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Goyal-Honavar A, Chacko G, Chacko AG. Supratentorial primary paraganglioma with good long-term outcome following radical excision. Br J Neurosurg 2023; 37:1766-1769. [PMID: 33754919 DOI: 10.1080/02688697.2021.1902476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Paragangliomas are tumours of extra-adrenal paraganglia. They may metastasize to the brain but primary paragangliomas are exceedingly rare in the supratentorial region and long-term outcomes after surgery is largely unknown. This description of an excellent outcome 13 years following surgery in a 40-year-old gentleman with a primary paraganglioma near the falx provides an important perspective on the value of gross total resection in these tumours. We also review the options for adjuvant therapy in tumours that cannot be excised completely. CASE DESCRIPTION We describe a supratentorial paraganglioma in the parasagittal region in a 40-year-old gentleman who presented with clinical and radiological features suggestive of a right parafalcine meningioma. Histopathological examination following gross total excision of the tumour revealed histological and immunochemical features of a paraganglioma. A detailed search for a systemic primary was negative and the patient remains disease-free 13 years after the surgery. CONCLUSIONS Differentiating between tumours arising primarily and those that are metastatic deposits in the central nervous system requires long-term follow-up and monitoring for the appearance of occult primary tumours. Gross total resection is likely to provide good long-term outcomes.
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Affiliation(s)
| | - Geeta Chacko
- Section of Neuropathology, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Ari G Chacko
- Section of Neurosurgery, Christian Medical College, Vellore, India
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2
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Abstract
Introduction Paragangliomas are rare endocrine tumors that arise from the extra-adrenal autonomic paraganglia and sympathetic paragangliomas usually secret catecholamines and are located in the sympathetic paravertebral ganglia of thorax, abdomen, and pelvis. In contrast, most parasympathetic paragangliomas are nonfunctional and located along the glossopharyngeal and vagal nerves in the neck and at the base of the skull. Such neoplasms, although rare, are clinically important because they may recur after surgical resection and 10% of them give rise to metastases causing death with the lymphatic nodes, bones, liver, and lungs being the most common locations. Case presentation We present a case of a 26-year-old male patient that was diagnosed with paraganglioma of the right-frontal lobe infiltrating the falx and frontal bone which was diagnosed after suffering from a headache and abnormal vision. On initial work-up he was found to have right pulmonary nodules that increased in size after follow up and other nodules appeared in the contralateral lung. He underwent subtotal resection of the brain tumor and complete resection of the bilateral pulmonary nodules. Conclusion To our knowledge, paraganglioma is considered to be a rare entity in the central nervous system with very few cases being reported in the supratentorial region and no cases were reported of metastatic such paraganglioma to the lung.
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3
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Hayashi T, Mete O. Head and neck paragangliomas: what does the pathologist need to know? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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4
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A supratentorial primary parenchymal paraganglioma. J Clin Neurosci 2011; 18:986-8. [DOI: 10.1016/j.jocn.2010.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 11/18/2022]
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5
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Landi A, Tarantino R, Marotta N, Rocco P, Antonelli M, Salvati M, Delfini R. Paraganglioma of the filum terminale: case report. World J Surg Oncol 2009; 7:95. [PMID: 20003361 PMCID: PMC2797510 DOI: 10.1186/1477-7819-7-95] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 12/11/2009] [Indexed: 11/18/2022] Open
Abstract
Background Paragangliomas affecting the filum terminale are extremely rare, benign tumors. The literature yielded thirty-two cases of paraganglioma in this site. Case presentation A 49 year-old-man, whose presenting symptoms were low back pain and left leg weakness, was diagnosed as having a paraganglioma of the filum terminale. The clinical, histological and radiological characteristics of this case, that brings the total number of cases described to 33, are discussed in the light of published data. Conclusions This extremely rare pathology can usually be successfully treated by total surgical resection, which represents the gold standard. In the event of incomplete removal, assiduous long-term follow-up is mandatory.
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Affiliation(s)
- Alessandro Landi
- Department of Neurosurgery, University of Rome Sapienza, Rome, Italy.
