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Ohara N, Kaneko M, Yaguchi Y, Ishiguro H, Ishizaki F, Maruyama R, Suzuki K, Komeyama T, Usuda H, Yamazaki Y, Sasano H, Kaneko K, Kamoi K. A case of normotensive incidentally discovered adrenal pheochromocytoma. Clin Case Rep 2018; 6:2303-2308. [PMID: 30564317 PMCID: PMC6293157 DOI: 10.1002/ccr3.1772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/03/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022] Open
Abstract
Pheochromocytomas are catecholamine-producing neuroendocrine tumors that arise from the adrenal medulla. The clinical presentation includes headache, palpitation, and hypertension, but pheochromocytomas are sometimes clinically silent. The present case highlights the importance of biochemical testing for pheochromocytoma in patients with adrenal incidentaloma, even if they are completely normotensive and asymptomatic.
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Affiliation(s)
- Nobumasa Ohara
- Department of Endocrinology and MetabolismNagaoka Red Cross HospitalNiigataJapan
- Department of Endocrinology and MetabolismUonuma Institute of Community MedicineNiigata University Medical and Dental HospitalNiigataJapan
| | - Masanori Kaneko
- Department of Endocrinology and MetabolismNagaoka Red Cross HospitalNiigataJapan
| | - Yuta Yaguchi
- Department of Endocrinology and MetabolismNagaoka Red Cross HospitalNiigataJapan
| | - Hajime Ishiguro
- Department of Endocrinology and MetabolismNagaoka Red Cross HospitalNiigataJapan
| | - Fumio Ishizaki
- Department of UrologyNagaoka Red Cross HospitalNiigataJapan
| | - Ryo Maruyama
- Department of UrologyNagaoka Red Cross HospitalNiigataJapan
| | - Kazuya Suzuki
- Department of UrologyNagaoka Red Cross HospitalNiigataJapan
| | | | - Hiroyuki Usuda
- Department of PathologyNagaoka Red Cross HospitalNiigataJapan
| | - Yuto Yamazaki
- Department of PathologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Hironobu Sasano
- Department of PathologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Kenzo Kaneko
- Department of Endocrinology and MetabolismNagaoka Red Cross HospitalNiigataJapan
| | - Kyuzi Kamoi
- Department of Internal MedicineOjiya General HospitalNiigataJapan
- Center of Diabetes, Endocrinology and MetabolismJoetsu General HospitalNiigataJapan
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Gahremanpour A, Pattakos G, Reul RM, Mirzai-Tehrane M. Diagnostic Imaging and Treatment of a Left Atrial Paraganglioma. Tex Heart Inst J 2017; 44:296-298. [PMID: 28878589 DOI: 10.14503/thij-16-5749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chow LTC, Chan MHM, Wong SKC. Functional Ulnar Nerve Paraganglioma: First Documented Occurrence in the Extremity With Hitherto Undescribed Associated Extensive Glomus Cell Hyperplasia and Tumorlet Formation. Int J Surg Pathol 2017; 26:64-72. [PMID: 28697655 DOI: 10.1177/1066896917720750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extra-adrenal paraganglioma has never been described in the extremities. A 34-year-old woman complained of an enlarging mass in the right forearm for 18 months. Imaging showed a circumscribed vascular tumor attached to the ulnar nerve; biopsy revealed features of paraganglioma. The resected tumor consisted of zellballen pattern of chief cells staining positively for chromogranin with surrounding S100-positive sustentacular cells. The chief cells contained many neurosecretory granules and mitochondria, whereas the sustentacular cells contained a large amount of rough endoplasmic reticulum and some microfilaments. There was adjacent extensive glomus cell hyperplasia and tumorlet formation. The intraoperative blood pressure dropped abruptly on tumor removal. The serum normetanephrine level decreased from a preoperative level of 1987 pg/mL (normal < 149 pg/mL) to normal after operation. The patient admitted on questioning to a history of paroxysmal attacks of transient palpitation, hand tremors, and sweating; imaging showed no evidence of tumor in other parts of the body, and there was no family history of similar tumor; she remained well 33 months after the operation. This occurrence of functional ulnar nerve paraganglioma with the hitherto undescribed associated glomus cell hyperplasia and tumorlet formation attests to the probable existence of normal sympathetic paraganglia in the extremity and their intimate functional relationship with glomus bodies.
