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Milinkovic M, Soldatovic I, Zivaljevic V, Bozic V, Zivotic M, Tatic S, Dundjerovic D. Comprehensive Investigation of Angiogenesis, PASS Score and Immunohistochemical Factors in Risk Assessment of Malignancy for Paraganglioma and Pheochromocytoma. Diagnostics (Basel) 2024; 14:849. [PMID: 38667494 PMCID: PMC11049119 DOI: 10.3390/diagnostics14080849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
A challenging task in routine practice is finding the distinction between benign and malignant paragangliomas and pheochromocytomas. The aim of this study is to conduct a comparative analysis of angiogenesis by assessing intratumoral microvascular density (MVD) with immunohistochemical (IHC) markers (CD31, CD34, CD105, ERG), and S100 immunoreactivity, Ki67 proliferative index, succinate dehydrogenase B (SDHB) expressiveness, tumor size with one the most utilized score Pheochromocytoma of Adrenal Gland Scales Score (PASS), using tissue microarray (TMA) with 115 tumor samples, 61 benign (PASS < 4) and 54 potentially malignant (PASS ≥ 4). We found no notable difference between intratumoral MVD and potentially malignant behavior. The group of potentially malignant tumors is significantly larger in size, has lower intratumoral MVD, and a decreased number of S100 labeled sustentacular cells. Both groups have low proliferative activity (mean Ki67 is 1.02 and 1.22, respectively). Most tumors maintain SDHB expression, only 6 cases (5.2%) showed a loss of expression (4 of them in PASS < 4 group and 2 in PASS ≥ 4). PASS score is easily available for assessment and complemented with markers of biological behavior to complete the risk stratification algorithm. Size is directly related to PASS score and malignancy. Intratumoral MVD is extensively developed but it is not crucial in evaluating the malignant potential.
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Affiliation(s)
- Marija Milinkovic
- Department of Pathology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Ivan Soldatovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Vladan Zivaljevic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Vesna Bozic
- Department of Pathology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Maja Zivotic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (S.T.); (D.D.)
| | - Svetislav Tatic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (S.T.); (D.D.)
| | - Dusko Dundjerovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (S.T.); (D.D.)
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2
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Marketou ME, Kapsoritakis N, Bourogianni O, Patrianakos A, Kochiadakis G, Plevritaki A, Papadaki S, Zervakis S, Parthenakis F, Koukouraki S. Hybrid imaging of neuroendocrine tumors in the heart: Union is strength. J Nucl Cardiol 2023; 30:298-312. [PMID: 34622428 DOI: 10.1007/s12350-021-02804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
Cardiac neuroendocrine tumors (NETs) are particularly rare tumors that can lead to a very poor clinical outcome, partly because of metastases but mainly because of manifestations of the hormonal activity they exhibit. Prompt diagnosis is important in order to start the most effective treatment for their removal or management, with the fewest complications. They are often difficult to diagnose, especially in their early stages. One of the reasons for this is that the heart is an organ with a high rate of metabolism and is located in close proximity to other high-metabolism organs. In addition, the anatomic location and their small size render their diagnosis extremely challenging. In recent years, hybrid imaging methods have revolutionized the diagnostic approach to oncology patients and have established a place in the diagnosis of cardiac NETs, because they provide both anatomical and functional information at the same time. Positron emission tomography/computed tomography (PET/CT), PET/magnetic resonance imaging (PET/MRI) and single-photon emission computed tomography/CT (SPECT/CT) are widely used in clinical practice because of the very important metabolic information, the high sensitivity and specificity. However, prospective studies are needed to confirm the true clinical and prognostic value of various hybrid imaging diagnostic techniques in cardiac NETs.
