惡性頸動脈體瘤肺轉移一例并文獻復習_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 李怡 ¹ , 陳其章 ¹ , 雷豐豐 ¹ , 陳泉 ²

1. ;
2. ;

Corresponding?author：

李怡, Email: mj7690@163.com

Keywords：

惡性頸動脈體瘤; 肺轉移; 臨床表現; 影像學特點; 治療

DOI：

10.7507/1671-6205.202111023

Video：

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目的探討惡性頸動脈體瘤（malignant carotid body tumor，MCBT）的發病機制、臨床表現、影像學特點及治療。方法回顧 1 例確診 MCBT 的患者資料并結合相關文獻進行復習，以“頸動脈體瘤”、“肺轉移”以及“carotid body tumor”、“lung metastasis”和“pulmonary metastasis”為檢索詞檢索中國知網、萬方、Pubmed 等數據庫，對相關文獻進行分析。結果患者女，20 歲，以“頭暈、伴咳嗽”為首發癥狀，胸部 CT 示兩肺多發粟粒結節，在外院診斷“肺結核”，抗結核治療 10 d 因出現胃腸道反應停用。入院查體發現左側下頜角無痛性腫塊，結合頸動脈 CT 血管成像（CT angiography，CTA）和正電子發射計算機體層顯像聯合計算機體層攝影檢查結果，考慮 MCBT。文獻復習共納入 36 篇文獻，合計 42 例患者。患者臨床表現不典型。頸動脈CTA 病變征象呈“破杯征”，典型“抱球征”消失。手術是主要治療方法，放射治療、化學治療作為輔助手段，基因檢測和分子靶向治療是近年來的研究方向。結論 MCBT 臨床上缺乏特征性表現，當 CT 表現為粟粒結節樣肺轉移瘤時，易誤診為肺結核。應對入院患者進行細致查體，可疑患者行頸動脈 CTA 等檢查，診斷后盡早徹底切除腫瘤以改善患者預后。

