Results of Treatment in Glomus Jugulare Tumors with Emphasis on Radiotherapy

Since the confirmation of the presence of the glomus jugulare in man by Guild, in 1941, the diagnosis of tumor arising from this structure has been made with increasing frequency. The combination of clinical findings with the typical histologic appearance is diagnostic of this neoplasm, which is malignant mainly by virtue of its property of local invasion. In this paper we propose to add 5 cases of glomus jugulare tumor to 35 biopsy-proved cases collected from the American and British literature and to attempt an evaluation of the efficacy of the various therapeutic modalities. The composition of the material is shown in Table I. The histologic appearance of the glomus body was described by LeComte (1950) as follows: “Nests or clusters of chief cells, which are fairly large, resemble epithelium and vary in shape from round to spindle shaped, depending on how the tissue is processed. These nests are surrounded by a supporting fibrous stroma which is rich in capillaries.” The structures are thus identical in histologic appearance with the carotid body. Description of Case Material Age: The age distribution in our collected series was from eighteen to seventy-one years (Table II), with most patients in the thirty- to sixty-year group. Location: The side of involvement was given in 35 of the 40 cases, 22 of the tumors being on the right and 13 on the left. Thus, left side predominance as described by Hawkins was not seen. Length of History: The time from the onset of symptoms to the first therapeutic measure, either surgery or irradiation, is shown in Table III. Only 10 per cent of patients had any definitive treatment within a year of the onset of symptoms and 17 per cent had no treatment until at least ten years had elapsed. The insidious progression of the tumor adds to the difficulty of assessing the value of treatment. Patients were divided into two groups on the basis of the clinical findings. This was to separate the localized from the more extensive lesions. Group I consists of the patients with aural signs and symptoms, e.g., tinnitus, deafness, aural discharge, or a polyp present in the auditory canal. Also in this category are patients with seventh cranial nerve involvement. These findings suggest that the tumor is confined to the vicinity of the jugular bulb, from the adventitia of which structure most of these tumors arise (Fig. 1). This group numbered 15, or 38 per cent of the 40 cases. In Group II are those patients showing signs of involvement of cranial nerves other than the seventh and eighth (usually the ninth to twelfth), or evidencing other signs of more distal spread, e.g., into the posterior fossa. Twenty-five cases, or 62 per cent, fell in this group. X-ray Findings: Roentgenologically one may see sclerosis of the mastoid and petrous bones, but at a later stage there may be erosion of the mastoid, with large defects appearing in the petrous temporal bone and enlargement of the jugular foramen.