisAverage margin dose, modality, isodose line, volume decrease, follow-up duration, and tumor control rate data were extracted and analyzed.ConclusionGamma Knife was the most commonly implemented radiosurgery modality and was used in eight studies. The mean marginal dose varied between 13.2 and 20 Gy. The pooled tumor control rate was 95.4% (95% CI: 93.6-97.2%) over a median follow-up duration ranging between 27.4 and 148 months. Clinical data on outcomes of SRS for the treatment of GTs are sparse and primarily limited to single institutional analyses, with considerable variation in tumor volume and follow-up duration. This meta-analysis provides an in-depth analysis of the available data in the literature and reviews the reported outcomes. Future studies on SRS for GT should include data on tumor growth before radiation as well as follow-up periods sufficiently long to identify true tumor control.

Mixed tumors are well-circumscribed lesions exhibiting epithelial and/or myoepithelial cells and they usually occur in the skin and salivary glands. Soft tissue mixed tumors are extremely rare. Therefore, radiographic findings of soft tissue mixed tumors have very rarely been described in the radiologic literature. Here, we report a rare case of subungual mixed tumor in a 65-year-old female who presented with left 2nd finger pain, describe the radiographic findings, and discuss the differential diagnosis of the tumor. [ABSTRACT FROM AUTHOR]

Purpose: The excision of subungual glomus tumors on the distal phalanx may cause nail deformities. Herein, we report our nail-sparing and sub-nail bed approach for the excision of subungual glomus tumors, which enables subungual glomus tumor excision without removal of the nail plate and further allows access to the tumor mass by dissecting beneath the nail bed and germinal matrix to minimize postoperative pain and nail bed injury. Therefore, the present article describes this operative approach and reports surgical outcomes with respect to patient satisfaction, pain, and the final postoperative nail shape. Methods: Thirty-two cases of clinically diagnosed subungual glomus tumors treated with this approach were retrospectively evaluated. Mean pain scores were measured at 1 week postoperatively and at the last follow-up. Patients were asked for their subjective opinion regarding the final nail shape, and their responses were assessed as "satisfied" or "unsatisfied." The objective results for the final nail shape were graded as "excellent," "good," or "poor" by two orthopedic hand surgeons. Results: The mean postoperative pain score (visual analog scale) at 1 week was 1.8. No patients reported pain at the last follow-up. Subjectively, 96.6% of patients were satisfied with the operation. Objectively, the postoperative nail shape was excellent in 9.3% of cases, good in 87.5%, and poor in 3.1%. Conclusion: This approach provides minimal postoperative pain, high patient satisfaction, and favorable cosmetic outcomes with respect to the nail shape by avoiding removal of the nail plate and incision of the nail bed and germinal matrix. [ABSTRACT FROM AUTHOR]

Gallbladder paraganglioma is a very rare condition, and only a few cases have been reported in the literature. Herein, we present and discuss the clinical and radiological findings of a 72-year-old woman who complained of heaviness, pain, and on and off watery discharge from the left ear for 1 year and reduced hearing in both ears. She was thoroughly investigated radiologically where multiple paragangliomas were found with the discovery of the very rare gallbladder paraganglioma. There is a need to realize the importance of thorough radiological evaluation in cases of head and neck paraganglioma to look for more such lesions in the body for early identification of patients with familial paraganglioma syndromes. With this practice, gene mutation carriers can be identified early in the course of their disease and brought to surgical attention before their disease becomes extensive and potentially life-threatening.

