1
|
Wasserman PG, Savargaonkar P. Paragangliomas: classification, pathology, and differential diagnosis. Otolaryngol Clin North Am 2001; 34:845-62, v-vi. [PMID: 11557443 DOI: 10.1016/s0030-6665(05)70351-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article discusses the paraganglion system and extra-adrenal paragangliomas. In particular, the clinicopathologic, immunohistochemical, and ultrastructural features of paragangliomas and neuroendocrine neoplasms of the larynx are presented with a discussion of the differential diagnosis.
Collapse
Affiliation(s)
- P G Wasserman
- Division of Cytopathology, Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
| | | |
Collapse
|
2
|
Noorda RJ, Wuisman PI, Kummer AJ, Winters HA, Rauwerda JA, Egeler-Peerdeman SM. Nonfunctioning malignant paraganglioma of the posterior mediastinum with spinal cord compression. A case report. Spine (Phila Pa 1976) 1996; 21:1703-9. [PMID: 8839476 DOI: 10.1097/00007632-199607150-00018] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Case report and review of the literature. OBJECTIVE To present a case with an uncommon nonfunctioning malignant paraganglioma of the posterior mediastinum with compression of the spinal cord. An update survey is given with respect to diagnostic, histopathologic, and therapeutic aspects of paragangliomas. SUMMARY OF BACKGROUND DATA Paragangliomas in the posterior mediastinum are uncommon and rarely may produce spinal cord compression. To illustrate the low incidence, only two cases of paraganglioma of the posterior mediastinum were reported by the Mayo Clinic, Rochester, Minnesota, during a 40-year period. METHOD Case report and review of the literature. RESULT The diagnosis was made by modern imaging techniques (computed tomography, magnetic resonance imaging, and metaiodobenzylguanidine scan) and verified by computed tomography guided per thoracic puncture. A wide local resection was performed; the patient is disease-free 1 year after surgery. CONCLUSION The uncertainty of prognosis and possibility of local recurrence of paragangliomas even after a long period emphasizes the importance of wide local surgical resection with or without adjuvant therapy and makes long-term follow-up and continued surveillance of the patient mandatory.
Collapse
Affiliation(s)
- R J Noorda
- Department of Orthopaedic Surgery, Academic Hospital, Free University, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
3
|
Roche PH, Figarella-Branger D, Regis J, Peragut JC. Cauda equina paraganglioma with subsequent intracranial and intraspinal metastases. Acta Neurochir (Wien) 1996; 138:475-9. [PMID: 8738400 DOI: 10.1007/bf01420312] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case of cauda equina paraganglioma is described; subsequent intracranial and intraspinal metastases occurred after partial resection and adjunctive radiotherapy. Cerebrospinal fluid dissemination is a rare complication of spinal paragangliomas. Factors predictive of this unusual biological behaviour are discussed.
Collapse
Affiliation(s)
- P H Roche
- Department of Neurosurgery, Hôpital de la Timone, Marseille, France
| | | | | | | |
Collapse
|
4
|
Fried G, Wikström LM, Höög A, Arver S, Cedermark B, Hamberger B, Grimelius L, Meister B. Multiple neuropeptide immunoreactivities in a renin-producing human paraganglioma. Cancer 1994; 74:142-51. [PMID: 7911735 DOI: 10.1002/1097-0142(19940701)74:1<142::aid-cncr2820740123>3.0.co;2-o] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A case of a renin-producing paraganglioma of adrenal origin with metastases to the retroperitoneal area, paravaginal area, and the ovary is reported with immunohistochemical findings indicating expression of multiple neuropeptide immunoreactivities. The patient was 23 years old at the time of diagnosis, and died from metastatic spread of the tumor 7 years later. METHODS Tumor tissue was examined by light microscopy, indirect immunohistochemistry, and electron microscopy. RESULTS The tumor tissue investigated contained several cells exhibiting opioid peptide-like immunoreactivities (i.e., enkephalin and dynorphin-like immunoreactivity [LI]). A lower number of cells displayed neuropeptide Y-, galanin-, somatostatin-, neurotensin-, substance P-, peptide histidine-isoleucine-, cholecystokinin-, renin-, and calbindin-LI. CONCLUSION To the authors' knowledge, galanin, dynorphin, peptide histidine-isoleucine, cholecystokinin, and calbindin have not been reported previously to occur in paraganglioma, and renin has been reported to occur very rarely. A review of recent literature suggest that enkephalin-, neuropeptide Y-, and somatostatin-like immunoreactivities may be useful as diagnostic markers for paragangliomas.
