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Dowden JE, Staveley-O'Carroll KF, Kimchi ET, Camp ER, Morgan KA, Adams DB. Ampullary Gangliocytic Paraganglioma with Lymph Node Metastasis. Am Surg 2015. [DOI: 10.1177/000313481508101106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob E. Dowden
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | | | - Eric T. Kimchi
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - E. Ramsay Camp
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - Katherine A. Morgan
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - David B. Adams
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
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Yang JW, Han J, Lee HW, Cho SY, Kim HK. A Rare Case of Thymic Gangliocytic Paraganglioma. J Pathol Transl Med 2015; 50:165-7. [PMID: 26447134 PMCID: PMC4804141 DOI: 10.4132/jptm.2015.07.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Jung Wook Yang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Woo Lee
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Youn Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Grin A, Streutker CJ. Neuroendocrine tumors of the luminal gastrointestinal tract. Arch Pathol Lab Med 2015; 139:750-6. [PMID: 26030244 DOI: 10.5858/arpa.2014-0130-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Neuroendocrine tumors (NETs) of the gastrointestinal tract have been recognized for more than a century. Despite histologic similarities between different sites in the tract, behavior varies between areas. All of these tumors have malignant potential, but determination of exact risk is difficult. OBJECTIVES To review the diagnosis of luminal gastrointestinal NETs, including a discussion of grading. Grading by mitotic index/activity, in conjunction with tumor size/stage, has been found to be the strongest predictor of behavior. DATA SOURCES Literature review of luminal gastrointestinal NETs was performed and the results summarized. CONCLUSIONS Our understanding of these lesions is incomplete and continues to evolve.
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Affiliation(s)
- Andrea Grin
- From the Department of Laboratory Medicine and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Wang B, Zou Y, Zhang H, Xu L, Jiang X, Sun K. Duodenal gangliocytic paraganglioma: report of two cases and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:9752-9759. [PMID: 26617685 PMCID: PMC4637770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/24/2015] [Indexed: 06/05/2023]
Abstract
We report two cases of Gangliocytic paraganglioma (GP), one of which was accompanied by lymph node metastasis. Histologically, the tumor was composed of three morphologically distinct cell populations: spindle cells, ganglion-like cells and epithelioid cells. The epithelioid cells were positive for cytokeratin (AE1/AE3), synaptophysin (Syn), chromogranin A (CgA), CD56 and progesterone receptor (PR). Ganglion-like cell types showed positive reactivity for Syn and CD56. In contrast, the spindle-shaped cells showed positive reactivity for S-100. The patient with lymph node metastasis has a good prognosis. Nonetheless, close surveillance is still necessary for patients with GP because a few cases of GP with regional lymph node metastasis and even distant metastasis have been published, including a malignant case of GP showing a lethal course.
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Affiliation(s)
- Bo Wang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang, China
| | - Yinying Zou
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang, China
| | - Han Zhang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang, China
| | - Liming Xu
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang, China
| | - Xiaojun Jiang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang, China
| | - Ke Sun
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang, China
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Sharma S, Gaspar BL, Kumar P, Yadav TD, Vasishta RK. Gangliocytic Paraganglioma With Atypical Immunohistochemical Features Presenting as Extrahepatic Biliary Obstruction. Int J Surg Pathol 2015; 23:561-6. [PMID: 26081293 DOI: 10.1177/1066896915589969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gangliocytic paraganglioma is a rare benign tumor of upper gastrointestinal tract that most commonly involves the second part of duodenum. The tumor is detected incidentally on imaging in most of the cases. However, presentation with extrahepatic biliary obstruction is extremely rare. We recently encountered a 50-year-old male patient who was evaluated for extrahepatic biliary obstruction and was found to have a periampullary mass on imaging. The patient underwent pylorus-preserving pancreaticoduodenectomy along with liver biopsy and hepatoduodenal lymph node dissection. On histopathological examination, a tumor was detected in the periampullary region of duodenum, which was confirmed to be gangliocytic paraganglioma on immunohistochemistry along with atypical histological and immunohistochemical features.