BackgroundGlomus tumors are difficult to manage surgically because they are vascular tumors that are topographically associated with important vascular and neuronal structures. Hence, there is a strong risk of incomplete resection and a high morbidity rate. In addition, they grow slowly. Recent treatments have increasingly involved a combination of surgical resection and radiosurgery. We present our experience in treating glomus tumors of the skull base with stereotactic radiosurgery as an upfront therapy.MethodsWe analyzed data from 13 consecutive patients with glomus tumors that were initially treated with stereotactic radiosurgery in our institute from February 2010 to April 2012. The tumor control rate, resolution of symptoms, and the complication rate were tabulated.ResultsAll patients were female with a median age of 63 (mean 62.7+/-14.6 years). The median treatment dose was 25.8 Gy (27.6 Gy +/- 9.5 Gy) and the median tumor volume 10.4 mL (9.2 +/- 6.5). The median follow-up was 47.4 months (51.8+/-11.2 months, range 31-74). The tumor control rate was 92.3%; 46.7% of the patients had noticeable tumor shrinkage. This happened at a median interval of 17 months (18.7+/-6.8) after treatment. Most patients with tinnitus had resolution of their symptoms (87.5%). Four patients presented with new symptoms and four patients with worsening of pre-existing symptoms. The time course of symptomatic improvement followed that of tumor size reduction. However, there was no statistical correlation between the amount of tumor reduction and symptomatic relief.ConclusionStereotactic radiosurgery (SRS) is an effective upfront treatment option in the management of glomus tumors.

A 63-year-old man with a 2-year history of a slowly growing mass in the chin area was referred to the Department of Oral and Maxillofacial Surgery, Dankook University Dental Hospital. Physical examination revealed a 1.2 × 1.0 cm bluish mass in the middle of his chin, which was tentatively diagnosed as a hemangioma. Considering the size and location of the lesion, an excisional biopsy was performed under local anesthesia. Bleeding and other complications were not observed. The results of histopathological examination revealed glomangioma. This study aimed to report a case of solitary glomangioma arising in the chin, which is not the usual location of this tumor. To the best of our knowledge, this is the first report of a solitary glomangioma in the chin area in the oral and maxillofacial surgery literature.

A glomus tumor is a soft tissue tumor that arises from the glomus body, a peripheral organ responsible for temperature regulating skin temperature. It accounts for about 1% to 5% of tumors occurring in the hand, is mainly located in the subungual region, and is less than 1 cm in size. The diagnosis is mainly based on clinical symptoms, and the main symptoms are pain at the site of the glomus tumor, pinpoint tenderness, and cold intolerance. The pain is severe and usually requires surgical resection, and the results of complete resection of the tumor are good. This case report presents a 37-yearold female patient who developed pain in the radial side around the proximal interphalangeal joint of the right second finger without any traumatic history. On physical examination and imaging, a glomus tumor of the digital nerve was diagnosed and resected. After surgery, the symptoms improved and there was no recurrence. A careful examination and accurate diagnosis and treatment are necessary for symptomatic masses. [ABSTRACT FROM AUTHOR]

Glomus tumors are rare soft-tissue neoplasms that constitute 2% of all soft-tissue tumors in the extremities. They are painful lesions that can impair quality of life. Diagnosis is often delayed as they can easily be confused with more common pathologies. They are best diagnosed through MRI scan or ultrasonography of the concerned digit. We present two cases in this article, one of a subungual glomus tumor of the great toe (Hallux) and one of the index finger. Both tumors had a delay in diagnosis as this tumor cannot easily be diagnosed through simple radiographs. They showed classical clinical symptoms. Both were eventually diagnosed on MRI scan. Surgical excision is the gold standard in treatment of subungual glomus tumors and is also curative. We used a transungual approach for the hallux and a lateral subperiosteal approach for the index finger. In conclusion, glomus tumors are rare, benign tumors that commonly occur in the sub-ungual region. High clinical suspicion is important for clinical diagnosis. MRI scan and ultrasound can diagnose the tumor and yield information about local spread. Surgical excision is usually curative with approximately 10% chance of recurrence and rare chance of malignant transformation. [ABSTRACT FROM AUTHOR]

Malignant glomus tumors (GTs) are very rare, and diagnosis requires consideration of specific histologic criteria based on a combination of criteria such as size of the tumor, degree of nuclear atypia, and the level of mitotic activity. GTs that do not fulfill the histologic criteria for malignancy but show at least one feature other than nuclear atypia should be classified as GT of uncertain malignant potential (GTUMP). We report the case of a 65-year-old female with a slowly progressing soft-tissue swelling in the right lower arm near the elbow joint that was successfully treated through wide surgical excision and histologically diagnosed as a GTUMP. On follow-up after 3 months, there was no evidence of recurrence or metastasis. Malignant GTs and GTUMPs are rare, and the nomenclature and classification of these tumors is controversial. These findings and the difficulty of differential diagnosis in a continuum between benignity and malignancy prompted our report.