Collapse
Affiliation(s)
- G Fried
- Department of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Fukuda T, Kobayashi H, Kamishima T, Watanabe H, Inoue Y, Ohnishi Y, Naito M, Emura I, Hirono T. Peripheral carcinoid tumor of the lung with focal melanin production. Pathol Int 1994; 44:309-16. [PMID: 8044298 DOI: 10.1111/j.1440-1827.1994.tb03369.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of carcinoid tumor of the lung with focal melanin production was encountered in a 56 year old Japanese woman. The tumor was found 16 years previously by mass survey chest X-ray and had enlarged two-fold in the intervening period. The tumor consisted of a variety of tumor cells showing a spindle, polygonal and pleomorphic appearance with abundant vasculature in the stroma. All tumor cells showed argyrophilia, together with a few showing argentaffinity. Melanin-containing tumor cells were also present in parts. Ultrastructurally, most tumor cells possessed various numbers of neurosecretory granules and a few of them contained granular type melanosomes. Tumor cells were connected with desmosomes and a few of them contained tonofilament-like microfilaments. Only a few contained both neurosecretory granules and melanin. By immunohistochemistry, serotonin, met-enkephalin and beta-endorphin positive cells were observed scattered throughout the tumor. A few tumor cells positive for tyrosine hydroxylase were also detected. Additionally, most tumor cells were positive for keratin. On the basis of these findings, the tumor of the current case is a pulmonary carcinoid tumor with focal melanin production.
Collapse
Affiliation(s)
- T Fukuda
- Second Department of Pathology, Niigata University, School of Medicine, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Argos MD, Ruiz A, Sanchez F, Garcia C, Gaztambide J. Gastric leiomyoblastoma associated with extraadrenal paraganglioma and pulmonary chondroma: a new case of Carney's triad. J Pediatr Surg 1993; 28:1545-9. [PMID: 8301486 DOI: 10.1016/0022-3468(93)90092-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Carney's triad is extremely rare. The authors report on a 12-year-old patient who had gastric epithelioid leiomyosarcoma, multiple pulmonary chondroma, and mediastinal paraganglioma. Thirty-five other cases are reviewed and analyzed.
Collapse
Affiliation(s)
- M D Argos
- Pediatric Surgical Service, Maternity and Children's Hospital, Malaga, Spain
| | | | | | | | | |
Collapse
|
7
|
Lam KY, Chan AC. Paraganglioma of the urinary bladder: an immunohistochemical study and report of an unusual association with intestinal carcinoid. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1993; 63:740-5. [PMID: 8103319 DOI: 10.1111/j.1445-2197.1993.tb00507.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two cases of paraganglioma of the urinary bladder are reported. Their immunohistochemical profiles and the clinical features are compared with other cases in the literature. The three pan-endocrine markers (neuron-specific enolase, synaptophysin and chromogrannin) were positive in both cases. Positivity to other neuropeptides (including the present two cases and those in literature) includes adrenocorticotropic hormone (three out of five cases), calcitonin (two out of nine cases), gastrin (two out of six cases), glial fibrillary acidic protein (one out of five cases), glucagon (two out of six cases), serotonin (five out of nine cases), and somatostatin (four out of eight cases). A previously unmentioned association between paraganglioma of the urinary bladder and carcinoid in the gastrointestinal tract is noted in one of the present cases. This peculiar association highlights the importance of multiplicity of tumours of the neuroendocrine system other than the classical multiple endocrine neoplasia syndromes.
Collapse
Affiliation(s)
- K Y Lam
- Department of Pathology, University of Hong Kong, Queen Mary Hospital
| | | |
Collapse
|
8
|
Salim SA, Milroy C, Rode J, Corrin B, Hamid Q. Immunocytochemical characterization of neuroendocrine tumours of the larynx. Histopathology 1993; 23:69-73. [PMID: 7690008 DOI: 10.1111/j.1365-2559.1993.tb01185.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty-two neuroendocrine tumours of the larynx were investigated using a panel of immunocytochemical markers. Three were small cell carcinomas, eight were large cell neuroendocrine carcinomas and 11 were paragangliomas. Twenty were positive for protein gene product 9.5, 19 for neuron-specific enolase, 15 for chromogranin A, nine for bombesin, eight for substance P, eight for neuropeptide Y, eight for metenkephalin, seven for somatostatin, five for calcitonin, eight for calcitonin gene-related peptide and one for vasoactive intestinal polypeptide. Bombesin immunoreactivity was largely restricted to the small cell carcinomas and large cell neuroendocrine carcinomas and neuropeptide Y, metenkephalin and substance P to the paragangliomas. This comprehensive immunocytochemical analysis of neuroendocrine tumours of the larynx demonstrates that these tumours represent special entities but have similar patterns of immunostaining to those of neuroendocrine tumours in other sites.