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Ohara N, Uemura Y, Mezaki N, Kimura K, Kaneko M, Kuwano H, Ebe K, Fujita T, Komeyama T, Usuda H, Yamazaki Y, Maekawa T, Sasano H, Kaneko K, Kamoi K. Histopathological analysis of spontaneous large necrosis of adrenal pheochromocytoma manifested as acute attacks of alternating hypertension and hypotension: a case report. J Med Case Rep 2016; 10:279. [PMID: 27729064 PMCID: PMC5059976 DOI: 10.1186/s13256-016-1068-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors. Hypertension secondary to pheochromocytoma is often paroxysmal, and patients occasionally present with sudden attacks of alternating hypertension and hypotension. Spontaneous, extensive necrosis within the tumor that is associated with catecholamine crisis is an infrequent complication of adrenal pheochromocytoma, but its pathogenesis remains unclear. Case presentation A 69-year-old Japanese man developed acute-onset episodic headaches, palpitations, and chest pains. During the episodes, both marked fluctuations in blood pressure (ranging from 40/25 to 300/160 mmHg) and high plasma levels of catecholamines were found simultaneously. Radiological findings indicated a 4-cm left adrenal pheochromocytoma. These episodic symptoms disappeared within 2 weeks with normalization of plasma catecholamine levels. Two months later, the patient underwent adrenalectomy. Microscopic examinations revealed pheocromocytoma with a large central area of coagulative necrosis. The necrotic material was immunohistochemically positive for chromogranin A. Granulation tissue was adjacent to the necrotic area, accompanied by numerous hemosiderin-laden macrophages and histiocytes with vascular proliferation. Viable tumor cells, detected along the periphery of the tumor, demonstrated pyknosis, and the Ki-67 labeling index was 2 % in the hot spot. No embolus or thrombus formation was found in the resected specimen harboring the whole tumor. The Pheochromocytoma of the Adrenal gland Scaled Score was 2 out of 20. The patient’s postoperative course was unremarkable for > 7 years. Conclusions Presumed causal factors for the extensive necrosis of adrenal pheochromocytoma in previously reported cases include hemorrhage into the tumor, hypotension induced by a phentolamine administration, embolic infarction, high intracapsular pressure due to malignant growth of the tumor, and catecholamine-induced vasoconstriction. In the present case, histopathological and clinical findings suggest that under conditions of chronic ischemia due to catecholamine-induced vasoconstriction, an acute infarction occurred after sudden attacks of alternating hypertension and hypotension. Over the subsequent 2 weeks, repetitive massive release of catecholamines from the infarcts into circulation likely accelerated infarction progression by causing repeated attacks of alternating hypertension and hypotension and resulted in the large necrosis. This case highlights the need for physicians to consider acute spontaneous tumor infarction accompanying episodic catecholamine crisis as a rare but severe complication of pheochromocytoma.
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Affiliation(s)
- Nobumasa Ohara
- Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan. .,Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Yasuyuki Uemura
- Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Naomi Mezaki
- Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Keita Kimura
- Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Masanori Kaneko
- Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Hirohiko Kuwano
- Department of Cardiovascular Medicine, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Katsuya Ebe
- Department of Cardiovascular Medicine, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Toshio Fujita
- Department of Cardiovascular Medicine, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Takeshi Komeyama
- Department of Urology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Hiroyuki Usuda
- Department of Pathology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takashi Maekawa
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kenzo Kaneko
- Department of Endocrinology and Metabolism, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata, 940-2085, Japan
| | - Kyuzi Kamoi
- Department of Internal Medicine, Ojiya General Hospital, Niigata, Japan.,Center of Diabetes, Endocrinology and Metabolism, Joetsu General Hospital, Niigata, Japan