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Affiliation(s)
- Maria E Marketou
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece.
| | - Nikolaos Kapsoritakis
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Olga Bourogianni
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros Patrianakos
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - George Kochiadakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Anthoula Plevritaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Papadaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Stelios Zervakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Fragiskos Parthenakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Koukouraki
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
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3
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Miller S, Schaller T. [Benign and malignant neoplasms of the adrenal glands from the perspective of pathology]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:831-839. [PMID: 35925136 DOI: 10.1007/s00104-022-01644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
In the case of neoplasms of the adrenal glands that are radiologically and clinically unclear, the indications for surgical resection as well as the subsequent clarification of the entity and dignity on the surgical specimen are difficult. The diagnostics of adrenal neoplasms, in particular the clear distinction between an adenoma and a carcinoma are often tricky from the point of view of a pathologist. In the following, not only the problems of classification and the possibilities of diagnostics in pathology but also an overview of the most important differential diagnoses of other benign and malignant tumors of the adrenal cortex and medulla are presented.
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Affiliation(s)
- Silvia Miller
- Allgemeine und Spezielle Pathologie, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Tina Schaller
- Allgemeine und Spezielle Pathologie, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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Harley RJ, Lee JH, Ostrander BT, Finegersh A, Pham TB, Tawfik KO, Ren Y, Faraji F, Friedman RA. Local Tumor Behavior Associated With Survival Among Patients With Paraganglioma of the Head and Neck. OTO Open 2022; 6:2473974X221086872. [PMID: 35571573 PMCID: PMC9096223 DOI: 10.1177/2473974x221086872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this study was to evaluate the utility of
ICD-O-3–classified local tumor behavior as a
prognosticator of head and neck paraganglioma (HNP) outcomes. Study Design Retrospective cohort study. Setting National Cancer Database between 2004 and 2016. Methods This study included patients aged ≥18 years who were diagnosed with HNP.
Clinical outcomes and clinicopathologic features were compared with regard
to local tumor behavior. Results Our study included 525 patients, of which the majority had HNP classified as
locally invasive (45.9%) or borderline (37.9%). The most common anatomic
sites involved were the carotid body (33.7%), intracranial regions (29.0%),
or cranial nerves (25.5%). Carotid body tumors were exclusively locally
invasive, whereas intracranial and cranial nerve HNP were overwhelmingly
benign or borderline (94% and 91%, respectively). One-fourth of patients
underwent pathologic analysis of regional lymph nodes, of which the majority
were positive for metastasis (80.6%). Metastasis to distant organs was twice
as common in patients with locally invasive tumors vs benign (15% vs 7.1).
For benign disease, surgery with radiotherapy (adjusted hazard ratio [aHR],
40.45; P = .006) and active surveillance (aHR, 24.23;
P = .008) were associated with worse survival when
compared with surgery alone. For locally invasive tumors, greater age (aHR,
1.07; P < .0001) and positive surgical margins (aHR,
4.13; P = .010) were predictors of worse survival, while
combined surgery and radiotherapy were predictors of improved survival vs
surgery alone (aHR, 0.31; P = .027). Conclusion While criteria for tumor behavior could not be defined, our results suggest
that such a classification system could be used to enhance HNP risk
stratification and guide clinical management decisions.