Familial glomangiomatosis is a rare autosomal dominant vascular malformation caused by a mutation in the glomulin GLMN gene. It is characterized by the appearance of multiple glomus tumors composed of dysmature veins surrounded by glomus cells. We present a case of an 11-year-old girl with familial glomangiomatosis successfully treated with Nd:YAG long-pulse laser. Three sessions of laser treatment were performed, resulting in more than 80% reduction of the lesion and complete disappearance of pain, with no adverse effects reported. This case report demonstrates the excellent risk-benefit ratio of Nd:YAG long-pulse laser in the treatment of familial glomangiomatosis. [ABSTRACT FROM AUTHOR]

Introduction: Glomus tumor is a painful, subcutaneous tumor. The lesion may occur in various locations. In the case of the nail apparatus, it affects both the matrix area and the nail bed. Case report: We present a 71-year-old patient who presented to our clinic with a painful nodule lasting for about 15 years, located on the fifth finger of his left hand. After surgical removal, a histological examination was performed, which confirmed the clinical suspicion of glomus tumor. Intraoperative contact onychoscopy revealed a gray-blue nodule with linear vessels at the periphery. Conclusions: In the differential diagnosis of glomeroma, the following should be considered: pyogenic granuloma, subugual viral wart, melanoma, hemangioma, leiomyoma, sweat gland tumor, gout, neuroblastoma and hemangioma. Dermoscopy can be useful in the differential diagnosis, but the final diagnosis is based on a histopathological examination. Surgical removal of the lesion is considered the treatment of choice. [ABSTRACT FROM AUTHOR]

Gallbladder paraganglioma is a very rare condition, and only a few cases have been reported in the literature. Herein, we present and discuss the clinical and radiological findings of a 72-year-old woman who complained of heaviness, pain, and on and off watery discharge from the left ear for 1 year and reduced hearing in both ears. She was thoroughly investigated radiologically where multiple paragangliomas were found with the discovery of the very rare gallbladder paraganglioma. There is a need to realize the importance of thorough radiological evaluation in cases of head and neck paraganglioma to look for more such lesions in the body for early identification of patients with familial paraganglioma syndromes. With this practice, gene mutation carriers can be identified early in the course of their disease and brought to surgical attention before their disease becomes extensive and potentially life-threatening. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Pathology is the property of Canadian Association of Pathologists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx. Methods: We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005–December 31, 2017). Patient, tumor, embolization, and outcomes data were extracted by reviewing inpatient and outpatient clinical and imaging records. Results: Seven patients were studied (5/7 [71%] female), 6 with glomus jugulares and 1 with a glomus vagale. The median age was 52 years, and the most common presenting symptom was cranial neuropathy (6/7 [86%]). The tumor vascular supply was from the ascending pharyngeal artery in all 7 cases (100%) with additional feeders including the occipital artery in 5 (71%); internal carotid artery in 3 (43%); middle meningeal, vertebral, and internal maxillary artery each in 2 (29%); and posterior auricular artery in 1 (14%). The median postembolization tumor devascularization was 80% (range, 64–95%). The only postembolization complication was a facial palsy in 1 patient. Conclusion: Preoperative embolization with Onyx affords excellent devascularization for the majority of skull base paragangliomas, and it may facilitate resection of these hypervascular lesions. The advantages provided by Onyx with respect to penetration of intratumoral vessels must be weighed against the risk of cranial neuropathy. [ABSTRACT FROM AUTHOR]