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6
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Nitsche M, Prinz M, Hermann RM, Christiansen H, Weiss E. Paraganglioma of the cerebellum: case report and review of the literature. Int J Clin Oncol 2005; 10:447-52. [PMID: 16369753 DOI: 10.1007/s10147-005-0529-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 08/18/2005] [Indexed: 10/25/2022]
Abstract
Intracerebral paragangliomas are tumors with a low incidence. Only 13 cases have been reported in the literature to date. This type of tumor shows characteristic histopathological features but unclear histogenesis. Owing to its low incidence, little knowledge exists concerning the best therapeutic strategy. We report on a 55-year-old male patient with the diagnosis of a paraganglioma of the cerebellum. We compare our patient's case to similar cases reported in the literature, describe the typical course of the disease, and discuss therapeutic options. No relapse of disease was observed in our patient within 2 years of diagnosis. Surgery and adjuvant conventionally fractionated external beam radiotherapy seem to be well tolerated and feasible. A review of patients reported in the literature and a comparison to our patient reveals a good prognosis for intracerebral paragangliomas. The optimal therapeutic strategy with regard to the benefit of adjuvant radiotherapy after total or subtotal resection has yet to be defined.
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Affiliation(s)
- Mirko Nitsche
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Georg-August-Universität, Robert-Koch Strasse 40, 37075 Goettingen, Germany.
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7
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Deb P, Sharma MC, Gaikwad S, Gupta A, Mehta VS, Sarkar C. Cerebellopontine angle paraganglioma – report of a case and review of literature. J Neurooncol 2005; 74:65-9. [PMID: 16078110 DOI: 10.1007/s11060-004-5952-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Majority of the cerebellopontine angle (CPA) tumors are acoustic neuromas, while bulk of the non-acoustic tumors are formed by meningiomas and epidermoid cysts. Primary paraganglioma is a rare tumor in this location, with only two such cases having been reported in the literature, till date. Recently, a case has been described wherein a paraganglioma was apparently arising as a primary lesion in the cerebellar hemisphere. We report another case of an intracranial paraganglioma of the CPA in a 40-year-old female, which did not have any vascular attachment but had focal cerebellar extension.
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Affiliation(s)
- Prabal Deb
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, 110029, New Delhi, India
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8
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Naggara O, Varlet P, Page P, Oppenheim C, Meder JF. Suprasellar paraganglioma: a case report and review of the literature. Neuroradiology 2005; 47:753-7. [PMID: 16047139 DOI: 10.1007/s00234-005-1422-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
Paragangliomas arising in the suprasellar region are extremely rare. We report a case of suprasellar paraganglioma in a 47-year-old man who presented with amnesia and impaired visual acuity without any endocrine dysfunction. Magnetic resonance imaging (MRI) showed a large enhancing tumour in the suprasellar area. Following subtotal surgical excision, the diagnosis of paraganglioma was confirmed by pathology. In this case report we describe the MRI pattern of suprasellar paraganglioma and review the literature of this uncommon lesion.
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Affiliation(s)
- O Naggara
- Department of Neuroradiology, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75013 Paris, France.
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9
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Sousa J, O'Brien D, Crooks D. Paraganglioma of the filum terminale. J Clin Neurosci 2005; 12:584-5. [PMID: 15921911 DOI: 10.1016/j.jocn.2004.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 07/07/2004] [Indexed: 11/20/2022]
Abstract
Paraganglioma of the filum terminale is rare. The authors report a case of paraganglioma of the filum terminale presenting with paraparesis on a background of spastic quadriparesis. The clinical presentation, radiological findings and current literature are presented.
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Affiliation(s)
- J Sousa
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK.
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10
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Abstract
✓ The author reports two cases of cauda equina paraganglioma (CEP) and provides a review of all previously published cases. The current radiological, neurosurgical, and pathological literature on this rare tumor is also reviewed.
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Affiliation(s)
- Miguel Gelabert-González
- Neurosurgical Service, Department of Surgery, Clinic Hospital of Santiago, University of Santiago de Compostela, Santiago, Spain.
