Glomus tumors
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Transcript of Glomus tumors
GLOMUS TUMORSDr. AJAY MANICKAMJR – RG KAR MEDICAL COLLEGE
THE GLOMUS TUMORS These are chemodactomas or non-
chromaffin paragangliomas arise from glomus bodies distributed along the parasympathetic nerve in the skull base, thorax & neck
GLOMUS TUMOURS Glomus tympanicum –
middle ear promontory Glomus jugulare – jugular
foramen Glomus vagale – when
arising from neck extending towards jugular foramen
When arises from carotid bulb – Carotid Body tumors
PATHOGENESIS Hypervascular tumours arising
from glomus bodies Glomus bodies are found within
adventitia of the jugular bulb, course of glossopharyngeal nerve, vagus nerve, tympanic canaliculus, retrofacial air cells, promontory, geniculate ganglion
They secrete catecholamines, although few cases hypersecretion of noradrenaline, dopamine, serotonin have also been described
Few cases may go for malignant changes and metastasis
CLINICAL FEATURES Incidence Middle aged, female Familial with autosomal dominant pattern but can be
sporadic also
SYMPTOMS Hearing loss Pulsatile tinnitus Blocking sensation of ear Blood stained discharge Otalgia Cranial nerve paralysis –
6,7,9,10,11,12 CN weakness – producing symptoms like diplopia, hoarseness, aspiration, inability to lift shoulder
SIGNS RISING SUN – reddish blue
retrotympanic mass – behind the TM Bleeding and polypoidal mass seen
when there is invasion of TM BROWN’S SIGN – smooth dark mass
blanches in response to via pneumatic pressure through seigelization
CLASSIFICATION - FISCH Type A – tumour localized in ME cavity Type B – tympanomastoid tumours with no destruction of
bone in infralabyrinthine compartment in the temporal bone
Type C – tumour invading bone of the infralabyrinthine compartment
Type D – tumours with intracranial extension
INVESTIGATIONS Audiogram – initially conductive – later SNHL MRI with gadolinium contrast – T1 weighed
image shows salt & pepper appearance CT SCAN – PHELP’S SIGN – normal crest
between the carotid canal and jugular foramen lost
Digital subtraction angigraphy – helps us to know feeding arteries for preoperative embolization
24 hour urine Vanillyl mandelic acid level – as tumour secrete catecholamines which can cause increase in BP
TREATMENT Surgery Type A & B – Trans mastoid approach Type C & D – Lateral skull base approach Embolization – preoperative before 48 hours can reduce
intra operative bleeding Radiotherapy & chemotherapy for unresectable tumours LASER assisted excision - gives good results