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Kulkarni MM, Khandeparkar SGS, Deshmukh SD, Karekar RR, Gaopande VL, Joshi AR, Kesari MV, Shelke RR. Risk Stratification in Paragangliomas with PASS (Pheochromocytoma of the Adrenal Gland Scaled Score) and Immunohistochemical Markers. J Clin Diagn Res 2016; 10:EC01-EC04. [PMID: 27790441 DOI: 10.7860/jcdr/2016/20565.8419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Paragangliomas (PGLs) are rare tumours that arise in sympathetic and parasympathetic paraganglia and are derived from neural crest cells. Presence of metastasis is the only absolute criterion for malignancy. There is no single histo-morphological feature indicating malignant potential and multiple parameters have been proposed to prognosticate the individual case. This includes studies conducted using Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and Immunohistochemical (IHC) markers. AIM We have studied ten cases of paraganglioma and attempted to correlate the prognosis with multiple clinicopathological variables. MATERIALS AND METHODS This study was done in a tertiary care general hospital over a period of five years. Available clinical records and histopathology slides of all patients were reviewed. Using Pheochromocytoma of the Adrenal Gland Scaled Score (PASS), we divided the cases into two groups-tumours showing high risk behaviour (PASS≥4) and tumours showing benign behaviour (PASS<4). IHC analysis was done using synaptophysin, chromogranin, S100 and Ki67. We correlated S100 immunoreactivity and Ki67 proliferative index with PASS score. Both PASS score and IHC markers were also correlated with clinical outcome. RESULTS There were six Pheochromocytomas (PHC) and four Paragangliomas (PGL). Two paragangliomas were retroperitoneal and one each was located in ear (HNPGL) and broad ligament. PASS score was ≥4 in five cases and <4 in five cases. Out of five cases in which PASS was ≥4, three cases showed clinical evidence of malignancy and two cases were benign. All the cases in which PASS was <4 were clinically benign. S100 immunoreactivity was grade 1 in two cases, grade 2 in six cases and grade 3 in two cases. The cases in which S100 immunoreactivity was grade 1 were malignant. One case in which S100 was grade 2 was clinically malignant. Ki67 labeling index was raised (>3%) in two cases, which were malignant correlated with malignant PASS score. CONCLUSION We conclude that the following clinicopathological parameters should be taken into account for risk assessment of malignant behaviour of paragangliomas- location, size, PASS score, S100 immunoreactivity and Ki67 labeling index.
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Affiliation(s)
- Maithili Mandar Kulkarni
- Associate Professor, Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - Siddhi Gaurish Sinai Khandeparkar
- Associate Professor, Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - Sanjay D Deshmukh
- Professor, Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - R R Karekar
- Associate professor, Department of Medicine, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - Vandana L Gaopande
- Professor, Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - Avinash R Joshi
- Professor, Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - Mrunal V Kesari
- Assistant Professor, Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
| | - R R Shelke
- Professor, Department of Surgery, Shrimati Kashibai Navale Medical College and General Hospital , Pune, Maharashtra, India
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Corner S, Walsh T, Padilla L, MacNeill A, Wallig M, Kiupel M, Terio K. Histologic and Immunohistochemical Characterization of Pheochromocytomas in 20 Clouded Leopards ( Neofelis nebulosa). Vet Pathol 2016; 54:269-276. [PMID: 27543451 DOI: 10.1177/0300985816664791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clouded leopards in North American zoological institutions have a high frequency of pheochromocytomas and were identified in 32 of 70 (45%) animals necropsied. Archival sections of adrenal gland from 20 adult clouded leopards with unilateral or bilateral pheochromocytomas collected between 1984 and 2011 were examined by light microscopy and immunohistochemistry, and case demographics were reviewed. Affected leopards were older than 10 years of age (mean, 16 years; range, 11-19 years), and males were overrepresented (12 males, 8 females). Pedigree analysis yielded no evidence for heritability. Five clouded leopards had bilateral neoplasms. Pheochromocytoma was the cause of death due to invasion of the caudal vena cava and fatal hemorrhage in 4 cases. Most pheochromocytomas were well-demarcated, nodular, and expansile masses composed of cords and packets of neoplastic polygonal cells. Five pheochromocytomas had vascular invasion, of which 4 resulted in hemorrhage that was the cause of death. One of the latter pheochromocytomas also had pulmonary metastasis. Ultrastructurally, neoplastic cells had cytoplasmic structures consistent with both norepinephrine- and epinephrine-containing granules. In all cases, neoplasms were immunohistochemically positive for chromogranin A, protein gene product 9.5, and synaptophysin. A subset of neoplasms evaluated by tissue microarray were positive for met-enkephalin and β-endorphin and negative for melan-A. Histologically, 7 of 20 (35%) clouded leopards with pheochromocytomas had retinal detachment, retinal degeneration, or intramyocardial muscular arteriosclerosis, suggestive of hypertension. Pheochromocytomas can cause mortality and may be a source of clinically significant hypertension in clouded leopards. These neoplasms share similar histologic, immunohistochemical, and ultrastructural characteristics with those of other species.
