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Parapharyngeal lesions - Coggle Diagram
Parapharyngeal lesions
Post Styloid
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Paraganglioma: second most common neurogenic PPS tumor: from nodose ganglion of vagus, carotid body (most common - 65%), jug bulb
Familial paraganglioma: younger age and multiple sites. MEN 2- VHL, NF1. Genetic defect Is SDHA/B/C.
should do CT , MRI, 24 hr urs collection of vanillymandelic acid and metanephrines, serum catecholamines
CT shows Irregular destruction of jug foramen and temp bone - MRI shows salt and pepper mix on T1 and T2
Histology: Chief cells - granule storing (unaffected by radiotherapy), sustentacular cells - schwann-like cells, zelballen pattern, chief cell clusters enclosed In fibrous septa
Most common benign neoplasm of the temporal bone - females, left, 5th decade. Carotid body, tympanic, jugular
5% malignant, 3% active secretors
Vessels feeding: Ascending pharyngeal, post auricular, occipital, IMAX, Ipsilateral or contralateral ICA.
Glomus tympanicum: type of paraganglioma - arise In the middle ear, part of ear between eardrum and Inner ear structures
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CPA lesions
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Meningioma (5%)
CT: Isodense to brain, may see calcifications
MRI: t1 -isointense to brain, T2: hyperintense to brain, hypointense to CSF, GAD enhacement
Sessile, broad base, obtuse angle to petrous bone, eccentric over IAC, have dural tail, calficiations
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Epidermoid (3%)
CT: Hypodense to CSF, T1 - hypointense to brain, Isointense to CSF, T2 hyperintense to brain, FLAIR Intermediate
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Uncommon: Metastatic, lipoma, dermoid, teratoma, chordoma, chondrosarcoma, giant cell tumor
Chordoma: Rare, slow growing malingnacy from notochord remnant. Histology: Physaliferous cells (soup bubble appearance) - sphenoocciptal, vertral or sacrococcygeal types. Classic, chondroid or atypical types.
Petrous apex lesions
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Glomus tumours (tympanicum, jugulare)
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