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Affiliation(s)
- Saniya Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Balan Louis Gaspar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pradeep Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Thakur Deen Yadav
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar Vasishta
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Hechtman JF, Harpaz N. Neurogenic polyps of the gastrointestinal tract: a clinicopathologic review with emphasis on differential diagnosis and syndromic associations. Arch Pathol Lab Med 2015; 139:133-9. [PMID: 25549149 DOI: 10.5858/arpa.2013-0431-rs] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Primary neurogenic gastrointestinal polyps are encountered relatively frequently in routine pathology practice. They encompass a variety of neoplastic entities with clinical, morphologic, and molecular features that reflect the diversity of neural elements within the gastrointestinal system. Although most are benign and encountered incidentally, accurate diagnosis may have important clinical implications because of the associations of certain neurogenic polyps with familial syndromes or other conditions. We review the pathology of these polyps with an emphasis on the diagnostic challenges that they pose and on newly described subtypes.
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Affiliation(s)
- Jaclyn F Hechtman
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Hechtman); and the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Harpaz)
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Okubo Y, Nemoto T, Wakayama M, Tochigi N, Shinozaki M, Ishiwatari T, Aki K, Tsuchiya M, Aoyama H, Katsura K, Fujii T, Nishigami T, Yokose T, Ohkura Y, Shibuya K. Gangliocytic paraganglioma: a multi-institutional retrospective study in Japan. BMC Cancer 2015; 15:269. [PMID: 25886293 PMCID: PMC4399421 DOI: 10.1186/s12885-015-1308-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gangliocytic paraganglioma (GP) is an extremely rare benign tumor that commonly arises from the second part of the duodenum. Since GP exhibit neither prominent mitotic activity nor Ki-67 immunoreactivity, this tumor is often misdiagnosed as neuroendocrine tumor (NET) G1 (carcinoid tumor). However, patients with GP may have a better prognosis than patients with NET G1. This fact emphasizes the importance of differentiating GP from NET G1, but few studies have reported the epidemiology and histopathology of GP because of its rarity. To differentiate GP from NET G1 with ease, we conducted a multi-institutional retrospective study analyzing the morphometric and immunohistochemical features of this tumor. METHODS Since only a limited number of patients with GP could be identified in our institute, we conducted a multi-institutional retrospective study of GP in Japan, which was approved by the Ethics Committee of our medical institute. The obtained tissue sections underwent detailed morphometric and immunohistochemical analyses. Additionally, to differentiate GP from NET G1 with ease, immunohistochemical findings were compared. RESULTS In our examination of 12 cases of duodenal GP, we found that epithelioid cells of GP exhibited positive reactivity for progesterone receptor and pancreatic polypeptide, whereas tumor cells of NET G1 were completely negative reactivity for both. Additionally, although GP is considered to be an extremely rare NET, we found that four (40.0%) of the ten patients at our institute with duodenal NET G1 actually had GP. CONCLUSIONS Although GP is regarded as a rare NET, our results suggest that it accounts for a substantial percentage of duodenal NETs. Additionally, confirmation of immunoreactivity for progesterone receptor and pancreatic polypeptide can assist in differentiating GP from NET G1.
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Affiliation(s)
- Yoichiro Okubo
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Tetsuo Nemoto
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Megumi Wakayama
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Minoru Shinozaki
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Takao Ishiwatari
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Kyoko Aki
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Masaru Tsuchiya
- Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Hajime Aoyama
- Department of Pathology and Oncology, University of the Ryukyus, 59, Nishihara-cho, Nakagami-gun, Okinawa, 903-0214, Japan.
| | - Kanade Katsura
- Department of Pathology, Japanese Red Cross Kyoto Daini Hospital, 355-5, Jokyo-ku, Kyoto, 602-8026, Japan.
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Takashi Nishigami
- Department of Pathology, Steel Memorial Hirohata Hospital, 3-1, Himeji, Hyogo, 671-1122, Japan.
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 1-1-2, Nakao, Asahi-ku, Yokohama, Kanagawa, 245-0815, Japan.
| | - Yasuo Ohkura
- Department of Pathology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, 181-8611, Japan.
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan. .,Department of Dermatology, Peking University First Hospital, Beijing, China.
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Lau N, Hari D, French S. SOX10 expression in a gangliocytic paraganglioma — A case report. Exp Mol Pathol 2015; 98:99-101. [DOI: 10.1016/j.yexmp.2014.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/30/2022]
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Loftus TJ, Kresak JL, Gonzalo DH, Sarosi GA, Behrns KE. Duodenal gangliocytic paraganglioma: A case report and literature review. Int J Surg Case Rep 2015; 8C:5-8. [PMID: 25600615 PMCID: PMC4353939 DOI: 10.1016/j.ijscr.2015.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/03/2015] [Indexed: 02/02/2023] Open
Abstract
Differentiation between GP and GIST alters treatment algorithms. Primary management of duodenal GP consists of resection with negative margins. Surveillance alone is safe and effective following resection with negative margins. For regionally advanced disease, consider adjuvant radiotherapy.