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Affiliation(s)
- S Corner
- 1 Zoological Pathology Program, College of Veterinary Medicine, University of Illinois, Brookfield, IL, USA.,2 Department of Pathobiology and Diagnostic Investigation, Michigan State University, Lansing, MI, USA
| | - T Walsh
- 3 Smithsonian National Zoological Park, Washington, DC, USA
| | - L Padilla
- 4 Saint Louis Zoo, Saint Louis, MO, USA
| | - A MacNeill
- 5 Microbiology, Immunology & Pathology Department, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.,6 Department of Pathobiology, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - M Wallig
- 6 Department of Pathobiology, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - M Kiupel
- 7 Department of Pathobiology and Diagnostic Investigation, Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, MI, USA
| | - K Terio
- 1 Zoological Pathology Program, College of Veterinary Medicine, University of Illinois, Brookfield, IL, USA
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Diffuse Cytokeratin Positivity in an Intradural Paraganglioma of the Lumbar Vertebra: A Diagnostic Pitfall! Appl Immunohistochem Mol Morphol 2015; 24:e22-4. [PMID: 26371434 DOI: 10.1097/pai.0000000000000229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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González-Orús Álvarez-Morujo R, Arístegui Ruiz M, Martin Oviedo C, Álvarez Palacios I, Scola Yurrita B. Management of vagal paragangliomas: review of 17 patients. Eur Arch Otorhinolaryngol 2014; 272:2403-14. [PMID: 24973966 DOI: 10.1007/s00405-014-3141-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022]
Abstract
Vagal paragangliomas are very rare benign vascular tumors of neuroendocrine nature, and are much less frequent than carotid and jugulo-tympanic tumors. The goal of this retrospective study is to review the clinical and genetic findings, surgical treatment, and complications of vagal paragangliomas, as well as to discuss the management options. During the period 1990-2013, 17 patients with vagal paragangliomas were referred to our institution. There were ten patients with isolated tumors, and seven with multicentric paragangliomas. There were nine women and eight men. Mean age of patients was 51.4 years. Five cases had a positive family history of paraganglioma (29.4 %). Germline mutations of SDH genes were found in six of our patients (35.3 %). Many options were considered in the management of vagal paragangliomas. Surgical treatment was performed in 11 young patients (64.7 %) using different approaches: in 4 patients the tumor was resected through a transcervical approach; in 3 through a transcervical-transmandibular approach; in 1 it was resected using a transcervical-transmastoid approach, and in 3 a type A infratemporal fossa approach was performed. In all operated cases, the removal of the tumor led to sacrificing of the vagus nerve. Postoperative hypoglossal nerve deficit was reported in 4 cases (36.3 %). In six elderly patients (35.3 %), we decided to "wait-and-scan" in order to avoid creating greater morbidity than that of the tumor itself. Many factors should be considered in the treatment of vagal paragangliomas: the age and general condition of the patient, the biological behavior of the tumor, tumor size, genetic results, bilaterality, multicentricity, lower cranial nerve function, and of course the potential morbidity of the surgical treatment itself. Rehabilitation and, possibly surgery, are necessary to treat postoperative lower cranial nerve deficits.
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Affiliation(s)
- Ricardo González-Orús Álvarez-Morujo
- Department of Otolaryngology, Head and Neck Surgery, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo St, 46, 28007, Madrid, Spain,
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Grossi AB, Leifsson PS, Jensen HE, Vainer B, Iburg T. Histologic and immunohistochemical classification of 41 bovine adrenal gland neoplasms. Vet Pathol 2012; 50:534-42. [PMID: 23242804 DOI: 10.1177/0300985812469638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tumors of the adrenal glands are among the most frequent tumors in cattle; however, few studies have been conducted to describe their characteristics. The aim of this study was to classify 41 bovine adrenal neoplasms from 40 animals based on macroscopic and histologic examination, including electron microscopy and immunohistochemistry for melan A, synaptophysin, chromogranin A, vimentin, pan-cytokeratin, 2',3'-cyclic nucleotide-3'-phosphohydrolase (CNPase), and Ki-67. The tumors were classified as 23 adrenocortical adenomas, 12 adrenocortical carcinomas, 2 schwannomas, 2 pheochromocytomas (1 malignant), and 1 ganglioneuroma. Five histologic features were characteristic of metastasizing adrenocortical tumors: invasion of the capsule, vascular invasion, diffuse growth pattern, spindle-cell morphology, and nuclear pleomorphism. Adrenocortical tumors with at least 3 of these features were classified as malignant. Immunohistochemically, adrenocortical tumors expressed melan A (16/19), vimentin (14/26), cytokeratin (11/26), and chromogranin A (9/27), whereas pheochromocytomas expressed chromogranin A (2/2), synaptophysin (2/2), and vimentin (1/2). Both schwannomas expressed CNPase. An immunohistochemistry panel consisting of antibodies against melan A, synaptophysin, and CNPase was considered most useful to classify bovine adrenal tumors. However, the distinction between benign and malignant adrenocortical tumors was based on histologic features as in human medicine.
