Glomus tumors

GLOMUS TUMOURS

1. Glomus tumors Dr. AJAY MANICKAM JR – RG KAR MEDICAL COLLEGE

2. 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

3. 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

4. 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

5. Clinical features Incidence Middle aged, female Familial with autosomal dominant pattern but can be sporadic also

6. 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

7. 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

8. 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

9. 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

10. 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