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11
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Abstract
Paragangliomas arising as primary neoplasms in the intracranial portion of the central nervous system are relatively uncommon and only have been rarely reported. We report a case of apparent primary paraganglioma arising in the left cerebellar hemisphere in an 11-year-old girl who presented with a 6-month history of headaches. The tumor was marked by a nested architectural pattern (zellballen), delimited by S-100-positive sustentacular cells. Morphologic and immunohistochemical features of the neoplasm are discussed and literature is reviewed regarding involvement of the central nervous system by paraganglioma.
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Affiliation(s)
- Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA
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12
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Di Patre PL, Szalay I, Delavelle J. February 2004: a 44-year-old man with a 2-year history of epistaxis. Brain Pathol 2004; 14:339-40, 343. [PMID: 15446591 PMCID: PMC8095948 DOI: 10.1111/j.1750-3639.2004.tb00074.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 44-year old man presented with a 2-year history of epistaxis and a nodular lesion in the nasopharyngeal mucosa. Neuroimaging revealed a midline nasopharyngeal tumor extending through the skull base to the clivus. Following surgical resection, histological studies showed a paraganglioma, a tumor with a typical nesting pattern, abundant capillary network, and strong immunoreactivity for neuroendocrine markers. Paragangliomas of the head and neck are rare tumors, which may come to the neuropathologist's attention because of their propensity for intracranial spread. In particular, paragangliomas located in the nasopharynx may generate diagnostic difficulties, as they appear to have no connection with major paraganglia in the region. Morphologic criteria do not allow distinguishing between benign and malignant forms.
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13
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Abstract
A variety of surgical approaches to the posterior third ventricle and pineal region exist. The choice of approach is influenced by the exact location of the lesion, its expected pathologic findings, and the comfort level of the operating surgeon with the approach that is being considered. For most pineal region masses that are situated in the midline below the deep venous system, we favor the supracerebellar-infratentorial approach in the sitting position. For pineal region lesions that displace the deep venous system inferiorly or have significant lateral extension, we prefer the occipital-transtentorial approach in the three-quarter prone or sitting position. For lesions that are truly in the posterior third ventricle without extension posterior to the splenium, we prefer the interhemispheric-transcallosal approach in the lateral position.
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Affiliation(s)
- Alan P Lozier
- Neurological Institute of New York, New York Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, 710 West 171 Street, Box 174, New York, NY 10009, USA
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14
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Abstract
Various histological types of tumors arise in the pineal region. The most common tumors are pineal parenchymal tumors and germ cell tumors. Pineal parenchymal tumors are divided into pineocytoma, pineal parenchymal tumor with intermediate differentiation and pineoblastoma. Pineocytomas are well-differentiated tumors and retain the morphological and immunohistochemical features of pineal parenchymal cells. Lobular architectures and pineocytomatous rosettes are also typical features. In contrast, pineoblastomas are embryonal tumors resembling primitive neuroectodermal tumors (PNET). However, pineoblastomas are distinct from PNET in other sites due to their exhibiting photosensory differentiation including Flexner-Wintersteiner rosettes and fleurettes. Although pineal cysts are tumor-like lesions, and not true neoplasms, they are occasionally difficult to distinguish from pineocytoma and astrocytoma. From the therapeutic aspect, a precise differential diagnosis is critical. The pineal region is the most common site of the brain in which germ cell tumors occur. Germinoma, teratoma, embryonal carcinoma, yolk sac tumor and choriocarcinoma are encountered, and the latter three types of tumors usually constitute elements of mixed germ cell tumors. The morphological and immunohistochemical features of intracranial germ cell tumors are very similar to those of gonadal germ cell tumors, although there are some differences in germinoma. Pineal germinoma may exhibit carcinomatous differentiation. Other types of tumors are occasionally observed, including fibrillary and pilocytic astrocytoma, glioblastoma, ependymoma, melanoma, meningioma and so on. Metastatic pineal tumors are also rare. The most common site of origin for pineal metastasis is the lung.
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Affiliation(s)
- J Hirato
- Department of Pathology, Gunma University School of Medicine, Maebashi, Japan.