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Affiliation(s)
- A B Grossi
- Section of Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 3, DK-1870 Frederiksberg C, Denmark.
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Alvarenga CA, Lopes JM, Vinagre J, Paravidino PI, Alvarenga M, Prando A, Castilho LN, Soares P, Billis A. Paraganglioma of seminal vesicle and chromophobe renal cell carcinoma: a case report and literature review. SAO PAULO MED J 2012; 130:57-60. [PMID: 22344361 PMCID: PMC10906681 DOI: 10.1590/s1516-31802012000100010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 10/05/2010] [Accepted: 04/18/2011] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Extra-adrenal paragangliomas are rare tumors that have been reported in many locations, including the kidney, urethra, urinary bladder, prostate, spermatic cord, gallbladder, uterus and vagina. CASE REPORT This report describes, for the first time to the best of our knowledge, a primary paraganglioma of the seminal vesicle occurring in a 61-year-old male. The patient presented persistent arterial hypertension and a previous diagnosis of chromophobe renal cell carcinoma. It was hypothesized that the seminal vesicle tumor could be a metastasis from the chromophobe renal cell carcinoma. Immunohistochemical characterization revealed expression of synaptophysin and chromogranin in tumor cell nests and peripheral S100 protein expression in sustentacular cells. Succinate dehydrogenase A and B-related (SDHA and SDHB) expression was present in both tumors. CONCLUSIONS No genetic alterations to the VHL and SDHB genes were detected in either the tumor tissue or tissues adjacent to the tumor, which led us to rule out a hereditary syndrome that could explain the association between paraganglioma and chromophobe renal cell carcinoma in a patient with arterial hypertension.
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11
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Bono F, Testi MA, Rosai J. Desmoplastic Small Cell Tumor With Bizarre Giant Nuclei. Int J Surg Pathol 2011; 19:843-6. [DOI: 10.1177/1066896911400738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case is reported of an intra-abdominal desmoplastic small cell tumor featuring giant bizarre nuclei, an event not previously recorded in this entity to the best of the authors’ knowledge. The diagnosis was confirmed by immunohistochemistry and molecular genetics. A list is provided of the many other conditions in which this morphologically spectacular but clinically inconsequential nuclear change has been recorded.
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Affiliation(s)
| | | | - Juan Rosai
- Centro Diagnostico Italiano, Milan, Italy
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Park SB, Park S, Bang SH, Kim EK, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Go YH, Um SW. A Case of Middle Mediastinal Malignant Paraganglioma. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Bum Park
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Silvia Park
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Ha Bang
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyeh Go
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Distinguishing Clear Cell Renal Cell Carcinoma, Retroperitoneal Paraganglioma, and Adrenal Cortical Lesions on Limited Biopsy Material. Appl Immunohistochem Mol Morphol 2010; 18:414-21. [DOI: 10.1097/pai.0b013e3181ddf7b9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Metastatic extra-adrenal sympathetic paraganglioma in a horse. J Comp Pathol 2010; 143:199-202. [PMID: 20153870 DOI: 10.1016/j.jcpa.2010.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 12/14/2009] [Accepted: 01/07/2010] [Indexed: 11/22/2022]
Abstract
Post-mortem examination was performed on a horse that died after exhibiting signs of colic. Gross findings included haemoperitoneum and a large round encapsulated mass located in the sublumbar area cranial to the left kidney. On sectioning the mass was solid red to brown and small nodules of similar tissue were noted at the periphery of the mass. The spleen was firm and three nodules were found in one thyroid gland. Microscopically, the abdominal mass, adjacent nodules, the spleen and one thyroid nodule consisted of clusters and cords of round to oval neoplastic cells, separated by a fine collagen and reticulin fibre network. Immunohistochemically, tumour cells expressed chromogranin A, synaptophysin and neuron-specific enolase, but did not express cytokeratin. The findings were consistent with a metastatic extra-adrenal sympathetic paraganglioma.