Background and Purpose  This study was aimed to investigate the role of dynamic TurboFLASH gadolinium (Gd) magnetic resonance (MR) imaging in improving the differential diagnosis of skull base tumors. Methods  Eleven patients with skull base tumors underwent standard MR and ultrafast TurboFLASH sequence during gadolinium injection. Results  The characterization of tumor vascularity was performed. Different patterns of gadolinium uptake for each tumor type were observed. This is particularly important to identify tumors at high risk of intraoperative bleeding. All glomus tumors, typically highly vascularized, showed an enhancement at the arterial phase, reflecting the arterialization of these tumors which is not detectable on conventional MR. No signal increase at the arterial phase was instead observed in other cases in which the ruling out of a glomus tumor was important because of the location of the lesion. Moreover TurboFLASH identified the pathognomonic "filling-in" profile of cavernous sinus cavernous hemangiomas (CSCH), that is, the progressive centripetal enhancement of the lesion at the beginning of the venous phase. Conclusion  The dynamic analysis of tumor contrast enhancement with the TurboFLASH sequence provides useful additional information to that obtained with conventional MR, improving the differential diagnosis of skull base tumors, particularly in the distinction between glomus and nonglomus tumors and in diagnosing CSCH. [ABSTRACT FROM AUTHOR]

We present a patient with a painful, mobile nodule on the elbow. The nodule was skin-colored and had no punctum or discharge. It was excised and histopathology showed that the lesion was a glomangioma, or glomuvenous malformation. This is a neoplasm that arises from the glomus body, a thermoregulatory neurovascular structure. The glomus body is composed of glomus cells, vascular cells, and smooth muscle cells. Three subtypes of neoplasms may arise from the glomus body, depending on the extent to which they involve the three types of cells. They include glomus tumors, glomangiomas/glomuvenous malformations, and glomangiomyomas. This case was unusual in that it did not present with surface color change to indicate a vascular component. [ABSTRACT FROM AUTHOR]

Background: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. Aims/objectives: This study aimed to express the safety of paraganglioma surgery regarding complications, treatment, and outcomes of patients with head and neck glomus tumors. Materials and methods: Medical records of patients who were operated because of head and neck paraganglioma between 2006 and 2016 were reviewed. Results: The study group consisted of 49 patients (M/F: 6/43). The patients were distributed as follows: 22 glomus caroticum (GC) (44.8%), 8 glomus jugulare (GJ) (16.3%), 10 glomus tympanicum (GT) (20.4%), 4 glomus vagale (GV) (8.1%), 2 GC + GV (4%), 2 bilateral GC (4%) and 1 thyroidal glomus tumor (2%). All GC and GV tumors were resected via cervical approach. Three of GJ tumors were resected through transmastoid approach while five of them were resected through both transmastoid and cervical approach. Nine GT tumors were resected via transmastoid approach. One patient received cyberknife. Thyroid paraganglioma was diagnosed incidentally after total thyroidectomy. Mean follow-up period was 61.92 ± 35.11 months (1–124 m). Conclusions and significance: The choice of treatment depends on the size, location and biologic activity of tumor as well as the physical condition of the patient. Our results show that glomus tumors can be resected with low mortality and morbidity rates due to developing imaging and microsurgical methods. [ABSTRACT FROM AUTHOR]

Background: Glomus tumors present as painful lesions, most commonly in the fingertips. These can present to outpatient clinics of multiple specialties. Materials and Methods: Retrospective review was performed of 37 patients diagnosed as having glomus tumor in the thumb or fingertips over a 10-year period. The data collected included demographics, presenting symptoms, duration, previous treatment history, physical examination, treatment, and recurrence. The data were presented by means of descriptive statistics. Results: The mean duration of symptoms before presentation was 3.8 years (range 2 to 12 years). The mean age at presentation was 38 years (range 16 to 62 years), and female to male ratio was 21:16. Twenty-two patients had left-hand involvement; thumb 8, index finger 5, middle finger 5, ring finger 14, and little finger 5. Clinical and radiological assessments were made preoperatively. At presentation, 18 cases had nail changes, whereas 19 had no obvious nail changes – out of these, 4 had pulp involvement. The lesion involved the subungual region in 33 cases. The mean size of the lesion was 3.8 mm (range 2 to 10 mm). Thirty-six patients were found to have histopathologically proven glomus tumors, whereas in one no specific lesion was found on histopathological examination; this patient returned with recurrence of symptoms at 2-month follow-up. There was no other patient experienced recurrence of symptoms. Conclusion: Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses. [ABSTRACT FROM AUTHOR]