Introduction Gangliocytic paraganglioma is a rare tumor that is most commonly located in the duodenum. At presentation, it may be confused with a gastrointestinal stromal tumor (GIST), but distinguishing between these tumors is critical because the natural history and treatment of these two tumors differs markedly. Duodenal gangliocytic paraganglioma typically exhibits benign behavior with occasional regional lymph node metastasis and no reports of tumor associated deaths. Recurrence after resection is rare. Presentation of case A 50 year-old male presented with melena and hemoglobin concentration of 4.6 g/dl. Esophagogastroduodenoscopy demonstrated a submucosal mass in the third portion of the duodenum with no active bleeding. CT scan identified no regional lymphadenopathy or distant metastasis. The tumor was resected through a longitudinal duodenotomy with negative margins. Discussion Endoscopic resection of duodenal gangliocytic paraganglioma appears to be safe and effective when tumor may be removed in its entirety by this method. If the tumor is not suspended by a stalk or there is suspicion for regional lymph node disease then surgical management is preferred. Radiation oncologists at high volume centers have endorsed utilization of adjuvant radiotherapy to the postsurgical bed in cases involving lymph node metastasis. Utilization of chemotherapy for management of this disease has not been reported. Conclusion Localized duodenal gangliocytic paragangliomas are best managed by resection with negative margins. In cases in which the tumor is resected with negative margins, it appears to be safe to embark on a course of surveillance and forego adjuvant therapy.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, the University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Jesse L Kresak
- Department of Pathology, the University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - David H Gonzalo
- Department of Pathology, the University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - George A Sarosi
- Department of Surgery, the University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Kevin E Behrns
- Department of Surgery, the University of Florida College of Medicine, Gainesville, FL 32610, USA.
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60
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Feuerstein JD, Yee EU, Pleskow D. Not every ampullary mass is deadly. Gastroenterology 2014; 147:e3-4. [PMID: 25450088 DOI: 10.1053/j.gastro.2014.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Joseph D Feuerstein
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Eric U Yee
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Douglas Pleskow
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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61
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Li B, Li Y, Tian XY, Luo BN, Li Z. Malignant gangliocytic paraganglioma of the duodenum with distant metastases and a lethal course. World J Gastroenterol 2014; 20:15454-15461. [PMID: 25386095 PMCID: PMC4223280 DOI: 10.3748/wjg.v20.i41.15454] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
Gangliocytic paraganglioma (GP) is rare and has been regarded as benign in general with a good prognosis. We present a patient with duodenal GP showing a malignant and lethal clinical course. A 47-year-old male patient was found to have a duodenal tumor and enlarged regional lymph nodes. The patient initially underwent a pancreaticoduodenectomy to resect the tumor and involved lymph nodes completely. Histological and immunohistochemical analyses showed findings typical of GP. However, the distant metastatic lesions in the liver and pelvic cavity were rapidly observed after surgery. The patient underwent chemotherapy and radiotherapy, as well as a second surgery to partly remove the metastatic mass in the pelvic cavity. The histological examination revealed no significant difference in histological features between the primary duodenal tumor and the metastatic pelvic mass. However, the patient finally died of the tumor due to the recurrence of the residual pelvic lesion and increased liver mass. To our knowledge, this is the first report of lethal GP with multifocal metastases. Our case confirms that GP should be regarded as a malignant potential tumor with behavior code of “1”, rather than a benign tumor of “0”.
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Park SJ, Kim DH, Lim H, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY, Kim JH, Park JY. Endoscopic resection as a possible radical treatment for duodenal gangliocytic paraganglioma: a report of four cases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:114-9. [PMID: 24561698 DOI: 10.4166/kjg.2014.63.2.114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gangliocytic paraganglioma (GP) is a rare, benign tumor which is usually found in the duodenum. We here report four recent cases of GP, with successful endoscopic resection in three cases, including a lesion on the ampulla of Vater. In all cases, each lesion had a stalk that facilitated removal using an endoscopic approach. Endoscopic mucosal resection is a feasible and safe treatment if the location, depth, and lymph node status are all favorable and is also helpful for definite diagnosis of unknown duodenal mass. To avoid morbidity resulting from open surgical resection, careful inspection for the peduncle of the GP will help determine the feasibility of endoscopic resection.