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Affiliation(s)
- Randall J. Harley
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason H. Lee
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Benjamin T. Ostrander
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Andrey Finegersh
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Tammy B. Pham
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Kareem O. Tawfik
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Yin Ren
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Farhoud Faraji
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Rick A. Friedman
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
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Mete O, Asa SL, Gill AJ, Kimura N, de Krijger RR, Tischler A. Overview of the 2022 WHO Classification of Paragangliomas and Pheochromocytomas. Endocr Pathol 2022; 33:90-114. [PMID: 35285002 DOI: 10.1007/s12022-022-09704-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 12/12/2022]
Abstract
This review summarizes the classification of tumors of the adrenal medulla and extra-adrenal paraganglia as outlined in the 5th series of the WHO Classification of Endocrine and Neuroendocrine Tumors. The non-epithelial neuroendocrine neoplasms (NENs) known as paragangliomas produce predominantly catecholamines and secrete them into the bloodstream like hormones, and they represent a group of NENs that have exceptionally high genetic predisposition. This classification discusses the embryologic derivation of the cells that give rise to these lesions and the historical evolution of the terminology used to classify their tumors; paragangliomas can be sympathetic or parasympathetic and the term pheochromocytoma is used specifically for intra-adrenal paragangliomas that represent the classical sympathetic form. In addition to the general neuroendocrine cell biomarkers INSM1, synaptophysin, and chromogranins, these tumors are typically negative for keratins and instead have highly specific biomarkers, including the GATA3 transcription factor and enzymes involved in catecholamine biosynthesis: tyrosine hydroxylase that converts L-tyrosine to L-DOPA as the rate-limiting step in catecholamine biosynthesis, dopamine beta-hydroxylase that is present in cells expressing norepinephrine, and phenylethanolamine N-methyltransferase, which converts norepinephrine to epinephrine and therefore can be used to distinguish tumors that make epinephrine. In addition to these important tools that can be used to confirm the diagnosis of a paraganglioma, new tools are recommended to determine genetic predisposition syndromes; in addition to the identification of precursor lesions, molecular immunohistochemistry can serve to identify associations with SDHx, VHL, FH, MAX, and MEN1 mutations, as well as pseudohypoxia-related pathogenesis. Paragangliomas have a well-formed network of sustentacular cells that express SOX10 and S100, but this is not a distinctive feature, as other epithelial NENs also have sustentacular cells. Indeed, it is the presence of such cells and the association with ganglion cells that led to a misinterpretation of several unusual lesions as paragangliomas; in the 2022 WHO classification, the tumor formerly known as cauda equina paraganglioma is now classified as cauda equina neuroendocrine tumor and the lesion known as gangliocytic paraganglioma has been renamed composite gangliocytoma/neuroma and neuroendocrine tumor (CoGNET). Since the 4th edition of the WHO, paragangliomas have no longer been classified as benign and malignant, as any lesion can have metastatic potential and there are no clear-cut features that can predict metastatic behavior. Moreover, some tumors are lethal without metastatic spread, by nature of local invasion involving critical structures. Nevertheless, there are features that can be used to identify more aggressive lesions; the WHO does not endorse the various scoring systems that are reviewed but also does not discourage their use. The identification of metastases is also complex, particularly in patients with germline predisposition syndromes, since multiple lesions may represent multifocal primary tumors rather than metastatic spread; the identification of paragangliomas in unusual locations such as lung or liver is not diagnostic of metastasis, since these may be primary sites. The value of sustentacular cells and Ki67 labeling as prognostic features is also discussed in this new classification. A staging system for pheochromocytoma and extra-adrenal sympathetic PGLs, introduced in the 8th Edition AJCC Cancer Staging Manual, is now included. This paper also provides a summary of the criteria for the diagnosis of a composite paragangliomas and summarizes the classification of neuroblastic tumors. This review adopts a practical question-answer framework to provide members of the multidisciplinary endocrine oncology team with a most up-to-date approach to tumors of the adrenal medulla and extra-adrenal paraganglia.
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Affiliation(s)
- Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, Canada.