Citation： 李怡, 陳其章, 雷豐豐, 陳泉. 惡性頸動脈體瘤肺轉移一例并文獻復習. 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.	Hajnzi? 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.	黃席珍. 化學感受器瘤的診斷和治療. 中華內科雜志, 1978, 17(3): 193-196,241.
25.	徐本義, 李樹玲. 惡性頸動脈體瘤合并廣泛轉移一例. 天津醫藥腫瘤學附刊, 1979, 6(4): 275.
26.	楊蔭清, 李潤明. 化學感受器瘤肺轉移生存八年1例報告. 西安交通大學學報(醫學版), 1981, (S3): 71-73.
27.	高繼東, 李積德, 賈乃鏞, 等. 惡性頸動脈體瘤合并閉經和泌乳一例. 中華內分泌代謝雜志, 2001, 17(1): 57.
28.	陶英杰, 劉經祖, 金銳. 10例惡性頸動脈體瘤之生物學行為分析. 中國腫瘤臨床, 2001, 28(4): 288-289.
29.	汪忠鎬, 潘松齡. 頸動脈體瘤的外科治療. 中國普通外科雜志, 2002, 11(7): 396-398.
30.	馬立公. 頸動脈體惡性化學感受器瘤1例報告. 實用放射學雜志, 2003, 19(3): 246-246.
31.	王鳳明, 章文成, 張侖, 等. 15例惡性頸動脈體瘤的診斷與治療. 中國腫瘤臨床, 2007, 34(20): 1185-1187.
32.	孫艷秋, 鮑海華, 趙希鵬, 等. CTA及MRA對頸動脈體瘤的診斷價值. 實用放射學雜志, 2008, 24(4): 462-464.
33.	張文超, 張侖, 王旭東, 等. 左上頸無痛性腫物明顯增大. 中國腫瘤臨床, 2007, 34(15): 883-886.
34.	沈碧霞, 陸建平, 金愛國, 等. 惡性頸動脈體瘤肝肺轉移1例. 中國醫學影像技術, 2011, 27(2): 436.
35.	黃群. 頸動脈體瘤惡變多器官轉移1例及文獻復習. 中國醫藥指南, 2012, 10(5): 235-236.
36.	張超, 羅濤, 寧雅嬋, 等. 9例頸動脈體瘤的診治. 中華胸心血管外科雜志, 2012, 28(11): 685-687.
37.	黃德亮, 馬玥瑩, 劉良發, 等. 頸動脈體瘤36例手術治療體會. 中華耳鼻咽喉頭頸外科雜志, 2013, 48(12): 1006-1010.
38.	洪亞然, 黃行志, 沈麗達. 惡性頸動脈體副神經節瘤1例報道并文獻復習. 昆明醫科大學學報, 2014, 35(2): 134-135.
39.	錢芳芳, 田建輝. 治療晚期頸動脈體瘤的經驗介紹. 名醫傳承中國民間療法, 2019, 27(17): 14-16.
40.	魏松鋒, 李亦工, 鄭向前, 等. 頸動脈體瘤相關致病基因與其臨床病理特征關系的初步研究. 現代腫瘤醫學, 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.	中華醫學會內分泌學分會. 嗜鉻細胞瘤和副神經節瘤診斷治療專家共識(2020 版). 中華內分泌代謝雜志, 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.	化召輝, 蔡高坡, 張林楓, 等. 頸動脈體瘤線粒體琥珀酸脫氫酶基因突變與臨床病理特征的關系及其對患者預后的預測價值. 中華實驗外科雜志, 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.	趙立威, 陳為軍, 劉亞飛, 等. 肺轉移瘤CT誤診為肺結核病例分析. 臨床誤診誤治, 2019, 32(7): 16-19.
53.	張艷, 楊潁, 高碩辰, 等. 超聲、CT對頸動脈體瘤的診斷價值. 中國實用醫刊, 2018, 45(4): 4-6.
54.	翟雪佳, 于順利, 樊青霞, 等. 轉移性嗜鉻細胞瘤和副神經節瘤的治療現狀及進展. 中華泌尿外科雜志, 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. Hajnzi? 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. 黃席珍. 化學感受器瘤的診斷和治療. 中華內科雜志, 1978, 17(3): 193-196,241.
25. 徐本義, 李樹玲. 惡性頸動脈體瘤合并廣泛轉移一例. 天津醫藥腫瘤學附刊, 1979, 6(4): 275.
26. 楊蔭清, 李潤明. 化學感受器瘤肺轉移生存八年1例報告. 西安交通大學學報(醫學版), 1981, (S3): 71-73.
27. 高繼東, 李積德, 賈乃鏞, 等. 惡性頸動脈體瘤合并閉經和泌乳一例. 中華內分泌代謝雜志, 2001, 17(1): 57.
28. 陶英杰, 劉經祖, 金銳. 10例惡性頸動脈體瘤之生物學行為分析. 中國腫瘤臨床, 2001, 28(4): 288-289.
29. 汪忠鎬, 潘松齡. 頸動脈體瘤的外科治療. 中國普通外科雜志, 2002, 11(7): 396-398.
30. 馬立公. 頸動脈體惡性化學感受器瘤1例報告. 實用放射學雜志, 2003, 19(3): 246-246.
31. 王鳳明, 章文成, 張侖, 等. 15例惡性頸動脈體瘤的診斷與治療. 中國腫瘤臨床, 2007, 34(20): 1185-1187.
32. 孫艷秋, 鮑海華, 趙希鵬, 等. CTA及MRA對頸動脈體瘤的診斷價值. 實用放射學雜志, 2008, 24(4): 462-464.
33. 張文超, 張侖, 王旭東, 等. 左上頸無痛性腫物明顯增大. 中國腫瘤臨床, 2007, 34(15): 883-886.
34. 沈碧霞, 陸建平, 金愛國, 等. 惡性頸動脈體瘤肝肺轉移1例. 中國醫學影像技術, 2011, 27(2): 436.
35. 黃群. 頸動脈體瘤惡變多器官轉移1例及文獻復習. 中國醫藥指南, 2012, 10(5): 235-236.
36. 張超, 羅濤, 寧雅嬋, 等. 9例頸動脈體瘤的診治. 中華胸心血管外科雜志, 2012, 28(11): 685-687.
37. 黃德亮, 馬玥瑩, 劉良發, 等. 頸動脈體瘤36例手術治療體會. 中華耳鼻咽喉頭頸外科雜志, 2013, 48(12): 1006-1010.
38. 洪亞然, 黃行志, 沈麗達. 惡性頸動脈體副神經節瘤1例報道并文獻復習. 昆明醫科大學學報, 2014, 35(2): 134-135.
39. 錢芳芳, 田建輝. 治療晚期頸動脈體瘤的經驗介紹. 名醫傳承中國民間療法, 2019, 27(17): 14-16.
40. 魏松鋒, 李亦工, 鄭向前, 等. 頸動脈體瘤相關致病基因與其臨床病理特征關系的初步研究. 現代腫瘤醫學, 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. 中華醫學會內分泌學分會. 嗜鉻細胞瘤和副神經節瘤診斷治療專家共識(2020 版). 中華內分泌代謝雜志, 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. 化召輝, 蔡高坡, 張林楓, 等. 頸動脈體瘤線粒體琥珀酸脫氫酶基因突變與臨床病理特征的關系及其對患者預后的預測價值. 中華實驗外科雜志, 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. 趙立威, 陳為軍, 劉亞飛, 等. 肺轉移瘤CT誤診為肺結核病例分析. 臨床誤診誤治, 2019, 32(7): 16-19.
53. 張艷, 楊潁, 高碩辰, 等. 超聲、CT對頸動脈體瘤的診斷價值. 中國實用醫刊, 2018, 45(4): 4-6.
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Chinese Journal of Respiratory and Critical Care Medicine

惡性頸動脈體瘤肺轉移一例并文獻復習

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