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15
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Sambaziotis D, Kontogeorgos G, Kovacs K, Horvath E, Levedis A. Intrasellar paraganglioma presenting as nonfunctioning pituitary adenoma. Arch Pathol Lab Med 1999; 123:429-32. [PMID: 10235503 DOI: 10.5858/1999-123-0429-ippanp] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Paragangliomas arising in the sellar region are rare. We report a case of intrasellar paraganglioma of a 54-year-old man who presented with gradually decreasing visual acuity. Physical examination revealed bitemporal hemianopsia with no apparent signs of endocrinologic dysfunction. Magnetic resonance imaging revealed a large sellar mass believed to be a nonfunctioning pituitary adenoma. The tumor was removed transsphenoidally and submitted for histologic examination. The morphologic features, based on histologic, immunocytochemical, and electron microscopic analyses, were consistent with the diagnosis of paraganglioma. The diagnostic morphologic features and the immunocytochemical profile of the tumor are reported.
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Affiliation(s)
- D Sambaziotis
- Department of Pathology and Neurosurgery, G. Gennimatas Athens General Hospital, Greece
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16
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Abstract
Paraganglioma arising in the thoracic extradural space is an uncommon tumor, with only four cases previously reported. The authors review the clinical and pathological features of thoracic paraganglioma and compare them to the more common paraganglioma of the cauda equina.
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Affiliation(s)
- L F Fitzgerald
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
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17
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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.
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Affiliation(s)
- P H Roche
- Department of Neurosurgery, Hôpital de la Timone, Marseille, France
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18
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Scheithauer BW, Parameswaran A, Burdick B. Intrasellar paraganglioma: report of a case in a sibship of von Hippel-Lindau disease. Neurosurgery 1996; 38:395-9. [PMID: 8869071 DOI: 10.1097/00006123-199602000-00034] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Although uncommon, paragangliomas are known to affect the central nervous system. Those that arise in the sellar region are particularly rare. We report the clinicopathological features of a paraganglioma occurring in the setting of von Hippel-Lindau disease, a disorder in which paragangliomas are known to occur. We also present a review of the literature.
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Affiliation(s)
- B W Scheithauer
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
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19
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Min KW, Scheithauer BW, Bauserman SC. Pineal parenchymal tumors: an ultrastructural study with prognostic implications. Ultrastruct Pathol 1994; 18:69-85. [PMID: 8191649 DOI: 10.3109/01913129409016276] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The pineal gland is host to a spectrum of neoplasms. Those considered to be derived from or differentiating toward pineal parenchymal cells are rare. Traditionally, pineal parenchymal tumors (PPTs) have been divided into 3 types: pineocytomas, pineoblastomas, and mixed or transitional tumors. Their characterization has been far from adequate and no firm diagnostic criteria, light microscopic or ultrastructural, have been established. In an attempt to provide more precise prognostic diagnostic criteria, we undertook a detailed ultrastructural analysis of 17 PPTs and found them to exhibit light microscopic and ultrastructural features strikingly similar to those of pineal parenchymal cells in varying stages of development, ranging from undifferentiated primitive neuroepithelial cells to mature pineal parenchymal cells. We endorse classification of PPTs based on a combination of their light microscopic and ultrastructural features. Accordingly, PPTs can be divided into three categories: 1) pinealoblastoma, 2) PPTs of intermediate or mixed differentiation, and 3) pineocytoma, a tumor of mature-appearing pineocytes. In keeping with this classification, our 3 pinealoblastomas behaved as highly malignant tumors. A correlation of morphology and prognosis was less evident between intermediate tumors and pineocytomas, perhaps the result of considerable variation in surgical and other therapies. Evidence of neurosensory differentiation, a feature noted to a varying extent in all but the pineoblastomas, included club-shaped "nerve endings" in 7 tumors, small numbers of dense core granules in 8, clear vesicles in 7, and structures suggestive of synapses in 4. With the exception of 3 undifferentiated PPTs or pinealoblastomas lacking nerve endings, all pineocytomas exhibited some combination of these markers of neuronal specialization. In that the ultrastructural features of these PPTs were more indicative of their aggressiveness than was their degree of light microscopic differentiation or grade, we consider electron microscopy a useful adjunct, not only in diagnosis but also in therapeutic decision-making and prognostication.