Die Therapie der seltenen Tumorentität zervikales Paragangliom (PG) durchläuft aktuell einen Paradigmenwechsel. Während bei kleinen Glomus-caroticum-Tumoren, malignen sowie endokrin aktiven Tumoren die chirurgische Resektion die Therapie der Wahl darstellt, sollte eine Operation bei lokal fortgeschrittenen Glomus-caroticum-Tumoren und vagalen PG kritisch diskutiert werden. Aufgrund der unmittelbaren Nähe dieser hypervaskularisierten Tumoren zu den kaudalen Hirnnerven besteht nach einer Resektion insbesondere bei lokal fortgeschrittenen zervikalen PG das Risiko gravierender nervaler Schäden mit einer erheblichen Beeinträchtigung der Lebensqualität, sodass ein restriktives operatives Vorgehen angebracht ist. Die externe Strahlentherapie kann eine gleichwertige primäre Therapieoption hinsichtlich Rezidivfreiheit bei geringerer Morbidität darstellen. Das langsame Tumorwachstum und die Tendenz der hereditären zervikalen PG zur Multifokalität bzw. signifikante Komorbiditäten älterer, asymptomatischer Patienten rechtfertigen ein zunehmend weniger aggressives Vorgehen in der Therapiestrategie dieser Tumoren. Mit dem Wait-and-scan-Management ist eine engmaschige, bildgebende und klinische Reevaluierung verbunden. Die Größe und Lokalisation des Tumors, dessen Wachstumsgeschwindigkeit, Genetik, Patientenalter und Allgemeinzustand sowie therapiebeeinflussende Komorbiditäten, das Vorliegen synchroner PG und/oder vasoaktiver katecholaminproduzierender Tumoren müssen vor dem Therapiebeginn identifiziert und in der multidisziplinären Therapieplanung zwingend berücksichtigt werden. Obwohl Best-practice-Algorithmen zur Therapie der zervikalen PG zur Verfügung stehen, haben die innovativen Entwicklungen der letzten Jahre zu patientenadaptierten, individuellen Therapieansätzen geführt. [ABSTRACT FROM AUTHOR]

Copyright of Jornal Brasileiro de Patologia e Medicina Laboratorial is the property of Sociedade Brasileira de Patologia Clinica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Glomus tumors are rare and benign hypervascular tumors. Surgery represented the mainstay of their treatment, even if it has been associated with high morbidity and mortality rates. Recently, the treatment shifted to a multimodal approach and Gamma Knife radiosurgery represents one of the treatment options. Methods: Authors retrospectively analyzed the clinical and radiological outcome of a series of patients who underwent Gamma Knife radiosurgery for glomus tumors. Results: Thirty patients underwent Gamma Knife radiosurgery. Mean tumor volume was 7.69 cc (range 0.36‐24.6). Mean tumor margin dose was 16 Gy (range 13‐18). Median follow‐up was of 91 months (mean 90; range 11‐172). Overall clinical control rate was 100%; overall volumetric tumor control rate was 96.6%. Patients' and tumors' characteristics, treatment data, and outcome have been analyzed. Conclusion: Gamma Knife radiosurgery represents a safe and effective treatment for glomus tumors. Longer follow‐up and larger cohort studies are needed to definitively outline the role of Gamma Knife radiosurgery for glomus tumors. [ABSTRACT FROM AUTHOR]