Collapse
Affiliation(s)
- S A Salim
- Ear, Nose and Throat Department, Enfield District Hospital, Middlesex, UK
| | | | | | | | | |
Collapse
|
9
|
Beham A, Schmid C, Fletcher CD, Auböck L, Pickel H. Malignant paraganglioma of the uterus. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1992; 420:453-7. [PMID: 1595196 DOI: 10.1007/bf01600518] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a malignant uterine paraganglioma in a 40-year-old female, who died 7 months after the initial diagnosis. On light microscopy the tumour showed a typical zellballen pattern as well as a pronounced cellular pleomorphism. In many tumour cells hyaline globules were demonstrated within the cytoplasm. Immunohistochemically the lesion was characterized by the presence of neuron-specific enolase, protein gene product 9.5 and synaptophysin, and electron microscopically by the occurrence of neurosecretory granules.
Collapse
Affiliation(s)
- A Beham
- Institute of Pathology, University of Graz Medical School, Austria
| | | | | | | | | |
Collapse
|
10
|
Ferrando J, Martorell M, Cantó A. Paraganglioma pulmonar primario. Aportación de un caso. Arch Bronconeumol 1992. [DOI: 10.1016/s0300-2896(15)31333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Pinedo Moraleda F, Martínez González MA, Ballestín Carcavilla C, Vargas Castrillón J. Gastrointestinal autonomic nerve tumours: a case report with ultrastructural and immunohistochemical studies. Histopathology 1992; 20:323-9. [PMID: 1315714 DOI: 10.1111/j.1365-2559.1992.tb00989.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of gastrointestinal autonomic nerve tumour with light microscopic, immunohistochemical and ultrastructural examination is reported. The tumour was composed of spindle cells or large cells with clear cytoplasm and showed intense staining for vimentin and focal staining for neuron-specific enolase, chromogranin, synaptophysin, gastrin, P substance and S-100 protein. Ultrastructural examination showed long processes with dense core granules and the absence of features characteristic of other gastrointestinal stromal tumours. In addition we noted small traces of basal lamina and the absence of synaptic vesicles. It seems that the biological behaviour of gastrointestinal autonomic nerve tumours is aggressive but there are too few reports on which to conclude anything about their prognosis. Our findings suggest that tumour has a neuroectodermal differentiation.
Collapse
Affiliation(s)
- F Pinedo Moraleda
- Department of Surgical Pathology, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | |
Collapse
|
12
|
Jovanovic R, Hacker GW, Falkmer UG, Falkmer S, Mendel L, Graf AH, Höög A, Kanjuh V, Silfverswärd C, Grimelius L. Paragangliomas: neuroendocrine features and cytometric DNA distribution patterns. A clinico-pathological study of 22 cases. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1991; 419:455-61. [PMID: 1750192 DOI: 10.1007/bf01650672] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Paragangliomas from 22 patients with extraadrenal tumours of this type were studied. Neuroendocrine features were examined using immunohistochemical techniques. Twenty-two antisera raised against neuroendocrine "markers", regulatory peptides, serotonin and intermediate filament proteins were studied in this group and cytometric DNA assessments were made by means of image cytometry. One normal and 5 hyperplastic carotid bodies were used as controls in the DNA cytometric investigations. Clinical and/or histopathological evidence of "malignancy" was present in 5 cases. The tumour cells showed heterogeneity with regard to their expression of different peptides, and the immunohistochemical analyses did not permit differentiation between benign and malignant paragangliomas. An euploid nuclear DNA distribution pattern was found in all controls and in 17 of the tumours; all except 1 were clinico-pathologically benign. An aneuploid DNA pattern was observed in 5 of the cases and some malignant features were present in 4 of these cases. DNA data may give further information apart from that obtained from the histopathological findings which may be of value in predicting the biological behaviour of this tumour type.
