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Constantinescu G, Preda C, Constantinescu V, Siepmann T, Bornstein SR, Lenders JWM, Eisenhofer G, Pamporaki C. Silent pheochromocytoma and paraganglioma: Systematic review and proposed definitions for standardized terminology. Front Endocrinol (Lausanne) 2022; 13:1021420. [PMID: 36325453 PMCID: PMC9618947 DOI: 10.3389/fendo.2022.1021420] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors with heterogeneous clinical presentations and potential lethal outcomes. The diagnosis is based on clinical suspicion, biochemical testing, imaging and histopathological confirmation. Increasingly widespread use of imaging studies and surveillance of patients at risk of PPGL due to a hereditary background or a previous tumor is leading to the diagnosis of these tumors at an early stage. This has resulted in an increasing use of the term "silent" PPGL. This term and other variants are now commonly found in the literature without any clear or unified definition. Among the various terms, "clinically silent" is often used to describe the lack of signs and symptoms associated with catecholamine excess. Confusion arises when these and other terms are used to define the tumors according to their ability to synthesize and/or release catecholamines in relation to biochemical test results. In such cases the term "silent" and other variants are often inappropriately and misleadingly used. In the present analysis we provide an overview of the literature and propose standardized terminology in an attempt at harmonization to facilitate scientific communication.
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Affiliation(s)
- Georgiana Constantinescu
- Department of Endocrinology and Diabetes, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Endocrinology, Grigore T. Popa University, Iasi, Romania
- Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden Inter-national University, Dresden, Germany
- *Correspondence: Christina Pamporaki, ; Georgiana Constantinescu,
| | - Cristina Preda
- Department of Endocrinology, Grigore T. Popa University, Iasi, Romania
| | - Victor Constantinescu
- Center of Clinical Neuroscience, University Clinic Carl-Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Timo Siepmann
- Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden Inter-national University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan R. Bornstein
- Department of Endocrinology and Diabetes, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Jacques W. M. Lenders
- Department of Endocrinology and Diabetes, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Graeme Eisenhofer
- Department of Endocrinology and Diabetes, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University of Dresden, Dresden, Germany
| | - Christina Pamporaki
- Department of Endocrinology and Diabetes, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- *Correspondence: Christina Pamporaki, ; Georgiana Constantinescu,
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Sun D, Yang P, Liu Y, Wang S. Paraganglioma of the spermatic cord: report of one case and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1779-1786. [PMID: 32782705 PMCID: PMC7414487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
Extra-adrenal paraganglioma is rare, and occurs in the retroperitoneum, and head and neck. The incidence rate of paraganglioma in urogenital system is very low, especially in the spermatic cord. A case of paraganglioma of spermatic cord is reported and relevant literature is reviewed. A spermatic cord mass was found in the right scrotum in a middle-aged man 2 years ago, without hormone symptoms. Understanding of clinical and intraoperative frozen pathology was inadequate. Ultrasound images showed that there was abundant blood supply around the right spermatic cord with clear boundaries. The conventional pathology of the tumor presented a typical histologic morphology of paraganglioma. Immunohistochemistry showed that chief tumor cells were CGA (+), syn (+), CD56 (+), SDHB (+), and sertoli cells were S-100 (strong+). There are few reported cases at present, and the etiology and pathogenesis are not clear yet. The rapid frozen pathologic diagnosis during operation is very challenging, and it is easily diagnosed by routine histology combined with immunohistochemistry. Gene detection is recommended if necessary. Early diagnosis is helpful to the choice of operation mode and the prevention and control of intraoperative risk.
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Affiliation(s)
- Di Sun
- Department of Medicine, Yantai Yuhuangding Hospital of Qingdao University Yantai, Shandong, P. R. China
| | - Ping Yang
- Department of Medicine, Yantai Yuhuangding Hospital of Qingdao University Yantai, Shandong, P. R. China
| | - Ying Liu
- Department of Medicine, Yantai Yuhuangding Hospital of Qingdao University Yantai, Shandong, P. R. China
| | - Suxia Wang
- Department of Medicine, Yantai Yuhuangding Hospital of Qingdao University Yantai, Shandong, P. R. China
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Yankelevich GR, Piraino J, Akanda S, Edwards DC, Gerges M, Snow ZA, McGreen B, Levy J, Ciocca V, Hagg MJ. Paraganglioma of the Spermatic Cord With Spinal Metastasis: A Case Report. Urology 2020; 143:e7-e11. [PMID: 32505620 DOI: 10.1016/j.urology.2020.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/25/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
A 40-year-old male with presented to the clinic with the chief complaint of right inguinal pain radiating to his right testicle and right thigh with no history of trauma, fever, chills, dysuria, hematuria, or unprotected sexual activity. Physical exam revealed right testicular tenderness with no palpable abnormality of the bilateral testes or spermatic cords. Scrotal ultrasound was performed and was unremarkable for testicular or other intrascrotal pathology. Concurrently, chronic low back pain had prompted a lumbar CT to be performed, which was indeterminate, but subsequent lumbar MRI performed three months later revealed abnormal signals in the vertebral bodies of T12, L3, and L5, concerning for occult metastatic disease or multiple myeloma. PET-CT was performed revealing hypermetabolic lesions throughout the axial skeleton and, most notably, hypermetabolic lesions in the left inguinal and left upper scrotum. At this time, about 4 months after the original visit, physical exam revealed a palpable mobile mass in the left upper scrotum that was distinct from the left testicle, and another mass palpable near the left inguinal ring.