Glomus tumors are benign tumors of the skin. Clinically, these tumors can present as solid, painful subcutaneous nodules, frequently seen on the hand (particularly subungual region). Glomangiomyomas are the least common histological type of glomus tumor. In the literature, there are only a few glomangiomyoma cases of the forearm location. We report a patient with a painful nodule, diagnosed as glomangio-myoma. Surgical excision was performed and no recurrence was observed after 5 years' followup. [ABSTRACT FROM AUTHOR]

Chemosensory glomus cells of the carotid bodies release transmitters, including ATP and dopamine mainly via the exocytosis of small dense core granules (SDCGs, vesicular diameter of ∼100 nm). Using carbon-fiber amperometry, we showed previously that with a modest uniform elevation in cytosolic Ca2+ concentration ([Ca2+]i of ∼0.5 µM), SDCGs of rat glomus cells predominantly underwent a "kiss-and-run" mode of exocytosis. Here, we examined whether a larger [Ca2+]i rise influenced the mode of exocytosis. Activation of voltage-gated Ca2+ channels by a train of voltage-clamped depolarizations which elevated [Ca2+]i to ∼1.6 μM increased the cell membrane capacitance by ∼2.5%. At 30 s after such a stimulus, only 5% of the added membrane was retrieved. Flash photolysis of caged-Ca2+ (which elevated [Ca2+]i to ∼16 μM) increased cell membrane capacitance by ∼13%, and only ∼30% of the added membrane was retrieved at 30 s after the UV flash. When exocytosis and endocytosis were monitored using the two-photon excitation and extracellular polar tracer (TEP) imaging of FM1-43 fluorescence in conjunction with photolysis of caged Ca2+, almost uniform exocytosis was detected over the cell's entire surface and it was followed by slow endocytosis. Immunocytochemistry showed that the cytoplasmic densities of dynamin I, II and clathrin (key proteins that mediate endocytosis) in glomus cells were less than half of those in adrenal chromaffin cells, suggesting that a lower expression of endocytotic machinery may underlie the slow endocytosis in glomus cells. An analysis of the relative change in the signals from two fluorescent dyes that simultaneously monitored the addition of vesicular volume and plasma membrane surface area, suggested that with an intense stimulus, SDCGs of glomus cells underwent full fusion without any significant "compound" exocytosis. Therefore, during a severe hypoxic challenge, glomus granules undergo full fusion for a more complete release of transmitters. [ABSTRACT FROM AUTHOR]

Glomus tumors are rare neoplasms that characteristically occur in subungual regions, but may also be found in other regions of the body. The clinical diagnosis of this tumor may be difficult if the tumor is located in an extradigital site. Most extradigital glomus tumors form in superficial locations. Herein, we present the case of a 34-year-old woman who experienced chronic knee pain with pinpoint tenderness resulting from a deep-seated periosteal glomus tumor of the distal femur. Extradigital glomus tumors should be considered in the differential diagnosis when characteristic clinical features and imaging findings indicative of glomus tumors are present, even if the tumor is located within deep tissues. [ABSTRACT FROM AUTHOR]

Introduction: Glomus tumors are rare benign mesenchymal neoplasms accounting for only 2% of all types of soft tissue tumors. Commonly located in the peripheral soft tissues, they are most frequently encountered in the subungual areas of fingers and toes, and very rarely in visceral organs due to the absence of glomus bodies. To date, 22 cases of primary renal glomus tumors have been described in the literature, of which 17 benign, with no evidence of recurrence or metastasis, three cases of malignant glomus tumor, and two cases with uncertain malignant potential. Case report: We report the 18th case of a benign glomus tumor of the kidney in a 49-year-old female patient, presenting the microscopic appearance (round, uniform cells with indistinct borders, scant finely granular eosinophilic cytoplasm, round nuclei lacking prominent nucleoli, arranged in solid sheets, accompanied by slit-like vascular spaces), the immunohistochemical profile (tumor cells showed immunoreactivity for smooth muscle actin, vimentin, as well as for CD34; they were negative for AE1/AE3, desmin, HMB-45, S-100 protein, renin, and chromogranin), and the differential diagnosis of this rare entity (juxtaglomerular tumor, angiomyolipoma, hemangioma, epithelioid leyomioma, solitary fibrous tumor, carcinoid tumor, and paraganglioma). Conclusion: Primary renal glomus tumors are rare tumors that radiologically can mimic other mesenchymal renal neoplasm. Accurate diagnosis is based on the microscopic appearance and especially the characteristic immunophenotype. [ABSTRACT FROM AUTHOR]

