0:00

So the first case that we had was a patient that had pulsatile tinnitus.

0:05

And this was a patient that ended up having multiple gloma tumors.

0:10

So I have to remember exactly where they all were when we first did it. But um,

0:15

yeah, here on this one, um,

0:16

on the left hand side we can see this large gloma tumor and it's actually,

0:20

it's narrowing that int uh, an, uh, excuse me,

0:24

external and internal carotid arteries.

0:26

So technically we're not supposed to use the term GLS tumors anymore.

0:29

People like to use the term paragangliomas. So in the old days,

0:33

I shouldn't say old days, maybe like, you know,

0:35

a few months ago I would call that a GLS Vali. Um,

0:38

but now we're supposed to say paraganglioma vagal type.

0:42

So that's one gloma tumor or paraganglioma. Then we have another,

0:47

uh, paraganglioma that's located here at the jugular. Raven.

0:51

Let me see if I can see that on the T two weighted images. Yeah,

0:54

we can see that right here. You can just follow my hashtag all the way up.

0:59

And that's a paraganglioma that's involved in the jugular foramen.

1:04

And then there's another GLS tumor right here. And this is actually, uh,

1:08

displacing the internal and the external carotid arteries. That would be a, uh,

1:12

GLS tumor, uh, uh, carotid body type.

1:15

And there's another gloma tumor right here, which is, uh, again,

1:19

arising more superiorly and anteriorly displaced in the carotid artery.

1:23

So given the location, that would be a vali as well too.

1:26

So this would be four paragangliomas and multiple paragangliomas.

1:30

So when you see something like this, you have to think of, um,

1:33

some type of familial type of, uh,

1:38

paragangliomas. Um, and there's the deficiency in the succinate dehydrogenase,

1:43

uh, gene, which is, has been associated with multiple paragangliomas.

1:48

Uh, so I can stop there and see if you have any questions for that,

1:51

for this case.

1:54

Not in the E, but I just, you know, expect, eh,

1:58

i I do not expect so many of them can in same patient.

2:03

Well, yesterday I was at tumor. You know, when I go to tumor boards,

2:06

I actually see the patients.

2:08

And so yesterday they showed me a case and the patient wasn't there.

2:12

But this one, they just showed me the films,

2:14

but she actually had multiple paragangliomas and they were actually metastatic.

2:19

And, uh, they were, uh, she actually underwent an octreotide scan.

2:22

Unfortunately, I don't have the disc for that. Um, but um,

2:27

I would like to, I I,

2:28

the octreotide scan was actually very helpful because not only did it the,

2:32

they literally the gloma tumors lit up, but, um, uh,

2:37

they were also, um, showed metastases to the liver.

2:40

So it was actually a malignant form of,

2:45

of metastatic paraganglioma. So it's actually metastatic paragangliomas.

2:50

Oh, you can really meta metastasis I thought is a bit 91.

2:56

Yeah, yeah. Um, yeah, it's, there is that form, which is very unusual

3:02

Because I used to think that if we have the right caric body para can,

3:06

I need to look hard for the left caric body.

3:10

I never expect it occur in other places like Nicum,

3:15

uh, the car. So it's quite new to me.

3:20

Yeah, well teach so.