Difference between revisions of "Paraganglioma"

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Image:Paraganglioma_-_chromo_-_intermed_mag.jpg | Paraganglioma - chromogranin A - intermed. mag. (WC)
Image:Paraganglioma_-_chromo_-_intermed_mag.jpg | Paraganglioma - chromogranin A - intermed. mag. (WC)
Image:Paraganglioma_-_s100_-_very_high_mag.jpg | Paraganglioma - S100 - very high mag. (WC)
Image:Paraganglioma_-_s100_-_very_high_mag.jpg | Paraganglioma - S100 - very high mag. (WC)
Image:Retroperitoneum Paraganglioma 2 MP PA.JPG|Retroperitoneum - Paraganglioma - Prominent vascular component (SKB)
Image:Retroperitoneum Paraganglioma 2 HP PA.JPG|Retroperitoneum - Paraganglioma  (SKB)
Image:Retroperitoneum Paraganglioma HP PA.JPG|Retroperitoneum - Paraganglioma - florid atypia  (SKB)
Image:Retroperitoneum Paraganglioma MP CTR.jpg|Retroperitoneum - Paraganglioma - large nests (SKB)
Image:Neck Paraganglioma HP CTR (2).jpg|Neck - Paraganglioma - nice Zeballen (SKB)
Image:Neck Paraganglioma CarotidBody MP PA.JPG|Neck Paraganglioma - Carotid Body Tumor (SKB)
Image:Neck Paraganglioma CarotidBody HP PA.JPG|Neck - Paraganglioma - Carotid Body Tumor (SKB)
Image:Ear Paraganglioma GlomusTympanicumTumor MP PA.JPG|Ear - Paraganglioma - Glomus Tympanicum Tumor (SKB)
Image:Ear Paraganglioma GlomusTympanicumTumor HP 2 PA.JPG|Ear - Paraganglioma - Glomus Tympanicum Tumor  (SKB)
Image:Bladder Paraganglioma PA DSCN4717.JPG|Bladder - Paraganglioma - Presented as micturation syncope (SKB)
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Revision as of 12:32, 31 March 2015

Paraganglioma
Diagnosis in short

Paraganglioma. H&E stain.
LM Zellballen (nests of cells), fibrovascular septae, salt-and-pepper nuclei, +/-hemorrhage (very common)
LM DDx neuroendocrine tumour, pheochromocytoma (paraganglioma of the adrenal gland), gangliocytic paraganglioma
IHC chromogranin +ve, synaptophysin +ve, CD56 +ve
Gross dusky colour
Site abdomen (adrenal gland paraganglioma = pheochromocytoma), head and neck (carotid body tumour)
Syndromes von Hippel Lindau, hereditary paragangliomatosis, neurofibromatosis type 1 (von Recklinghausen disease), MEN 2A, MEN 2B, Carney-Stratakis syndrome, Carney triad
Prevalence uncommon
Prognosis usually good, rarely malignant

Paraganglioma is a rare tumour arising from the paraganglion. A paraganglioma arising in the adrenal gland is known as a pheochromocytoma.

General

  • Definition: tumour of paraganglion.
    • Can be sympathetic or parasympathetic.
  • Most common paraganglioma = pheochromocytoma.[1]
    • Head & neck most common site - after abdomen.
  • Carotid body tumour = paraganglioma of carotid body.

Epidemiology

  • Rare.
  • Rarely malignant.

Familial syndromes associated with paragangliomas:[2]

Other associations - not proven to be genetic:

Clinical

  • 10% bilateral, multiple, familial, pediatric and malignant.[5]

Gross

  • Dusky colour.

Note:

Image:

Microscopic

Features:[6]

  • Zellballen - nests of cells - key low power feature.
    • Zellballen is "cell balls" in German.
  • Fibrovascular septae.
  • Finely granular cytoplasm (salt-and-pepper nuclei).
  • +/-Hemorrhage - very common.

DDx:

Images

Carotid body tumour:

  • Paraganglioma - intermed. mag. (WC)

  • Paraganglioma - high mag. (WC)

Duodenal paraganglioma - uncommon location:

  • Paraganglioma - low mag. (WC)

  • Paraganglioma - very high mag. (WC)

  • Paraganglioma - chromogranin A - intermed. mag. (WC)

  • Paraganglioma - S100 - very high mag. (WC)

  • Retroperitoneum - Paraganglioma - Prominent vascular component (SKB)

  • Retroperitoneum - Paraganglioma (SKB)

  • Retroperitoneum - Paraganglioma - florid atypia (SKB)

  • Retroperitoneum - Paraganglioma - large nests (SKB)

  • Neck - Paraganglioma - nice Zeballen (SKB)

  • Neck Paraganglioma - Carotid Body Tumor (SKB)

  • Neck - Paraganglioma - Carotid Body Tumor (SKB)

  • Ear - Paraganglioma - Glomus Tympanicum Tumor (SKB)

  • Ear - Paraganglioma - Glomus Tympanicum Tumor (SKB)

  • Bladder - Paraganglioma - Presented as micturation syncope (SKB)

Other:

  • Pheochromocytoma - high mag. (WC)

www:

IHC

Features:[7]

  • Chromogranin +ve.
  • Synaptophysin +ve.
  • S100 +ve/-ve.
  • Cytokeratin -ve.
  • EMA -ve.

EM

Features:[8]

  • Neurosecretory granules.
    • Electron dense core.
    • Typically perinuclear location.

Image:

See also

References

  1. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 327. ISBN 978-0443066856.
  2. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 328. ISBN 978-0443066856.
  3. ↑ Blay, JY.; Blomqvist, C.; Bonvalot, S.; Boukovinas, I.; Casali, PG.; De Alava, E.; Dei Tos, AP.; Dirksen, U. et al. (Oct 2012). "Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.". Ann Oncol 23 Suppl 7: vii49-55. doi:10.1093/annonc/mds252. PMID 22997454. http://annonc.oxfordjournals.org/content/23/suppl_7/vii49.full.
  4. ↑ Lefebvre, M.; Foulkes, WD. (Feb 2014). "Pheochromocytoma and paraganglioma syndromes: genetics and management update.". Curr Oncol 21 (1): e8-e17. doi:10.3747/co.21.1579. PMID 24523625.
  5. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 327. ISBN 978-0443066856.
  6. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 329-332. ISBN 978-0443066856.
  7. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 335. ISBN 978-0443066856.
  8. ↑ 8.0 8.1 URL: http://path.upmc.edu/cases/case408.html. Accessed on: 16 January 2012.
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