Difference between revisions of "Paraganglioma"

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===Images===
===Images===
*[[WC]]:
Carotid body tumour:
**Carotid body tumour:
<gallery>
***[http://commons.wikimedia.org/wiki/File:Carotid_body_tumour_2_intermed_mag.jpg Paraganglioma - intermed. mag. (WC)].
Image:Carotid_body_tumour_2_intermed_mag.jpg | Paraganglioma - intermed. mag. (WC)
***[http://commons.wikimedia.org/wiki/File:Carotid_body_tumour_2_high_mag.jpg Paraganglioma - high mag. (WC)].
Image:Carotid_body_tumour_2_high_mag.jpg | Paraganglioma - high mag. (WC)
**Duodenal paraganglioma - uncommon location:
</gallery>
***[http://commons.wikimedia.org/wiki/File:Paraganglioma_-_low_mag.jpg Paraganglioma - low mag. (WC)].
Duodenal paraganglioma - uncommon location:
***[http://commons.wikimedia.org/wiki/File:Paraganglioma_-_very_high_mag.jpg Paraganglioma - very high mag. (WC)].
<gallery>
***[http://commons.wikimedia.org/wiki/File:Paraganglioma_-_chromo_-_intermed_mag.jpg Paraganglioma - chromogranin A - intermed. mag. (WC)].
Image:Paraganglioma_-_low_mag.jpg | Paraganglioma - low mag. (WC)
***[http://commons.wikimedia.org/wiki/File:Paraganglioma_-_s100_-_very_high_mag.jpg Paraganglioma - S100 - very high mag. (WC)].
Image:Paraganglioma_-_very_high_mag.jpg | Paraganglioma - very high mag. (WC)
**Other:
Image:Paraganglioma_-_chromo_-_intermed_mag.jpg | Paraganglioma - chromogranin A - intermed. mag. (WC)
***[http://commons.wikimedia.org/wiki/File:Pheochromocytoma_high_mag.jpg Pheochromocytoma - high mag. (WC)].
Image:Paraganglioma_-_s100_-_very_high_mag.jpg | Paraganglioma - S100 - very high mag. (WC)
*www:
</gallery>
**[http://path.upmc.edu/cases/case523.html Paraganglioma with gangliocytic differentiation - several images (upmc.edu)].
Other:
<gallery>
Image:Pheochromocytoma_high_mag.jpg | Pheochromocytoma - high mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case523.html Paraganglioma with gangliocytic differentiation - several images (upmc.edu)].


==IHC==
==IHC==
Line 98: Line 103:
*Chromogranin +ve.
*Chromogranin +ve.
*Synaptophysin +ve.
*Synaptophysin +ve.
*S100 +/-.
*S100 +ve/-ve.
*Cytokeratin -ve.
*Cytokeratin -ve.
*EMA -ve.
*EMA -ve.
**+ve in RCC.
**+ve in [[renal cell carcinoma|RCC]].


==EM==
==EM==

Revision as of 04:27, 24 December 2013

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.[4]

Gross

  • Dusky colour.

Note:

Image:

Microscopic

Features:[5]

  • 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)

Other:

  • Pheochromocytoma - high mag. (WC)

www:

IHC

Features:[6]

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

EM

Features:[7]

  • 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. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 327. ISBN 978-0443066856.
  5. ↑ 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.
  6. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 335. ISBN 978-0443066856.
  7. ↑ 7.0 7.1 URL: http://path.upmc.edu/cases/case408.html. Accessed on: 16 January 2012.
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