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Affiliation(s)
- K W Min
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City 73190
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20
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Jamjoom ZA, Sadiq S, Naim-Ur-Rahman, Malabary T. Cerebello-pontine angle paraganglioma simulating an acoustic neurinoma. Br J Neurosurg 1991; 5:307-12. [PMID: 1892575 DOI: 10.3109/02688699109005192] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An unusual case of paraganglioma arising from the internal auditory meatus and growing into the cerebello-pontine angle is reported. Clinical features, pre-operative radiological appearances and intra-operative findings were indistinguishable from those of an acoustic neurinoma. However, the paraganglionic nature of the tumour was confirmed by the electron microscopic evidence of neurosecretory features.
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Affiliation(s)
- Z A Jamjoom
- Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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21
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Raftopoulos C, Flament-Durand J, Brucher JM, Stroobandt G, Chaskis C, Brotchi J. Paraganglioma of the cauda equina. Report of 2 cases and review of 59 cases from the literature. Clin Neurol Neurosurg 1990; 92:263-70. [PMID: 2171837 DOI: 10.1016/0303-8467(90)90032-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Paragangliomas of the cauda equina are not so rare as said in the literature. Two additional cases are presented with a global analysis of the 59 cases from the literature. The diagnosis of this pathology greatly benefit of the use of immunostainings as the cells are often neuron-specific enolase, neurofilament protein and somatostatin positive so that electron microscopy is thus no longer mandatory for establishing the diagnosis. In addition, we report the first magnetic resonance images of this tumor at this location.
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Affiliation(s)
- C Raftopoulos
- Department of Neurosurgery, Université Libre de Bruxelles, Belgium
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22
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Capella C, Riva C, Cornaggia M, Chiaravalli AM, Frigerio B, Solcia E. Histopathology, cytology and cytochemistry of pheochromocytomas and paragangliomas including chemodectomas. Pathol Res Pract 1988; 183:176-87. [PMID: 2838831 DOI: 10.1016/s0344-0338(88)80045-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The results of histopathological, histochemical and ultrastructural investigations on pheochromocytomas and paragangliomas have been reported. These results allowed the functional identification of the cell types composing many of such tumours. Moreover, comparison of these data with clinico-pathologic findings outlined the advantages and limits of cytologic studies for understanding the natural history of pheochromocytomas and paragangliomas and improving our diagnostic and prognostic criteria.
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Affiliation(s)
- C Capella
- Varese Multizonal Hospital, University of Pavia, Varese, Italy
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23
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Kamalian N, Abbassioun K, Amirjamshidi A, Shams-Shahrabadi M. Paraganglioma of the filum terminale internum. Report of a case and review of the literature. J Neurol 1987; 235:56-9. [PMID: 3323422 DOI: 10.1007/bf00314201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of paraganglioma of the filum terminale is presented where normal sympathetic ganglion cells were seen in conjunction with tumour cells in a well-encapsulated tumour, suggesting a possible origin from heterotopic sympathetic ganglion.
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Affiliation(s)
- N Kamalian
- Department of Pathology, Dr Shariati Hospital, School of Medicine, Tehran University, Iran
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24
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25
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Sonneland PR, Scheithauer BW, LeChago J, Crawford BG, Onofrio BM. Paraganglioma of the cauda equina region. Clinicopathologic study of 31 cases with special reference to immunocytology and ultrastructure. Cancer 1986; 58:1720-35. [PMID: 2875784 DOI: 10.1002/1097-0142(19861015)58:8<1720::aid-cncr2820580824>3.0.co;2-u] [Citation(s) in RCA: 112] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Thirty-one paragangliomas of the cauda equina region were studied (18 men and 13 women, ages 30-71 years [mean, 51 years]). Symptoms (1 day to 15 years in duration; mean, 48 months) included low back pain (87%), sensory/motor deficits (35%), urinary/fecal incontinence (13%), and paraplegia (6%). All patients studied had some myelographic block. Cerebrospinal fluid protein level ranged from 56 to 7000 mg/dl (mean, 1109 mg/dl). Most tumors were limited to the filum terminale, although one also involved the conus medullaris and two clearly arose from a caudal nerve root. All but one were entirely intradural. The tumor was totally excised in 26 cases; these patients remain disease-free. Of three patients whose tumors were excised subtotally, two received radiotherapy; the one non-radiated patient died of tumor-related complications. No autopsy was performed. One partially encapsulated tumor that had been subjected to biopsy and irradiation presented 1 year later with osseous invasion and retroperitoneal extension; 20 years after subtotal excision, this patient is alive but paraplegic. Morphologically, all tumors resembled paraganglioma at other sites. Cytologic atypia and mitotic activity generally were absent to mild. Fourteen (45%) cases showed ganglionic differentiation. All tumors tested were immunoreactive for neuron-specific enolase and neurofilament protein, and most showed somatostatin or serotonin reactivity. S-100 protein immunoreactivity was noted in sustentacular cells and, to a lesser extent, within chief cells and neurons. The authors conclude that paragangliomas are largely benign and encapsulated and respond to simple resection. When surgically feasible, gross total removal should be the goal of surgery. When subtotal resection is necessary or when local invasion leaves a question as to completeness of tumor removal, irradiation seems mandatory although far from guaranteeing prevention of recurrence. Biopsy alone is undesirable.
