复旦大学：《耳鼻咽喉科学》课程教学资源（PPT课件讲稿，英文版）Glomus jugular tumor

Glomus jugular tumor Chunfu dai m,d ph. d

Glomus jugular tumor Chunfu Dai M.D & Ph.D

Background Originate from chemoreceptor jugular vein a glomus jugulare tumor is arisen in the adventitia of the dome of the jugular bulb This tumor is part of the neuroendocrine system, these tumors are highly vascularized Glomus tumors represent 0.6% of neoplasms of the head and neck

Background ◼ Originate from chemoreceptor jugular vein ◼ glomus jugulare tumor is arisen in the adventitia of the dome of the jugular bulb ◼ This tumor is part of the neuroendocrine system, these tumors are highly vascularized. ◼ Glomus tumors represent 0.6% of neoplasms of the head and neck

Pathology J All paraganglia are composed of chief cells (type I cells, ie, chemoreceptive cells)and sustentacular cells(type l cells, ie, supporting cells). Developmentally, both types of cells are of neuroectodermal origin specifically, they arise from neural crest cells The vast majority of glomus tumors are benign and slow to grow with bone erosion

Pathology ◼ All paraganglia are composed of chief cells (type I cells, ie, chemoreceptive cells) and sustentacular cells (type II cells, ie, supporting cells). Developmentally, both types of cells are of neuroectodermal origin; specifically, they arise from neural crest cells ◼ The vast majority of glomus tumors are benign and slow to grow with bone erosion

Pathology Glomus jugulare tumors are typically located just under the skull base. at the bulb of the internal jugular vein. The tumors may spread superiorly into the jugular foramen, causing CN X, CN X and cn xi deficits The primary blood supply to jugulare tumors is via the ascending pharyngeal artery. In addition he occipital and posterior auricular arteries can contribute to vascularization Intraoperatively ligation of external carotid artery can significantly reduce the hemorrhage

Pathology ◼ Glomus jugulare tumors are typically located just under the skull base, at the bulb of the internal jugular vein. The tumors may spread superiorly into the jugular foramen, causing CN IX, CN X, and CN XI deficits. ◼ The primary blood supply to jugulare tumors is via the ascending pharyngeal artery. In addition, the occipital and posterior auricular arteries can contribute to vascularization. ◼ Intraoperatively ligation of external carotid artery can significantly reduce the hemorrhage

Symptoms Pulsatile tinnitus Conductive hearing loss, aural bleeding, and aural discharge Sensorineural hearing loss vertigo, aural pain and Cranial neuropathy. Such as it can compress CN X, X, and XI

Symptoms ◼ Pulsatile tinnitus, ◼ Conductive hearing loss, aural bleeding, and aural discharge. ◼ Sensorineural hearing loss, vertigo, aural pain and ◼ Cranial neuropathy. Such as it can compress CN IX, X, and XI. ◼

Symptoms Functioning tumors, which are rare, can increase risk of mortality. These active tumors secrete catecholamines which can lead to clinical manifestations of hypertension, headaches, palpitations and tachycardia

Symptoms ◼ Functioning tumors, which are rare, can increase risk of mortality. These active tumors secrete catecholamines, which can lead to clinical manifestations of hypertension, headaches, palpitations, and tachycardia

Signs Positive Brown's sign Aural polyp Cranial nerves involvement

Signs ◼ Positive Brown’s sign. ◼ Aural polyp ◼ Cranial nerves involvement

Lab tests Routine laboratory studies are not helpful In the rare patient with functioning lesions preoperative and postoperative catecholamine measures may help confirm successful resection of the lesion

Lab tests ◼ Routine laboratory studies are not helpful ◼ In the rare patient with functioning lesions, preoperative and postoperative catecholamine measures may help confirm successful resection of the lesion

Image study Acombination of contrast-enhanced ct MRI, and angiography is ideal for proper diagnosis and localization of the tumors 口MR Contrast-enhanced Ct Angiography remains of paramount importance if the diagnosis is obscure or if embolization is planed

Image study ◼ A combination of contrast-enhanced CT, MRI, and angiography is ideal for proper diagnosis and localization of the tumors. ◼ MRI ◼ Contrast-enhanced CT ◼ Angiography remains of paramount importance if the diagnosis is obscure or if embolization is planed

CT Glomus jugulare tumors are enhancing soft-tissue masses at the skull base. but skul base artifact can mask their presence These tumors are seen within the jugular foramen The demonstration of bone erosion of the jugular foramen and petrous apex is often a key finding in the diagnosis Careful review of bone windows is necessary

CT ◼ Glomus jugulare tumors are enhancing soft-tissue masses at the skull base, but skull￾base artifact can mask their presence. ◼ These tumors are seen within the jugular foramen. ◼ The demonstration of bone erosion of the jugular foramen and petrous apex is often a key finding in the diagnosis. Careful review of bone windows is necessary