- Endocrine Oncology Site, Princess Margaret Cancer Centre, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Anthony J Gill
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
- Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Sydney, Australia
| | - Noriko Kimura
- Department of Clinical Research, Division of Diagnostic Pathology, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Ronald R de Krijger
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arthur Tischler
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
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6
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De Filpo G, Cantini G, Rastrelli G, Vannini G, Ercolino T, Luconi M, Mannelli M, Maggi M, Canu L. Management and outcome of metastatic pheochromocytomas/paragangliomas: a monocentric experience. J Endocrinol Invest 2022; 45:149-157. [PMID: 34227051 PMCID: PMC8741659 DOI: 10.1007/s40618-021-01629-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pheochromocytoma (PHEO) and paraganglioma (PGL) are rare neuroendocrine tumors releasing catecholamines. Metastatic pheochromocytomas/paragangliomas (PPGLs) occur in about 5-26% of cases. To date, the management of patients affected by metastatic disease is a challenge in the absence of guidelines. AIM The aim of this study was to evaluate the overall survival (OS) and the progression-free survival (PFS) in metastatic PPGLs. METHODS Clinical data of 20 patients referred to the Careggi University Hospital (Florence, Italy) were retrospectively collected. Follow-up ranged from 1989 to 2019. Site and size of primary tumor, biochemical activity, genetic analysis and employed therapies were considered. Data were analyzed with SPSS version 27. RESULTS Nine PHEOs (45%) and 11 PGLs (55%) were enrolled. Median age at diagnosis was 43.5 years [30-55]. Mean follow-up was 104.6 ± 89.3 months. Catecholamines were released in 70% of cases. An inherited disease was reported in 50% of patients. OS from the initial diagnosis (OSpt) and from the metastatic appearance (OSmtx) were lower in older patients (OSpt p = 0.028; OSmtx p < 0.001), abdominal PGLs (OSpt p = 0.007; OSmtx p = 0.041), larger tumors (OSpt p = 0.008; OSmtx p = 0.025) and sporadic disease (OSpt p = 0.013; OSmtx p = 0.008). CONCLUSION Our data showed that older age at the initial diagnosis, sympathetic extra-adrenal localization, larger tumors and wild-type neoplasms are related to worse prognosis. Notably, the employed therapies do not seem to influence the survival of our patients. At present, effective treatments for metastatic PPGLs are missing and a multidisciplinary approach is indispensably required.
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Affiliation(s)
- G De Filpo
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
| | - G Cantini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Rastrelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Vannini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - T Ercolino
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
| | - M Luconi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Mannelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Maggi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - L Canu
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Mete O, Pakbaz S, Lerario AM, Giordano TJ, Asa SL. Significance of Alpha-inhibin Expression in Pheochromocytomas and Paragangliomas. Am J Surg Pathol 2021; 45:1264-1273. [PMID: 33826547 DOI: 10.1097/pas.0000000000001715] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alpha-inhibin expression has been reported in pheochromocytomas and paragangliomas (PPGLs). We analyzed alpha-inhibin immunohistochemistry in 77 PPGLs (37 pheochromocytomas [PCCs] and 40 paragangliomas) and correlated the results with catecholamine profile, tumor size, Ki-67 labeling index, succinate dehydrogenase B subunit and carbonic anhydrase IX (CAIX) staining, and genetic pathogenesis. PPGLs were classified as pseudohypoxic cluster 1 disease with documented VHL mutation or SDHx mutation or biochemical phenotype, whereas NF1-driven and RET-driven PPGLs and those with a mature secretory (adrenergic or mixed adrenergic and noradrenergic) phenotype were classified as cluster 2 disease. The Cancer Genome Atlas data on INHA expression in PPGLs was examined. Alpha-inhibin was positive in 43 PPGLs (56%). Ki-67 labeling indices were 8.07% and 4.43% in inhibin-positive and inhibin-negative PPGLs, respectively (P<0.05). Alpha-inhibin expression did not correlate with tumor size. Alpha-inhibin was expressed in 92% of SDHx-related and 86% of VHL-related PPGLs. CAIX membranous staining was found in 8 of 51 (16%) tumors, including 1 SDHx-related PCC and all 5 VHL-related PCCs. NF1-driven and RET-driven PPGLs were negative for alpha-inhibin and CAIX. Alpha-inhibin was expressed in 77% of PPGLs with a pseudohypoxia signature, and 20% of PPGLs without a pseudohypoxia signature (P<0.05). PPGLs with a mature secretory phenotype were negative for CAIX. The Cancer Genome Atlas data confirmed higher expression of INHA in cluster 1 than in cluster 2 PPGLs. This study identifies alpha-inhibin as a highly sensitive (90.3%) marker for SDHx/VHL-driven pseudohypoxic PPGLs. Although CAIX has low sensitivity, it is the most specific biomarker of VHL-related pathogenesis. While alpha-inhibin cannot replace succinate dehydrogenase B subunit immunohistochemistry for detection of SDHx-related disease, it adds value in prediction of cluster 1 disease. Importantly, these data emphasize that alpha-inhibin is not a specific marker of adrenal cortical differentiation, as it is also expressed in PCCs.
