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Difference between revisions of "Paraganglioma"
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| Site = abdomen (adrenal gland paraganglioma = pheochromocytoma), head and neck (carotid body tumour) | | Site = abdomen (adrenal gland paraganglioma = pheochromocytoma), head and neck (carotid body tumour) | ||
| Assdx = | | Assdx = | ||
| Syndromes = [[von Hippel Lindau]], hereditary paragangliomatosis, [[neurofibromatosis]] type 1 (von Recklinghausen disease), [[MEN 2A]], [[MEN 2B]], Carney-Stratakis syndrome, [[Carney triad]] | | Syndromes = [[von Hippel Lindau]], hereditary paragangliomatosis, [[neurofibromatosis]] type 1 (von Recklinghausen disease), [[MEN 2A]], [[MEN 2B]], [[Carney-Stratakis syndrome]], [[Carney triad]] | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
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*Definition: tumour of paraganglion. | *Definition: tumour of paraganglion. | ||
**Can be sympathetic or parasympathetic. | **Can be sympathetic or parasympathetic. | ||
**Locations of paraganglia | |||
***Paravertebral (retroperitoneal) | |||
***Near the large blood vessels of the head and neck and base of skull | |||
***Scattered in other tissues | |||
*Most common paraganglioma = [[pheochromocytoma]].<ref name=Ref_EP_327>{{Ref EP|327}}</ref> | *Most common paraganglioma = [[pheochromocytoma]].<ref name=Ref_EP_327>{{Ref EP|327}}</ref> | ||
**Head & neck most common | **Sites relate to locations of paraganglia | ||
*Carotid body tumour = paraganglioma of carotid body. | ****Head & neck most common - neck, ear, carotid body, base of skull | ||
****Retroperitoneal/abdomen | |||
****Bladder | |||
Special site names | |||
*Carotid body tumour = paraganglioma of carotid body - very vascular - right near a major artery. Don't stick a needle in it. | |||
*Glomus tympanicum tumor = paraganglioma of the middle ear - pulsitile tintinitis and conductive hearing loss. | |||
*Pheochromocytoma - basically a 'paraganglioma' in the adrenal medulla | |||
===Epidemiology=== | ===Epidemiology=== | ||
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*[[MEN 2A]]. | *[[MEN 2A]]. | ||
*[[MEN 2B]]. | *[[MEN 2B]]. | ||
*Carney-Stratakis syndrome - [[GIST]]s and paraganglioma.<ref>{{Cite journal | last1 = Blay | first1 = JY. | last2 = Blomqvist | first2 = C. | last3 = Bonvalot | first3 = S. | last4 = Boukovinas | first4 = I. | last5 = Casali | first5 = PG. | last6 = De Alava | first6 = E. | last7 = Dei Tos | first7 = AP. | last8 = Dirksen | first8 = U. | last9 = Duffaud | first9 = F. | title = Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal = Ann Oncol | volume = 23 Suppl 7 | issue = | pages = vii49-55 | month = Oct | year = 2012 | doi = 10.1093/annonc/mds252 | PMID = 22997454 | url = http://annonc.oxfordjournals.org/content/23/suppl_7/vii49.full }}</ref> | *[[Carney-Stratakis syndrome]] - [[GIST]]s and paraganglioma.<ref>{{Cite journal | last1 = Blay | first1 = JY. | last2 = Blomqvist | first2 = C. | last3 = Bonvalot | first3 = S. | last4 = Boukovinas | first4 = I. | last5 = Casali | first5 = PG. | last6 = De Alava | first6 = E. | last7 = Dei Tos | first7 = AP. | last8 = Dirksen | first8 = U. | last9 = Duffaud | first9 = F. | title = Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal = Ann Oncol | volume = 23 Suppl 7 | issue = | pages = vii49-55 | month = Oct | year = 2012 | doi = 10.1093/annonc/mds252 | PMID = 22997454 | url = http://annonc.oxfordjournals.org/content/23/suppl_7/vii49.full }}</ref> | ||
*[[Succinate dehydrogenase|SDH]] mutation associated (SDHB, SDHC and SDHD).<ref name=pmid24523625>{{Cite journal | last1 = Lefebvre | first1 = M. | last2 = Foulkes | first2 = WD. | title = Pheochromocytoma and paraganglioma syndromes: genetics and management update. | journal = Curr Oncol | volume = 21 | issue = 1 | pages = e8-e17 | month = Feb | year = 2014 | doi = 10.3747/co.21.1579 | PMID = 24523625 }}</ref> | *[[Succinate dehydrogenase|SDH]] mutation associated (SDHB, SDHC and SDHD).<ref name=pmid24523625>{{Cite journal | last1 = Lefebvre | first1 = M. | last2 = Foulkes | first2 = WD. | title = Pheochromocytoma and paraganglioma syndromes: genetics and management update. | journal = Curr Oncol | volume = 21 | issue = 1 | pages = e8-e17 | month = Feb | year = 2014 | doi = 10.3747/co.21.1579 | PMID = 24523625 }}</ref> | ||
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*Zellballen - nests of cells - '''key low power feature'''. | *Zellballen - nests of cells - '''key low power feature'''. | ||
**Zellballen is "cell balls" in German. | **Zellballen is "cell balls" in German. | ||
*Fibrovascular septae. | *Fibrovascular septae and sustentacular cells (structural support cell). | ||
*Finely granular cytoplasm (salt-and-pepper nuclei). | *Finely granular cytoplasm (salt-and-pepper nuclei). | ||
*+/-Hemorrhage - very common. | *+/-Hemorrhage - very common. | ||
| Line 124: | Line 135: | ||
*Chromogranin +ve. | *Chromogranin +ve. | ||
*Synaptophysin +ve. | *Synaptophysin +ve. | ||
*S100 +ve/-ve | *S100 +ve/-ve (+ve in sustentacular cells, not tumor cells) | ||
*Cytokeratin -ve. | *Cytokeratin -ve. | ||
*[[EMA]] -ve. | *[[EMA]] -ve. | ||
| Line 137: | Line 148: | ||
Image: | Image: | ||
*[http://path.upmc.edu/cases/case408/images/fig14.jpg Neurosecretory granules (upmc.edu)].<ref name=em_stuff>URL: [http://path.upmc.edu/cases/case408.html http://path.upmc.edu/cases/case408.html]. Accessed on: 16 January 2012.</ref> | *[http://path.upmc.edu/cases/case408/images/fig14.jpg Neurosecretory granules (upmc.edu)].<ref name=em_stuff>URL: [http://path.upmc.edu/cases/case408.html http://path.upmc.edu/cases/case408.html]. Accessed on: 16 January 2012.</ref> | ||
==Sign out== | |||
<pre> | |||
SOFT TISSUE, LEFT/RIGHT CAROTID BODY, EXCISION: | |||
- PARAGANGLIOMA (SIZE IN CM). | |||
- NEGATIVE RESECTION MARGIN. | |||
</pre> | |||
==See also== | ==See also== | ||