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Al-Harthy M, Al-Harthy S, Al-Otieschan A, Velagapudi S, Alzahrani AS. Comparison of pheochromocytomas and abdominal and pelvic paragangliomas with head and neck paragangliomas. Endocr Pract 2009; 15:194-202. [PMID: 19364686 DOI: 10.4158/ep.15.3.194] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare clinical, radiologic, and pathologic characteristics, as well as management and outcomes, in a series of pheochromocytomas, abdominal and pelvic paragangliomas, and pelvic paragangliomas with head and neck paragangliomas. METHODS In this retrospective study, we reviewed charts of all patients seen at our institution between January 1995 and December 2006. We searched pathology and medical record databases under the terms pheochromocytoma, paraganglioma, head and neck tumors, carotid body tumors, glomus jugulare, and neuroendocrine tumors. We compared clinical, radiologic, and pathologic characteristics, as well as management and outcomes, between patients with pheochromocytoma, abdominal and pelvic paraganglioma, and head and neck paraganglioma. RESULTS Eighty-six patients were included (46 with head and neck paraganglioma, 23 with pheochromocytoma, and 17 with abdominal or pelvic paraganglioma). Compared with patients with head and neck paraganglioma, patients with pheochromocytoma or abdominal and pelvic paraganglioma were younger (35.7 +/- 16 years vs 43 +/- 17 years, P = .042) and were more likely to have the classic triad associated with catecholamine hypersecretion of palpitation, excessive sweating, and headache (40% vs 0%, P<.001); hypertension (70% vs 37%, P = .005); and benign tumors (65% vs 43%, P = .03). Patients with head and neck paraganglioma and patients with pheochromocytoma/abdominal and pelvic paraganglioma were not different in female to male ratios (27:19 vs 29:11, respectively, P = .18), tumor size (5.8 +/- 2.7 cm vs 5.7 +/- 3 cm, respectively; P = .85), or remission rate (43% vs 60%, respectively, P = .13). CONCLUSIONS Head and neck paraganglioma are similar to pheochromocytoma and abdominal and pelvic paraganglioma in size and outcome, but occur at an older age, lack hyperadrenergic manifestations, and are more likely to have local pressure effects and result in persistent disease.
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Affiliation(s)
- Mohamed Al-Harthy
- Department of Medicine, Section of Endocrinology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Miller AD, Masek-Hammerman K, Dalecki K, Mansfield KG, Westmoreland SV. Histologic and immunohistochemical characterization of pheochromocytoma in 6 cotton-top tamarins (Saguinus oedipus). Vet Pathol 2009; 46:1221-9. [PMID: 19605896 DOI: 10.1354/vp.09-vp-0022-m-fl] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pheochromocytomas are uncommon neoplasms of the adrenal medulla that are most frequently reported in rats and select mouse strains. In many cases, especially those in man, pheochromocytoma is associated with familial tumor syndromes, because of inherited mutations in a variety of proto-oncogenes and tumor suppressor genes. Nonhuman primates are valuable animal models for a variety of human diseases because of their similar anatomy and physiology; however, cases of pheochromocytomas have only rarely been reported in nonhuman primates. Herein, we characterize the gross, histologic, and immunohistochemical features of pheochromocytoma in 6 cotton-top tamarins (Saguinus oedipus). Pheochromocytomas represented 6 of 114 of the total causes of death in the studied population (5.3%) and corresponded to 16% of the total number of neoplasms. The average age of affected animals was 17.9 years. On histologic examination, all cases were defined by tight bundles, nests, and cords of neoplastic chromaffin cells. All cases had concurrent myocardial degeneration and fibrosis of varying severity and chronicity. Three of the cases (50%) also had hyalinization and medial thickening of coronary arteries consistent with hypertension. On immunohistochemical examination, 6 of 6 of the cases (100%) stained positively for chromogranin A, synaptophysin, N-CAM (or CD56), and protein gene product 9.5. None of the cases stained for glial fibrillary acidic protein. Pedigree analysis revealed inter-relatedness in 4 of 6 animals, with progenitor animals also affected with pheochromocytomas. The tumors in this population illustrate comparable histologic and immunohistochemical staining patterns with cases in other laboratory animals and humans, and, therefore, may indicate common underlying genetic alterations that precipitate tumor development.
