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Clinical Problem Solving: Radiology
January 2013

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

SECTION EDITOR: C. DOUGLAS PHILLIPS, MD

JAMA Otolaryngol Head Neck Surg. 2013;139(1):94. doi:10.1001/jamaoto.2013.1150b

Diagnosis: Glomus facialis paraganglioma

Paragangliomas are vascular tumors that arise from glomus bodies, which are chemoreceptor cells that are derived from the primitive neural crest. The 4 main locations of these tumors in the head and neck area are the carotid bifurcation (carotid paraganglioma), the jugular bulb region (jugular paraganglioma), the middle ear cavity (tympanic paraganglioma), and the cervical portion of the vagus nerve (vagal paraganglioma).1 Large paragangliomas may invade the facial nerve; however, primary paragangliomas arising within the fallopian canal are rare.2 In most glomus facialis paragangliomas, the first symptom is facial paralysis. In some cases, an external auditory canal or retrotympanic mass may be observed.3 Histopathologic examination of paragangliomas shows vascular tissue around nests of small cells with round nuclei in a Zellballen pattern.1

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