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Affiliation(s)
- Ozgur Mete
- Department of Pathology, University Health Network
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Endocrine Oncology Site, The Princess Margaret Cancer Centre
| | - Sara Pakbaz
- Department of Pathology, University Health Network
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Antonio M Lerario
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes
| | - Thomas J Giordano
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
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8
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Reus X, Vicens C, García-Serra C. Young woman diagnosed with paraganglioma in primary care. BMJ Case Rep 2021; 14:14/7/e242448. [PMID: 34290011 DOI: 10.1136/bcr-2021-242448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 15-year-old young woman was referred to the emergency room for admission by her general practitioner after receiving the results of urinary metanephrines and catecholamines requested to study the tachycardia, sweating and headaches that she had been presenting progressively last year. Imaging tests showed a large right supraumbilical para-aortic paraganglioma that was successfully removed with surgery after previous medical preparation with adrenergic blockers. Genetic testing showed a heterozygous mutation of the gene succinate dehydrogenase-B. The classic triad of symptoms in these disorders consists of headaches, sweating and tachycardia, usually accompanied by hypertension. We wanted to present this case, a challenging diagnosis of paraganglioma in primary care.
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Affiliation(s)
- Xisco Reus
- Son Serra-La Vileta Health Care Centre, IB Salut, Palma de Mallorca, Spain
| | - Caterina Vicens
- Son Serra-La Vileta Health Care Centre, IB Salut, Palma de Mallorca, Spain
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9
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Torres-Costa M, Flores B, Torregrosa N, González M, Ríos A, Febrero B, Flores D, Rodríguez P, Carbonell P, Ortuño MI, Rodríguez JM. Malignant prediction in paragangliomas: analysis for clinical risk factors. Langenbecks Arch Surg 2021; 406:2441-2448. [PMID: 34101001 DOI: 10.1007/s00423-021-02222-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Paragangliomas are infrequent neuroendocrine tumours whose only criterion for malignancy is presence of metastases; thus, all paragangliomas show malignant potential. Actually, different risk factors have been analyzed to predict metastases but they remain unclear. PURPOSE To analyze clinical, histological, and genetic factors to predict the occurrence of metastasis. PATIENTS AND METHOD A multicentre retrospective observational analysis was performed between January 1990 and July 2019. Patients diagnosed with paraganglioma were selected. Clinical, histological, and genetic features were analyzed for the prediction of malignancy. RESULTS A total of 83 patients diagnosed with paraganglioma were included, of which nine (10.8%) had malignant paraganglioma. Tumour size was greater in malignant tumours than in benign (6 cm vs. 4 cm, respectively; p = 0.027). The most frequent location of malignancy was the thorax-abdomen-pelvis area observed in six cases (p = 0.024). No differences were observed in histological differentiation, age, symptoms, and catecholaminergic production. The most frequent genetic mutation was SDHD followed by SDHB but no differences were observed between benign and malignant tumours. In the univariate analysis for predictive factors for malignancy, location, tumour size, and histological differentiation showed statistical significance (p = 0.025, p = 0.014, and p = 0.046, respectively); however, they were not confirmed as predictive factors for malignancy in the multivariate analysis. CONCLUSION In this study, no risk factors for malignancy have been established; therefore, we recommend follow-up of all patients diagnosed with paraganglioma.
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Affiliation(s)
- Miquel Torres-Costa
- Department of Surgery, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain.