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Affiliation(s)
| | - Javier Piraino
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Shawon Akanda
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
| | | | - Michael Gerges
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Zachary A Snow
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Brian McGreen
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Jason Levy
- Department of Urology, Main Line Health, Philadelphia, PA
| | | | - Michael J Hagg
- Department of Urology, Main Line Health, Philadelphia, PA
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Prospective evaluation of 68Ga-DOTANOC positron emission tomography/computed tomography and 131I-meta-iodobenzylguanidine single-photon emission computed tomography/computed tomography in extra-adrenal paragangliomas, including uncommon primary sites and to define their diagnostic roles in current scenario. Nucl Med Commun 2019; 40:1230-1242. [DOI: 10.1097/mnm.0000000000001096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shehabeldin AN, Ro JY. Neuroendocrine tumors of genitourinary tract: Recent advances. Ann Diagn Pathol 2019; 42:48-58. [DOI: 10.1016/j.anndiagpath.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 01/25/2023]
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Abstract
Paratesticular paragangliomas are a rare occurrence. We present the case of a 43-year-old man who presented with paresthesia and paraparesis and was found to have pathologic fracture involving D1 vertebra as a manifestation of metastasis from a nonsecretory right paratesticular paraganglioma.
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Gontarz B, Hegde P, McFadden D. Paraganglioma of the spermatic cord: A case report and literature review. Int J Surg Case Rep 2019; 60:368-370. [PMID: 31288201 PMCID: PMC6614785 DOI: 10.1016/j.ijscr.2019.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022] Open
Abstract
A paraganglioma, or an extra-adrenal catecholamine-producing tumor, is a clinically significant neuroendocrine tumor with an incidence of 3–8 cases per million population. The majority of paragangliomas, 85–90%, occur in the adrenal glands and 98% are found in the abdomen. Unlike pheochromocytomas, where only 10% are malignant, paragangliomas carry a 40–50% malignancy rare, and their development is part of a hereditary syndrome in 30% of cases. The most common hereditary syndromes associated with paragangliomas are von Hipple-Lindau (VHL), multiple endocrine neoplasia 2 (MEN 2) and neurofibromatosis type 1 (NF1). Herein we describe and review the 13th paraganglioma documented arising from the spermatic cord.
Introduction Neuroendocrine tumors are a diverse and well-described entity with most arising from the gastrointestinal tract. A clinically significant example is the paraganglioma, or an extra-adrenal catecholamine-producing tumor. Presentation of case Herein we describe and review a paraganglioma arising from the spermatic cord in a 55 year old asymptomatic man. Discussion Paragangliomas are rare, with an incidence of 3–8 cases per million population. To date there are only 12 cases found in the literature. Conclusion In this article, we review our patient’s presentation, follow-up, and screening followed by a review of the literature of this fascinating tumor. Although rare, paraganglioma should be considered in the differential diagnosis of unusual groin masses. This work has been reported in line with the SCARE criteria (Agha et al., 2018).
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Affiliation(s)
- Brendan Gontarz
- Department of Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06032, United States.
| | - Poornima Hegde
- Department of Pathology and Laboratory Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06032, United States.
| | - David McFadden
- Department of Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06032, United States.
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Bachmeier C, Kuma L, Collins M, Sangla K. Succinate Dehydrogenase Subunit B Mutation Presenting with Spermatic Cord and Neck Paraganglioma. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2018-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Srivastava SK, Marathe N, Bhosale S, Purohit S, Raj A, Manghwani J. Paratesticular Paraganglioma with Metastasis to D1 Vertebra- A Case Report and Review of Literature. J Orthop Case Rep 2018; 8:92-95. [PMID: 30915305 PMCID: PMC6424310 DOI: 10.13107/jocr.2250-0685.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Paragangliomas are relatively rare tumors, accounting for only about 0.3% of all neoplasms. Most paragangliomas are defined as benign in nature, but 10-% possess metastatic potential. There have been scattered reports of metastatic paraganglioma in the literature, but in rare circumstances, paragangliomas can metastasize to the spinal column causing destruction or compression of the spinal cord, clinically manifesting as pain or neurological deficit. CASE REPORT We present a case of a 43-year-old man who presented with paresthesia and paraparesis and was found to have pathologic fracture involving D1 vertebra as a manifestation of metastasis from a non-secretory right paratesticular paraganglioma. CONCLUSIONS We will review the literature on the topic of metastatic paraganglioma, management of paragangliomas involving spine, and touch on the importance of angioembolization, staged procedures, and a team approach.
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Affiliation(s)
- S K Srivastava
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nandan Marathe
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India,Address of Correspondence: Dr. Nandan Marathe, Saraswati Prasad, Gaul Wada, Vasai (w), Palghar—, Maharashtra, India. E-mail:
| | - Sunil Bhosale
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shaligram Purohit
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Aditya Raj
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Jitesh Manghwani
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Kwon AY, Kang H, An HJ, Kim G, Kim TH, Heo JH, Lee HJ, Hong YK. Spermatic Cord Paraganglioma With Histologically Malignant Features. Urology 2016; 93:e7-8. [DOI: 10.1016/j.urology.2016.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/27/2022]
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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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Paragangliome du cordon spermatique. Prog Urol 2013; 23:486-8. [DOI: 10.1016/j.purol.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 03/08/2013] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
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