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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 337-338
Carotid body tumor and amyloidosis: An uncommon association


Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication9-Mar-2010
 

How to cite this article:
Gupta A, Khaira A, Bhowmik D, Agarwal SK, Tiwari SC. Carotid body tumor and amyloidosis: An uncommon association. Saudi J Kidney Dis Transpl 2010;21:337-8

How to cite this URL:
Gupta A, Khaira A, Bhowmik D, Agarwal SK, Tiwari SC. Carotid body tumor and amyloidosis: An uncommon association. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Nov 21];21:337-8. Available from: http://www.sjkdt.org/text.asp?2010/21/2/337/60206
To the Editor,

We report a 55 year old male with swelling over right submandibular area. It was 3.7 × 3.5 cm on palpation, progressively increasing, non­tender and pulsatile at the time of presentation. Physical examination revealed blood pressure of 106/62 mmHg with systemic examination being essentially normal. A contrast computed tomogram of the neck showed enhancing mass in right carotid space from carotid bifurcation to submandibular region. A carotid angiogra­phy showed excessive blush round carotid area with no evidence of carotid aneurysm. Pre anes­thesia investigations were normal except for trace urine proteins which were ignored. Exci­sion of mass along with surrounding lymph nodes was done. Histopathology showed a para­ganglioma with reactive lymph node hyper­plasia. A month later he reported with swelling all over the body. Blood pressure was 100/60 mmHg. Investigations showed hemoglobin 10.5 g/dL, total leukocyte count 8900/mm 3 , platelet count 333000/mm 3 , INR 1.2, blood urea 34 mg/ dL, serum creatinine 0.9 mg/dL, fasting plasma glucose 88 mg/dL, serum proteins 4.3 g/dL, serum albumin 1.1 g/dL and serum cholesterol 133 mg/dL. Urine routine showed proteins 4+, WBC 0-1, RBC 1-2/hpf. 24-hour urine pro­teins were 6 g/day. Serum electrophoresis and 24-hour urine immunofixation electrophoresis did not show anymonoclonal spike. Thyroid function tests were normal. ANA, ANCA, C3, C4 and Anti dsDNA were normal. Ultrasound abdomen showed normal study. Echocardio­graphy and nerve conduction studies were also normal. Renal biopsy was suggestive of amy­loidosis.

The incidence of secondary amyloidosis with tumors as underlying cause is declining. In one of the large study, it accounts for 2% of the causes. [1] Amongst tumors, the association of carotid body tumor with amyloidosis is scarce in world literature. Only one previous case of bilateral carotid body tumor with atypical me­ningioma with systemic amyloidosis has been reported at autopsy. However whether carotid body tumor or meningioma attributed to amy­loidosis in that case cannot be commented upon. [2] Another case of systemic amyloidosis had familial multiple endocrine neoplasia of which carotid body paragangliomas formed a part. [3] Our case is the first report of isolated uni­lateral paraganglioma associated with amyloi­dosis. No family history or other contributing etiology could be demonstrated. Due to lack of serum amyloid protein scintigraphy and immu­nohistochemical staining using antibodies to serum amyloid A protein, type of amyloid could not be demonstrated. However we feel that in our case it is secondary amyloidosis.

In conclusion, the report highlights a rare association of carotid body tumor paragang­lioma with secondary amyloidosis. A cause­effect relationship may exist between the two and needs to be looked into.

 
   References Top

1.Joss N, McLaughlin K, Simpson K, Boulton­Jones JM. Presentation, survival and prog­nostic markers in AA amyloidosis. Q J Med 2000;93:535-42.  Back to cited text no. 1      
2.Hanako A, Hideaki Y, Junko H, Yoichi N, Hideyuki K, Masaru T. An autopsy case of bilateral carotid body tumors associated with atypical meningioma and systemic amyloi­dosis. Pathol Clin Med 2000;18:165-9.  Back to cited text no. 2      
3.Larraza-Hernandez O, Albores-Saavedra J, Benavides G, Krause LG, Perez-Merizaldi JC, Ginzo A. Multiple endocrine neoplasia. Pitui­tary adenoma, multicentric papillary thyroid carcinoma, bilateral carotid body paragonglio­ma, parathyroid hyperplasia, gastric leiomyoma, and systemic amyloidosis. Am J Clin Pathol 1982;78:527-32.  Back to cited text no. 3      

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Correspondence Address:
Ankur Gupta
Department of Nephrology, All India Institute of Medical Sciences, New Delhi
India
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PMID: 20228525

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