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26
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Ueda N, Yoshida A, Fukunishi R, Fujita H, Yanagihara N. Nonchromaffin paraganglioma in the nose and paranasal sinuses. ACTA PATHOLOGICA JAPONICA 1985; 35:489-95. [PMID: 2992229 DOI: 10.1111/j.1440-1827.1985.tb00591.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Nonchromaffin paraganglioma occurring in the nose and paranasal sinuses are extremely rare. The authors have experienced a case of nonchromaffin paraganglioma of nasal cavity which extended to the epipharynx. To our knowledge, this reported case is the fourth case that has appeared in the world literature. The patient, a 31-year-old female, had complained of a right nasal obstruction and mucopurulent rhinorrhea for two years. The right nasal cavity was filled with a polypoid mass showing no bleeding tendency or necrosis. Radiographs revealed a homogeneous shadow which occupied the entire nasal cavity and paranasal sinuses. Histopathological studies revealed that the tumor showed typical findings of nonchromaffin paraganglioma and neurosecretory granules in cytoplasm were observed by electron microscopic study. Subsequently, the tumor recurred at on the posterior epipharyngeal wall after a duration of one year and three months, and was removed completely. Since then, there was no recurrence of the tumor until the present time.
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Prabhakar S, Sawhney IM, Chopra JS, Kak VK, Banerjee AK. Hemibase syndrome: an unusual presentation of intracranial paraganglioma. SURGICAL NEUROLOGY 1984; 22:39-42. [PMID: 6729688 DOI: 10.1016/0090-3019(84)90226-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of paraganglioma of parasellar origin in a 7-year-old girl is described. She presented with hemibase syndrome with involvement of a majority of the left cranial nerves. Three times in the past 2 years she had recurrent ophthalmoplegia with complete recovery. She was treated surgically and with postoperative radiotherapy. The site of origin of this paraganglioma as well as the clinical presentation are uncommon features in this case.
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Shuangshoti S, Suwanwela N, Suwanwela C. Combined paraganglioma and glioma of conus medullaris and cauda equina. J Surg Oncol 1984; 25:162-7. [PMID: 6700229 DOI: 10.1002/jso.2930250306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A mixed paraganglioma and glioma occurred in the conus medullaris and cauda equina of a woman. The tumor was subdural, encapsulated, and vascular. It was first manifested with symptoms and signs of compression of the cauda equina when she was 19 years of age and was excised when she was 24. The tumor was attached to the conus medullaris, the dura mater, and a nerve root of the cauda equina. Striking light and dark cells with an organoid arrangement mingled with a few glial fibrillary acidic protein (GFAP)-positive neuroglia forming a combined paraganglioma and glioma. Twenty-three paragangliomas were reported in the literature including the present case. The sex and age of recorded 19 patients demonstrated ten males and nine females with an average age of 46.3 years. Twenty tumors were subdurally situated at the conus medullaris and cauda equina. Three neoplasms were epidural and thoracic in location.