Collapse
Affiliation(s)
- R Jovanovic
- Department of Tumour Pathology, Karolinska Institute and Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Schröder S, Niendorf A, Achilles E, Dietel M, Padberg BC, Beisiegel U, Dralle H, Bressel M, Klöppel G. Immunocytochemical differential diagnosis of adrenocortical neoplasms using the monoclonal antibody D11. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1990; 417:89-96. [PMID: 2114700 DOI: 10.1007/bf02190525] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The monoclonal antibody D11 is a valuable aid in the accurate typing of adrenal tumours as, in formalin-fixed, paraffin-embedding material, strong nuclear D11 positivity was observed only in adrenocortical cells in 190 neoplasms (including 100 adrenal tumours). This pattern was demonstrated for all zona glomerulosa cells in 27 normal adrenals and for the neoplastic cells of 15 adrenocortical adenomas derived from that zone, as judged from clinically evident hyperaldosteronism. Normal cells of zona fasciculata and reticularis also showed strong diffuse D11 immunostaining and the same nuclear plus cytoplasmic D11 reactivity was evident in 15 benign and malignant adrenocortical neoplasms derived from these zones, documented by hypercortisolism. Cytoplasmic and/or nuclear D11 staining made topohistogenetic typing possible in 15 non-functioning cortical tumours. D11 immunostaining gave negative results in 50 specimens containing normal, hyperplastic and neoplastic adrenomedullary cells. In addition, absence of D11 reactivity was recorded in 4 adrenal metastases of extra-adrenal carcinomas, 5 paragangliomas, 25 primary renal carcinomas and 59 of 60 primary thyroid carcinomas. D11 immunocytochemistry allows the accurate typing of benign and malignant adrenocortical neoplasms, irrespective of histology and function. With this method, primary adrenocortical tumours can be separated from carcinomas metastatic to the adrenal gland, including secondary tumours of similar phenotype (such as renal carcinomas). By exclusion, D11 negativity provides evidence of the medullary origin of primary adrenal tumours even in the absence of clinical, structural, histochemical and conventional immunohistochemical indicators of phaeochromocytoma.
Collapse
Affiliation(s)
- S Schröder
- Institute of Pathology, University Hospital Hamburg-Eppendorf, Federal Republic of Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
A paraganglioma of the orbit in a 21-year-old woman is presented, containing oculo-cutaneous melanin in many tumor cells, occasionally adjacent to neurosecretory granules, and in macrophages. This tumor expands the list of neuroectodermal tumors with potential melaninization.
Collapse
Affiliation(s)
- W Paulus
- Ludwig Boltzmann Institut für klinische Neurobiologie, Krankenhaus Lainz, Wien, Austria
| | | | | |
Collapse
|
15
|
Abstract
A case of duodenal gangliocytic paraganglioma (DGP) in a 17-year-old boy is presented. In this case a lymph node in the peripancreatic region was involved by a metastatic tumor. A review of the literature on DGP indicates that this case represents the youngest patient and is the second case of DGP with metastasis. Immunohistochemical staining for neuron-specific enolase (NSE), neurofilament (NF), pancreatic polypeptide, and somatostatin showed positive results for epithelioid and ganglion-like cells, whereas spindle cells showed immunoreactivities for S-100 protein, NSE, and NF. The histogenesis of DGP is discussed.
Collapse
Affiliation(s)
- K Inai
- Department of Pathology, Hiroshima University School of Medicine, Japan
| | | | | | | |
Collapse
|
16
|
Arruda WO, Teive HA, Torres LF, Ramina R, Parolim MK, Maniglia JJ, Barrionuevo CE. [Glomus tumors of the temporal bone: a report of 6 cases]. ARQUIVOS DE NEURO-PSIQUIATRIA 1989; 47:51-60. [PMID: 2548464 DOI: 10.1590/s0004-282x1989000100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The authors review the clinical, radiological and pathological features of 6 cases of glomus tumors of the temporal bone. Out of the 6 patients, 5 were female; age was distributed between 22 and 76 years (mean 48 years). The main clinical features were hypoacusia, tinnitus and otoscopic findings suggestive of the diagnosis. In one case was noted the concomitant presence of a neurinoma of the VIII cranial nerve with a ipsilateral glomus tumor, and in another case there was a concomitancy of carotid body tumor with temporal glomus jugularis tumor. Metastases were not observed in any case. Tumoral lesions were successfully ressected employing microsurgical techniques and a multidisciplinary staff involving neurosurgeons, head and neck surgeons and otolaryngologists. Radioteraphy was not employed, neither pre-operative embolization. Some aspects related to the nosology, embriology, pathophysiology, diagnosis and treatment of this interesting type of neoplasms are discussed.
Collapse
Affiliation(s)
- W O Arruda
- Unidade de Ciências Neurológicas, Hospital de Clínicas da Universidade Federal do Paraná, Brasil
| | | | | | | | | | | | | |
Collapse
|
17
|
|