The article presents a case of an 18-year-old woman who was admitted due to pain in her right shoulder region, insidious in onset with no inciting event or glaring trauma. She underwent magnetic resonance (MR) imaging of the right upper extremity and open exploration of her right infraclavicular brachial plexus. She was eventually diagnosed with malignant glomus tumor of the brachial plexus and was treated with molecularly targeted therapy.

Background. Glomus tumors are rare and mostly benign lesions of the subcutaneous tissue. Single lesions are preferably located on theacral parts of the body, including the subungual nail apparatus. Observations. We analyzed our files for glomus tumors of the last 10 years and found four tumors, with an equal gender distribution. The patients' age ranged from 41 to 78 years. The dominant site was subungual on fingers. Advanced and long-standing tumors tend to destroy the overlying nail plate. Another tumor was found on the plantar heel. All patients had a delayed diagnosis between ¾ of a year to three years. Nail plate dermoscopy is a useful tool for diagnosis of early subungual lesions. All tumors were successfully treated surgically with rapid and complete pain relief. Histologically, all four tumors were of the glomangioma subtype with predominant vascular structure. No relapse occurred within a follow-up of up to nine years. Conclusions. Glomus tumors are rare. In case of subungual localization, nail plate dermoscopy is a useful non-invasive diagnostic tool. The treatment of choice is complete tumor removal by surgery. A better knowledge of this tumor will help to reduce the time to final diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Experiments conducted to understand how arbuscular mycorrhizal (AM) inoculation or biochar application affect plant growth and heavy metal uptake have thus far looked at single applications of either soil amendment. There is little evidence of their synergistic effects, in particular for plants grown in cadmium (Cd) contaminated soil. We conducted a mesocosm experiment to investigate the effect of AM inoculation ( Glomus intraradices BEG 141) and/or wheat-straw biochar amendment on maize ( Zea mays L. cv. Hongdan No. 897) growth, antioxidant enzymatic activities, and Cd uptake, as well as soil Cd speciation under applications of 0, 3, 6 mg Cd per kg soil. Applying either AM inoculant or biochar alone significantly increased maize growth and reduced Cd uptake. Furthermore, solo AM inoculation alleviating Cd stress more fully than biochar, in turn facilitating maize growth and decreasing soil Cd translocation into plant tissue. Still, solo biochar amendment was more effective at inducing soil alkalinization and contributing to Cd immobilization. Adding biochar together with AM inoculant significantly promoted fungal populations compared to a control. Amending soil with AM inoculant and biochar together produced the largest increase in maize growth and decrease in tissue Cd concentrations. This effect was additive, with 79.1% greater biomass, 51.42%, 82.91%, 43.96% higher activities of superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and 50.06%, 67.19%, 58.04% and 76.19% lower Cd concentrations in roots, stems, leaves, and ears, respectively, at a 6 mg kg −1 Cd contamination rate. The combined treatment also had a synergistic effect on inducing soil alkalinization and causing Cd immobilization, and decreasing Cd phytoavailability and post-harvest transfer risks. These results suggest that AM inoculation in combination with biochar application may be applicable not only for maize production but also for phytostabilization of Cd-contaminated soil. [ABSTRACT FROM AUTHOR]