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Affiliation(s)
- A D Miller
- New England Regional Primate Research Center, Division of Comparative Pathology, Department of Pathology, Harvard Medical School, Southborough, MA 01772-9102, USA.
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Lu JQ, Khalil M, Hu W, Sutherland GR, Clark AW. Tumor-to-tumor metastasis: esophageal carcinoma metastatic to an intracranial paraganglioma. J Neurosurg 2009; 110:744-8. [PMID: 19072308 DOI: 10.3171/2008.9.jns08397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tumor-to-tumor metastasis (TTM) is a relatively rare but well-documented phenomenon. The authors report a unique case of esophageal carcinoma metastatic to an intracranial paraganglioma. A sellar and suprasellar tumor was found using MR imaging in an 81-year-old man who presented with a 3-week history of progressive headache and blurred vision. A subtotal excision of the tumor was achieved. Histopathological examination of the tumor disclosed a neoplasm with two distinct components: one showing the classic Zellballen pattern of a paraganglioma, the other exhibiting malignant features leading to the diagnosis of a poorly differentiated carcinoma metastatic to a sellar/suprasellar paraganglioma. The primary esophageal carcinoma was not uncovered until 2 months later, after the patient presented with upper gastrointestinal bleeding. The patient died 4 months after initial presentation. This case expands the spectrum of TTM, and emphasizes the importance of TTM in the practice of pathology.
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Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology, University of Calgary, Alberta, Canada
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Morphophysiology of the Zuckerkandl's paraganglion: effects of dexamethasone and aging. Neurobiol Aging 2009; 31:2115-27. [PMID: 19167134 DOI: 10.1016/j.neurobiolaging.2008.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 11/26/2008] [Accepted: 12/02/2008] [Indexed: 11/23/2022]
Abstract
The extra-adrenal Zuckerkandl's paraganglion is used as a source of chromaffin cells for transplantation in parkinsonian animals. Aging can affect its viability, and this tissue needs further characterization for improving grafting procedures. The objectives were: (i) to compare the main morpho-functional characteristics of prepubertal and old Zuckerkandl's paraganglion (ZP), and (ii) to discern phenotypic changes after sub-chronic dexamethasone treatment in extra-adrenal tissue of prepubertal rats. For these purposes, immunostaining methods, stereology, voltammetry, cell culture, Western blotting, and ELISA were employed. The findings revealed that all paraganglia were composed of mesenchymal tissue and chromaffin cells. In prepubertal rats, chromaffin cells are arranged as large or small clusters. Large clusters (also known as "cell nests") contain densely packed chromaffin cells, and they are seen as fascicles in longitudinal sections. In old paraganglia, cell nests disappear, and chromaffin cells are found to be arranged as small cell clusters or dispersed throughout the mesenchyma. Paraganglionic chromaffin cells possess a rounded morphology with diameter ranging from 12 to 15 μm, with intracytoplasmic granules (100-500 nm in diameter) containing catecholamines. Prepubertal and old ZP chromaffin cells are mostly noradrenergics, and a few of them are dopaminergics. Aging reduces the amount of chromaffin tissue (28% in adult rats vs. 11% in old animals, both in relation to total volume of the paraganglion), and induces the presence of adrenergic cells and adrenaline. Both prepubertal and old cells express the neurotrophic factors GDNF and TGF-β₁, aging leading to reduced levels of both growth factors. Dexamethasone (50 μg/kg daily, 5 days) leads to the expression of phenylethanolamine-N-methyl-transferase in prepubertal paraganglia, and to a higher content and release of adrenaline.
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Abstract
Pheochromocytomas are rare, mostly benign catecholamine-producing tumors arising from the chromaffin cells of the adrenal medulla or in the paraganglia. Clinical presentation is highly variable but typically with hypertension, severe headaches, palpitations and sweating. Biochemical testing by 24 h urinary fractioned metanephrines or catecholamines and plasma free metanephrines as the most sensitive screening approach, confirms the catecholamine excess. Computed tomography scan and magnetic resonance imaging of the adrenal glands and abdomen as well as functional imaging with (123)Iod-MIBG scintigraphy and (18)F-dopa positron emission tomography are used for tumor localization. Because approximately a quarter of tumors develop secondary to germ-line mutations, screening for genetic alterations is important. The therapy of choice is the endoscopic adrenal sparing surgery following preoperative alpha-blockade. Regular follow-up remains essential due to possible recurrence and malignancy.
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