| | - Benito Flores
- Department of Surgery, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Nuria Torregrosa
- Department of Surgery, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Miguel González
- Department of Surgery, Hospital Universitario Reina Sofía, Murcia, Spain
| | - Antonio Ríos
- Department of Surgery, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Beatriz Febrero
- Department of Surgery, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Diego Flores
- Department of Surgery, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Pablo Rodríguez
- Department of Surgery, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Pablo Carbonell
- Center for Biochemistry and Clinical Genetics, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - María Isabel Ortuño
- Department of Pathology, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - José Manuel Rodríguez
- Department of Surgery, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
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10
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Zhou YY, Coffey M, Mansur D, Wasman J, Asa SL, Couce M. Images in Endocrine Pathology: Progressive Loss of Sustentacular Cells in a Case of Recurrent Jugulotympanic Paraganglioma over a Span of 5 years. Endocr Pathol 2020; 31:310-314. [PMID: 32548761 DOI: 10.1007/s12022-020-09632-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Yi Yuan Zhou
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael Coffey
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Mansur
- Department of Radiation Oncology, UH Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Jay Wasman
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Marta Couce
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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11
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Wernick BD, Furlough CL, Patel U, Samant S, Hoel AW, Rodriguez HE, Tomita TT, Eskandari MK. Contemporary management of carotid body tumors in a Midwestern academic center. Surgery 2020; 169:700-704. [PMID: 32868107 DOI: 10.1016/j.surg.2020.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Carotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection. METHODS A single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX). RESULTS Among 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21-79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1-9 days). At a mean follow-up of 12 months (range 1-63 months), there has been no recurrence. CONCLUSION Although carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.
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Affiliation(s)
- Brian Daniel Wernick
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Courtney L Furlough
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Urjeet Patel
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sandeep Samant
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tadaki T Tomita
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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12
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Li H, Xie J, Chen Z, Yang S, Lai Y. Diagnosis and treatment of a rare tumor-bladder paraganglioma. Mol Clin Oncol 2020; 13:40. [PMID: 32832083 DOI: 10.3892/mco.2020.2110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Bladder paragangliomas are very rare tumors that are often misdiagnosed. The present study retrospectively analyzed the clinical data and follow-up results of patients with bladder paraganglioma that were treated surgically in Peking University Shenzhen Hospital between 2012 and 2018, and reviewed the relevant literature. A total of 4 patients with bladder paraganglioma were treated surgically from 2012 to 2018. All patients were female with ages ranging from 28 to 54 years old (average, 47.25). A total of one patient exhibited micturition attacks and palpitations, and one other exhibited gross hematuria. A total of two patients exhibited while no obvious symptoms. One patient exhibited elevated plasma catecholamine, was well prepared with medicine and underwent partial cystectomy, and 3 patients were not successfully diagnosed with paraganglioma before surgery. These patients received transurethral resection and 2 had distinct blood pressure elevation during operation. After surgery, the patients were followed-up for 5-69 months, during which all had normal blood pressure and none experienced recurrence. Bladder paragangliomas exhibit a variety of clinical presentations, which can be nonspecific for the non-functional ones, therefore may easily lead to misdiagnosis. Surgeons must fully consider the possibility of this disease when dealing with non-epithelial bladder tumors. Surgical resection is an effective treatment. For cases successfully diagnosed before surgery, partial cystectomy should be a treatment priority.
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Affiliation(s)
- Hang Li
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China.,The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Jiaodi Xie
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Zebo Chen
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Shangqi Yang
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Yongqing Lai
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China.,The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
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13
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Cerqueira A, Seco T, Costa A, Tavares M, Cotter J. Pheochromocytoma and Paraganglioma: A Review of Diagnosis, Management and Treatment of Rare Causes of Hypertension. Cureus 2020; 12:e7969. [PMID: 32523826 PMCID: PMC7273359 DOI: 10.7759/cureus.7969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Pheochromocytomas (PHEO) and paragangliomas (PGL) are rare tumors originated in cells derived from the neural crest. The first ones are located in the adrenal medulla, and the second ones in the sympathetic and parasympathetic nervous system. These kind of tumors may secrete excess catecholamines, including epinephrine, norepinephrine, dopamine and/or their metabolite metanephrine, normetanephrine and 3-methoxytyramine, respectively. Its clinical manifestations depend on the location, the secretory profile and the malignant potential of the tumor. These tumors are frequently benign in their presentation. Some arise in the context of familiar syndromes, accounting for up to one-third of the total of diagnosis. The metastatic form is the most common presentation of the tumors with familiar origin and due to their rarity, their diagnosis and management is often difficult. Over the years, our knowledge and perception of PHEO and PGL has greatly expanded and changed. This review article aims to focus on the genetic, clinical, diagnostic, therapeutic and prognostic approaches, to give the clinician knowledge of the most recent updates regarding these themes.