Extra-adrenal paraganglioma has never been described in the extremities. A 34-year-old woman complained of an enlarging mass in the right forearm for 18 months. Imaging showed a circumscribed vascular tumor attached to the ulnar nerve; biopsy revealed features of paraganglioma. The resected tumor consisted of zellballen pattern of chief cells staining positively for chromogranin with surrounding S100-positive sustentacular cells. The chief cells contained many neurosecretory granules and mitochondria, whereas the sustentacular cells contained a large amount of rough endoplasmic reticulum and some microfilaments. There was adjacent extensive glomus cell hyperplasia and tumorlet formation. The intraoperative blood pressure dropped abruptly on tumor removal. The serum normetanephrine level decreased from a preoperative level of 1987 pg/mL (normal < 149 pg/mL) to normal after operation. The patient admitted on questioning to a history of paroxysmal attacks of transient palpitation, hand tremors, and sweating; imaging showed no evidence of tumor in other parts of the body, and there was no family history of similar tumor; she remained well 33 months after the operation. This occurrence of functional ulnar nerve paraganglioma with the hitherto undescribed associated glomus cell hyperplasia and tumorlet formation attests to the probable existence of normal sympathetic paraganglia in the extremity and their intimate functional relationship with glomus bodies. [ABSTRACT FROM AUTHOR]

Gastric glomus tumour is a rare benign mesenchymal neoplasm composed of modified smooth muscle cells and neoplastic counter part of perivascular glomus body. Commonest site of glomus tumour being distal extremities (Subungual region of the finger tips, palm wrist and toes). Usually benign, may metastasize to liver and cause death; malignant behavior more likely if > 5 cm. In the gastrointestinal tract, stomach is the most common site of glomus tumors and present as submucosal masses that project into the lumen or out onto the serosa. Rare in solid organs – liver, kidney, Gastrointestinal (GI) tract; common GI site is stomach and are usually single tumor. It comprises of about 1% of all gastric mesenchymal tumours. After the 1st description of gastric glomus tumour in 1951 by Key et al only few cases have been reported. The correct assessment of the patient optimizes the chance for an accurate pre operative diagnosis and leads to a correct surgical or endoscopic intervention. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46-year-old woman who was referred after she received a wedge liver biopsy for abnormal liver function tests during the time of a cholecystectomy. A histological evaluation of the liver lesion, brought on by the diagnosis of a stomach tumour as glomus tumour, reclassified the liver lesion as a glomus tumour.

Glomus tympanicum is a tumour classified under the group glomus tumours, and is also known as paragangliomas. It is thought to commonly occur in women in the fifth to sixth decades of life. Here, we report a case of a 77-year-old lady with multiple co-morbids and a diagnosis of glomus tympanicum presenting to us. Her symptoms included pulsatile tinnitus, and reduced hearing, and the management of the case was done with consideration for her underlying multiple comorbidities. This paper also describes the best modality of treatment for this patient with regard to her background history. The treatment goal was to improve her quality of life and control the disease. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to describe the clinical presentation, management, and outcomes of glomus tympanicum (GT) Grade 1–3 (based on Glasscock Jackson staging). Materials and Methods: This is a retrospective chart review of five patients who presented with GT (Grade 1–3) over a period of 4 years to a tertiary hospital. All of them had undergone tumor excision without preoperative embolization. Details of clinical features, diagnostic protocol, surgical approach based on grade of tumor, tumor control, treatment complications, and follow-up results were noted and analyzed. Results: All five patients presented with unilateral hearing loss and tinnitus. Imaging done was magnetic resonance imaging with gadolinium of the brain and high-resolution temporal bone computed tomography. Three patients had transmastoid facial recess approach and one had transcanal approach for tumor removal. One patient had canal wall down mastoidectomy. The average follow-up was 34.8 months. Symptomatic improvement in pulsatile tinnitus was observed in all patients. Hearing remained the same in 1 patient and improved in 4 patients. One patient presented with cholesteatoma 1 year postsurgery. None of the patients had recurrence/residual tumor. Conclusions: GT Grades 1–3 can be managed successfully without preoperative embolization. This gives satisfactory results with respect to hearing improvement and recurrence rates. [ABSTRACT FROM AUTHOR]