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Affiliation(s)
- Se Jeong Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea
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Papathomas TG, de Krijger RR, Tischler AS. Paragangliomas: update on differential diagnostic considerations, composite tumors, and recent genetic developments. Semin Diagn Pathol 2013; 30:207-23. [PMID: 24144290 DOI: 10.1053/j.semdp.2013.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent developments in molecular genetics have expanded the spectrum of disorders associated with pheochromocytomas (PCCs) and extra-adrenal paragangliomas (PGLs) and have increased the roles of pathologists in helping to guide patient care. At least 30% of these tumors are now known to be hereditary, and germline mutations of at least 10 genes are known to cause the tumors to develop. Genotype-phenotype correlations have been identified, including differences in tumor distribution, catecholamine production, and risk of metastasis, and types of tumors not previously associated with PCC/PGL are now considered in the spectrum of hereditary disease. Important new findings are that mutations of succinate dehydrogenase genes SDHA, SDHB, SDHC, SDHD, and SDHAF2 (collectively "SDHx") are responsible for a large percentage of hereditary PCC/PGL and that SDHB mutations are strongly correlated with extra-adrenal tumor location, metastasis, and poor prognosis. Further, gastrointestinal stromal tumors and renal tumors are now associated with SDHx mutations. A PCC or PGL caused by any of the hereditary susceptibility genes can present as a solitary, apparently sporadic, tumor, and substantial numbers of patients presenting with apparently sporadic tumors harbor occult germline mutations of susceptibility genes. Current roles of pathologists are differential diagnosis of primary tumors and metastases, identification of clues to occult hereditary disease, and triaging of patients for optimal genetic testing by immunohistochemical staining of tumor tissue for the loss of SDHB and SDHA protein. Diagnostic pitfalls are posed by morphological variants of PCC/PGL, unusual anatomic sites of occurrence, and coexisting neuroendocrine tumors of other types in some hereditary syndromes. These pitfalls can be avoided by judicious use of appropriate immunohistochemical stains. Aside from loss of staining for SDHB, criteria for predicting risk of metastasis are still controversial, and "malignancy" is diagnosed only after metastases have occurred. All PCCs/PGLs are considered to pose some risk of metastasis, and long-term follow-up is advised.
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Affiliation(s)
- Thomas G Papathomas
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC-University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Lin D, Hu Y, Xing X, Ding L, Liu H, Li Y, Xiang F. Pulmonary gangliocytic paraganglioma: a case report and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 7:432-437. [PMID: 24427368 PMCID: PMC3885502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
Gangliocytic paraganglioma (GP) is a rare histologic type of neuroendocrine tumors. We report a case of pulmonary GP in a 29-year-old male presenting with an asymptomatic endobronchial nodule. Grossly, the tumor showed a 4.0x3.8x3.5 cm well-defined nodule with yellowish cut surface. Microscopically, the tumor was composed of three distinct cellular types: epithelioid cells, ganglion-like cells and spindle cells. Meanwhile, transitional cells, having morphologic features between ganglion-like and epithelioid cells, were also presented. The epithelioid cells arranged in various morphologic architectures, including Zellballen, papillary, cystic and microcystic pattern. The epithelioid cells were positive for AE1/AE3, CAM 5.2, chromogranin A and synaptophysin. Ganglion-like cells showed immunoreactivity for chromogranin A and synaptophysin. A few ganglion-like cells were also positive for AE1/AE3 and/or CAM 5.2. The spindle cells were positive for S-100 protein and neurofilament. The transitional cells showed a similar immunohistochemical profile to the epithelioid cells. The authors believe stem cell theory is a reasonable explanation for the origin of GP. GP probably originate from some kind of mucosa associated stem cell which can differentiate into diverse cellular lineages.
