Radiology Grand Rounds XIX

Here is a case of Glomus Jugulare for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

Glomus tumours
Synonyms are paragangliomas and chemodectomas
Location is usually jugular bulb, middle ear, carotid body, vagus nerve, periaortic, larynx, ciliary ganglion, mandible, nose and fallopian canal

Origin is embryonic neuroepithelium in close association with autonomic nervous system
4% are functional
4% are metastatic
Mostly benign and hypervascular

Imaging
CT findings-destruction, expansion, involvement of sites as mentioned above no soft tissue component, intense enhancement with salt and pepper appearance.
MRI shows better delineation of characteristics, extent across CV junction, encasement of vessels, involvement of cranial nerves and IAM as well as intracranial extent

Treatment is controversial
For a small lesion may be only radiosurgery
For a bigger lesion combination of surgery with radiation

The Glasscock-Jackson and Fisch classifications of glomus tumors are widely used. The Fisch classification of glomus tumors is based on extension of the tumor to surrounding anatomic structures and is closely related to mortality and morbidity.
Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)
Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement
Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the pterous apex
Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canal
Type C2 tumor - Tumor invading the vertical portion of the carotid canal
Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal
Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter
Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Images Courtesy

Teleradiology Providers