A Rare Case of Carotid Body Tumor Presenting with Internal Carotid Artery Blood Supply and Carotid Sinus Syndrome.

Correspondence To the Editor: Carotid body tumor (CBT) is a highly vascular neoplasm of neural crest origin arising in paraganglial cells of the carotid bifurcation. Branches from external carotid artery or glomic artery arising at the bifurcation of common carotid artery dominate in the blood supply mode. Only very few cases with supplementary blood supply from an internal carotid artery (ICA) have been reported in literature, but were still short of imaging proof. Here, we report an extremely rare case of CBT with blood supply from ICA, which had been performed 4 times of unaccomplished surgical explorations before the tumor was excised during the 5 th time of surgery. She also presented carotid sinus syndrome that was also extremely rare among CBT patients. A 52‑year‑old woman was admitted to the Department of Otolaryngology Head and Neck Surgery with a history of neck mass on the right side for 25 years and 4 times of surgical explorations. She felt dizziness when the mass had grown for 20 years, experienced palpitation and vomiting once 5 years ago when she was working in the field, faintness and falling to the bed twice at later time, but never had vertigo. Physical examination revealed a mass sized 8 cm × 10 cm in the right neck. Enhanced computed tomography (CT) angiography and digital subtraction angiography demonstrated a mass located at carotid bifurcation with rich blood supply germinated from ICA stump, the distal end of ICA was almost obstructed [Figure 1a and 1b]. Routine electrocardiogram revealed no abnormalities. Matas test was unable to be carried out because the tumor was so large, extending from the right skull base to the supraclavicular fossa, which made a tangible compression infeasible, while balloon occlusion test proved that a temporary 30 min occlusion of ICA brought about no significant symptoms and signs of neurological or sensorimotor system, preoperative embolization was not routinely carried out. During surgery, the internal jugular vein, vagus nerve, hypoglossal nerve and sympathetic trunk were preserved. The ICA and external carotid arteries were hard to free from surrounding tissues, and a carotid artery bypass was also not easy to put into the carotid artery. When the ICA was cut across, the blood oozed out very slow rather than ejaculated [Figure 1c]. Based on the occlusion test results, the carotid arteries including internal, external and common carotid artery were ligated. The patient was followed for 2 years and …