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Affiliation(s)
- Dongliang Lin
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
| | - Yanjiao Hu
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
| | - Xiaoming Xing
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
| | - Li Ding
- Department of Prevention Care, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
| | - Hui Liu
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
| | - Yujun Li
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
| | - Fenggang Xiang
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao UniversityQingdao, China
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Abdelbaqi MQ, Tahmasbi M, Ghayouri M. Gangliocytic paraganglioma of the appendix with features suggestive of malignancy, a rare case report and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:1948-52. [PMID: 24040463 PMCID: PMC3759505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/15/2013] [Indexed: 06/02/2023]
Abstract
We report a case of appendicial paraganglioma in a 40 year old female who presented with acute appendicitis and underwent laparoscopic appendectomy. To the best of our knowledge this is the first reported case of appendicial gangliocytic paraganglioma with features suggestive of malignancy in the modern literature. Van Eeden S. et al. reported the first case of appendicial paraganglioma in a 47 year old man who also presented with acute appendicitis. The appendectomy specimen showed a distended appendix with thickened wall, and a 1.3 cm mucosal based yellow lesion. Microscopically this lesion was centered in the submucosa and consisted of three different cell types: (a) epithelioid cells with pale eosinophilic finely granular cytoplasm containing bland oval nucleus with stippled chromatin, that form solid nests lying in a trabecular pattern and in formations reminiscent of 'Zellballen' as seen in paragangliomas (b) second type cells have large vesicular nuclei with prominent nucleoli and abundant cytoplasm that are scattered singly, (c) third type cells with bland elongated nuclei form broad fascicle and envelop the epithelioid and ganglion cells. Immunohistochemical analysis showed the epithelioid cell nests immunoreactive for synaptophysin and the ganglion-like cells and spindle Schwann cells to be immunoreactive for S100 protein, whereas all three cells populations were negative for CAM5.2 and Pancytokeratin. We do believe that an accurate diagnosis of Gangliocytic paraganglioma (GP) of the appendix was rendered, detailed microscopic examination of doubled hematoxylin and eosinophil stained sections as well as the immunohistochemical phenotype of the three components have been undertaken to confirm the diagnosis of GP.
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Affiliation(s)
- Maisoun Qassim Abdelbaqi
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research InstitutionTampa, Florida
- Department of Pathology and Cell Biology, University of South FloridaTampa, Florida, USA
| | - Maryam Tahmasbi
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research InstitutionTampa, Florida
- Department of Pathology and Cell Biology, University of South FloridaTampa, Florida, USA
| | - Masoumeh Ghayouri
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research InstitutionTampa, Florida
- Department of Pathology and Cell Biology, University of South FloridaTampa, Florida, USA
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Miquelestorena-Standley E, Cormier B, Bonneau C, Saint-Marc O, Causse X, Michenet P. [A periampullary tumor]. Ann Pathol 2013; 33:134-6. [PMID: 23582843 DOI: 10.1016/j.annpat.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 01/19/2013] [Accepted: 02/08/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Elodie Miquelestorena-Standley
- Service d'anatomie et de cytologie pathologiques, hôpital de la Source, centre hospitalier régional d'Orléans, BP 86709, 45067 Orléans cedex 2, France.
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Nuño-Guzmán CM, Arróniz-Jáuregui J, Alvarez-López F, Corona JL, Cerda-Camacho F, Rostro R, Gutiérrez-Manjarrez JI. Obstructing gangliocytic paraganglioma in the third portion of the duodenum. Case Rep Gastroenterol 2012; 6:489-95. [PMID: 22855666 PMCID: PMC3409504 DOI: 10.1159/000341586] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Gangliocytic paragangliomas are infrequent tumors almost exclusively found in the second portion of the duodenum. An unusual case of a gangliocytic paraganglioma in the third portion of the duodenum with obstructive symptoms is herein reported. A 16-year-old male patient presented with epigastric pain, postprandial plenitude and reflux. A barium swallow failed to demonstrate abnormalities. Endoscopy showed a pedunculated submucosal tumor, originating at the third duodenal portion and causing partial obstruction. Biopsy was not performed due to the risk of bleeding. CT scan demonstrated a polypoid lesion. Through a transmesocolic approach and an anterior duodenotomy, resection of the tumor was performed. No lymph node or other organ affection was found. Histologic examination revealed a gangliocytic paraganglioma. Immunohistochemical examination was performed. Gangliocytic paragangliomas originating in the third or fourth portion of the duodenum, as in the present case, are extremely rare. Characteristic histologic features including epithelioid cells, spindle-shaped cells and ganglion-like cells were met. The majority of cases manifest with a similar benign behavior. Local resection of the tumor is recommended for these cases. An infrequent case of a gangliocytic paraganglioma located in the third portion of the duodenum, with a less common clinical presentation, is herein reported.