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Abstract
An unusual, well demarcated, and encapsulated neoplasm of the cauda equina is presented. At first, the tumor was considered to be a variant of myxopapillary ependymoma, but the reaction for glial fibrillary acidic protein was negative. At the ultrastructural level, the neoplastic cells contained many small dense core vesicles, and the diagnosis of paraganglioma was established. The literature and histogenesis of paraganglioma of the cauda equina is reviewed.
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Abstract
Only three cases of tracheal paraganglioma have been reported in the literature. This paper describes an additional case, which showed pharmacological and ultrastructural evidence of hormone secretion. It is suggested that this tumor is derived from true paraganglia located in the trachea and not from misplaced or aberrant paraganglionic tissue. Hemoptysis was the only presenting symptom in two of the four reported cases and significant bleeding occurred during biopsy in the other two cases. The long-term prognosis appears good if complete resection is possible.
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Abstract
Pathologic survey was performed on 43 cases of intracranial germinoma and 12 cases of pinealoma. The present study suggests that, in Japan, the incidence of teratoma groups including germinoma is remarkably higher than that in U.S. and Europe, whereas the rate of true pinealoma is lower. Using ultrastructural, enzyme-histochemical, and fluorescence-histochemical methods for a few surgical specimens, a strong similarity between intracranial germinoma (so-called "pinealoma" with a two-cell pattern) and seminoma and dysgerminoma was confirmed. The true pinealoma could be classified as pineoblastoma and pineocytoma, according to the degree of pineocyte differentiation of the tumor cells, and as "neuroblastoma-like" and "pineal-like" on the basis of the histologic architecture.
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Abstract
From our study of eight pineoblastomas and five pineocytomas and a review of the literature, we have described two clinicopathologic syndromes that characterize these neoplasms. Pineoblastomas highly resemble the medulloblastoma-neuroblastoma group of tumors and occur mostly in young people. The tempo of progression of the disease is fast, the length of illness is short. These are infiltrating neoplasms that commonly spread via the cerebrospinal fluid. They are radiosensitive. Histologically they are also similar to the medulloblastoma-neuroblastoma group and are characterized by the scarcity of cytoplasmic processes and by the Homer Wright rosette. They contain giant cells. Pineocytomas are tumors of adults. The tempo of progression of the disease is slow, and the length of illness is long. They expand by compressing the surrounding tissues. Histologically they are characterized by the abundance of cytoplasmic processes and by the pineocytomatous rosette. They contain giant cells. Areas composed of neoplastic gangliocytes and astrocytes in various combinations are common variants in some of these neoplasms.
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Lack EE, Cubilla AL, Woodruff JM. Paragangliomas of the head and neck region. A pathologic study of tumors from 71 patients. Hum Pathol 1979; 10:191-218. [PMID: 422190 DOI: 10.1016/s0046-8177(79)80008-8] [Citation(s) in RCA: 203] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The histopathology of 72 paragangliomas originating in the head and neck region of 71 patients is presented. There were 45 carotid body, 13 vagal body, eight jugulotympanic, and three nasal paragangliomas. In addition, two arose in the larynx and one in the area of the aortic arch. Tumors occurred in four unrelated families. The two most important histologic features leading to a diagnosis of paraganglioma were zellballen and the presence of cytoplasmic argyrophil granules in all cases in which staining with the Grimelius technique was carried out. Ultrastructural study of three carotid body and two vagal body paragangliomas revealed both light and dark chief cells. Tumor cells contained membrane bound, electron dense neurosecretory types of granules, which usually ranged in diameter from 120 to 200 nm. Follow-up information was available for 67 patients (94 per cent). Two of the three nasal paragangliomas, 50 per cent of the jugulotympanic paragangliomas, 17 per cent of the vagal body paragangliomas, and 10 per cent of those of the carotid body recurred locally following attempted surgical resection. All patients treated with radiation had persistent tumor. Four (9 per cent) of the carotid body paragangliomas were malignant, all four patients dying with widespread metastases. One vagal body paragangliomas metastasized to regional lymph nodes (the patient was alive and well at five years), and another caused death by direct intracranial extension. In contrast to the benign tumors, malignant paragangliomas tended to show foci of necrosis and vascular invasion. Mitotic figures, which usually were not identified in the benign cases, were seen in all malignant tumors.
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