Taikyoku Tei

Chemodectoma of the Glomus Jugulare with Multiple Metastases

A relatively rare case of chemodectoma of the glomus jugulare with multiple metastases is reported. Ten years ago, a 37-year-old male was seen because of dysphagia and a mass in the right retro-auricular region. The mass in the right jugular foramen was partially resected and irradiated. Histological examination revealed a chemodectoma. Five years thereafter the patient was readmitted with an epidural mass involving the left eighth cervical nerve root. One year later he developed a chest pain and lumbago. A bone scan revealed multiple skeletal metastases. Histologically, specimens from the right parietal bone and the right 10th rib showed a chemodectoma. He was again irradiated. He was again admitted with paraplegia, 9 years after the first admission. With repeated irradiation with a total dose of 16, 700 rads in 10 years, he died with cachexia and aspiration pneumonia at the age of 47. The autopsy revealed multiple metastases of chemodectoma to bone, spinal epidural space, lung, and pancreas. Although chemodectoma of the glomus jugulare is generally considered to be a rare benign tumor, slow metastatic spread to various organs is not uncommon. A careful search for metastatic lesions, possibly for years is essential when following up the patient.

Spontaneous Extrusion of Peritoneal Tubes after Ventriculoperitoneal Shunting

Migration of peritoneal tubes was observed in two cases of ventriculoperitoneal (VP) shunting. The first patient had undergone revision of VP shunting for hydrocephalus at the age of 7 months. He had been well until the age of 16 months, when umbilical erosion was noted. Physical examination revealed that the distal tip of the peritoneal tube (non-spiral wire type) was protruding through the umbilicus. However, the patient was well, and the tube was replaced. The removed tube was contaminated with Staphylococcus aureus, but administration of antibiotics prevented postoperative infection. The second patient, an 8-month-old boy, was brought in because of failure to thrive and feeding difficulty 5 months after VP shunting for hydrocephalus. Physical examination disclosed that the distal tip of the peritoneal tube (again, a non-spiral wire type) was protruding through the anus. The cerebrospinal fluid obtained by puncture of the fontanelle yielded a turbid fluid. There was no evidence of peritonitis. The distal tube was removed, and ventricular drainage, along with administration of antibiotics, was maintained for 1 month. The shunting system was then revised. There have been 53 reported cases of migration of shunting tubes, most of which were located in the bowel. Transumbilical migration has been previously reported only once. In that case as well as ours, Pudenz peritoneal tubes without a spiral wire were used. However, several authors have noted an increased incidence of spontaneous extrusion of the Raimondi type peritoneal tube with a spiral wire. Meningitis and/or ventriculitis carried the worst prognosis. Patients with VP shunts should be regularly examined to avoid the sort of rare complication described here.