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Affiliation(s)
- Carlos M Nuño-Guzmán
- Department of General Surgery, Antiguo Hospital Civil de Guadalajara 'Fray Antonio Alcalde', Guadalajara, Mexico
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68
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Hadjittofi C, Parisinos CA, Somri M, Matter I. Totally laparoscopic resection of a rare duodenal tumour. BMJ Case Rep 2012; 2012:bcr.02.2012.5860. [PMID: 22669863 DOI: 10.1136/bcr.02.2012.5860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 39-year-old woman presented to the gastroenterology clinic with recurrent right-upper-quadrant pain and elevated liver enzymes. Endoscopy revealed a small submucosal mass at the edge of the major duodenal papilla, which was not amenable to endoscopic resection. The mass was successfully resected by laparoscopy. The papilla was subsequently reconstructed and a cannula inserted in the common bile duct. The postoperative period was uneventful and the patient was discharged on the third postoperative day. Subsequent pathological examination of the excised mass revealed a gangliocytic paraganglioma. Six weeks later, the patient was free of symptoms and the cannula was removed by duodenoscopy.
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69
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Torimitsu S, Nemoto T, Wakayama M, Okubo Y, Yokose T, Kitahara K, Ozawa T, Nakayama H, Shinozaki M, Sasai D, Ishiwatari T, Takuma K, Shibuya K. Literature survey on epidemiology and pathology of cardiac fibroma. Eur J Med Res 2012; 17:5. [PMID: 22472419 PMCID: PMC3351722 DOI: 10.1186/2047-783x-17-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 03/27/2012] [Indexed: 11/10/2022] Open
Abstract
Background Although cardiac fibroma has been regarded as benign tumor, it presents various symptoms and may lead to death. Unfortunately, only a few studies have reported the epidemiology, embryology, and histopathology of the tumor, and the factors predicting poorer outcome are still obscured. Methods In July 2011 we searched for English and Japanese cases of cardiac fibroma using the PubMed and IgakuChuoZasshi databases. We then extracted and sampled raw data from the selected publications in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) style as much as was possible. Results Details of a total of 178 patients with cardiac fibroma were retrieved. The mean age was 11.4 years (median: 2.8 years). Tumor sizes ranged from 8.0 to 150.0 mm (mean 53.1 mm). The left ventricle was found to be the most common site associated with the tumor at a rate of 57.3%, followed by the right ventricle, and interventricular septum. The highest mortality was found in patients with septal involvement (58.6%). In all, 111 patients survived among the 160 patients with a recorded outcome. A younger age of the patient at the time of diagnosis was associated with a decreased survival rate. In addition, a significant positive association was found between ages for patients younger than 17 years of age and the diameter of the tumor at the time of diagnosis (r = 0.341, P = 0.006). Conclusions Both the younger age of patients at the time of diagnosis and septal involvement can be regarded as factors significantly indicating a poor prognosis. Furthermore, our statistical analyses support the following hypotheses. First, the high ratio of tumor-to-heart size may generate low cardiac output and therefore lead to poor outcome. Second, the ratio of the sites where cardiac fibroma occurred corresponds with the ratio of the muscular weight of the cardiac chamber. Third, cardiac fibroma involving the interventricular septum more frequently induces conduction system disease.
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Affiliation(s)
- Suguru Torimitsu
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo 143-8541, Japan
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Abstract
This article reviews the most common and characteristic mesenchymal lesions found in the gastrointestinal tract and intraabdominal location in a pattern-based approach: spindle and epithelioid tumors (gastrointestinal stromal tumor, schwannoma, glomus tumor, leiomyoma and leiomyosarcoma, inflammatory fibroid polyp, perineurioma, melanoma, calcifying fibrous tumor, sclerosing mesenteritis, mesenteric fibromatosis, and inflammatory myofibroblastic tumor), and clear and granular tumors (clear cell sarcoma, granular cell tumor, gangliocytic paraganglioma, and ganglioneuroma). Information includes gross and histologic features, diagnosis and differential diagnosis, and histologic and other diagnostic techniques, including immunohistochemistry related to projected patient outcome, along with prognosis, staging, and treatment.
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Affiliation(s)
- Dora Lam-Himlin
- Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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