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Affiliation(s)
- Ana Cerqueira
- Internal Medicine, Hospital Senhora Da Oliveira, Guimarães, PRT
| | - Tiago Seco
- Internal Medicine, Hospital Senhora Da Oliveira, Guimarães, PRT
| | - Ana Costa
- Internal Medicine, Hospital Senhora Da Oliveira, Guimarães, PRT
| | - Maria Tavares
- Internal Medicine, Hospital Senhora Da Oliveira, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora Da Oliveira, Guimarães, PRT
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14
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Abstract
Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare, heterogeneous neuroendocrine neoplasms of the autonomous nervous system of chromaffin cell origin that may arise within the adrenal medulla (PCCs) or the sympathetic and parasympathetic paraganglia (PGLs). Currently referred to by the umbrella term pheochromocytomas-paragangliomas (PPGLs), these distinct tumors are characterized by specific histopathology as well as biological and clinical profiles. PPGLs may occur as part of hereditary syndromes (40% of cases) or as sporadic tumors. Currently, there are 12 different hereditary syndromes with characteristic genetic abnormalities, at least 15 well-characterized driver genes and distinct tumor metabolic pathways. Based on the Cancer Genome Atlas (TCGA) taxonomic schemata, PPGLs have been classified into three main clusters of specific genetic mutations and tumor pathways with clinical, biochemical, and prognostic implications. Imaging plays a pivotal role in the initial diagnosis, tumor characterization, evaluation of treatment response, and long-term surveillance. While MDCT and MRI help in the anatomic localization, SPECT, and PET using different radiotracers are crucial in the functional assessment of these tumors. Surgery, chemotherapy, and radiotherapy are currently available treatment options for PPGLs; antiangiogenic drugs are also being used in treating metastatic disease. Evolving knowledge regarding the different genetic abnormalities involved in the pathogenesis of PPGLs has identified potential therapeutic targets that may be utilized in the discovery of novel drugs.
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15
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Schreiner F, Beuschlein F. Disease monitoring of patients with pheochromocytoma or paraganglioma by biomarkers and imaging studies. Best Pract Res Clin Endocrinol Metab 2020; 34:101347. [PMID: 31662271 DOI: 10.1016/j.beem.2019.101347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors, a large proportion of which secrete catecholamines. PPGL are associated with a high cardiovascular morbidity and come with a risk of malignancy. The therapy of choice is surgical resection. Nevertheless, PPGL are associated with a lifelong risk of tumor persistence or recurrence. Currently, there are no clinical, biochemical, histopathological or imaging characteristics, which can predict or exclude malignant behavior or tumor recurrence. Therefore, long-term follow-up is recommended even after apparent complete surgical removal. Early detection of recurrence is essential to reduce cardiovascular morbidity and mortality due to catecholamine secretion, to prevent morbidity by mass effects of paraganglioma (PGL) or by metastatic spread of disease. Due to the rarity of these tumors, no prospective data on long-term surveillance exist. In fact, current recommendations are based on retrospective analyses, expert opinions and case studies. The aim of this review is to provide an overview on the current state of knowledge with regard to known factors that increase the risk of recurrence and might impact disease monitoring as well as the available possibilities for biochemical and imaging follow-up. Based on this overview, we aim to propose a practical approach for a patient-oriented follow-up after surgical removal of a PPGL.
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Affiliation(s)
- Florentine Schreiner
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zurich, Switzerland; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
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16
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Jasim S, Jimenez C. Metastatic pheochromocytoma and paraganglioma: Management of endocrine manifestations, surgery and ablative procedures, and systemic therapies. Best Pract Res Clin Endocrinol Metab 2020; 34:101354. [PMID: 31685417 DOI: 10.1016/j.beem.2019.101354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metastatic pheochromocytomas and paragangliomas (MPPGs) are rare neuroendocrine tumors. Most patients present with advanced disease that is associated with manifestations of catecholamine release. Surgical resection of the primary tumor and ablative therapies of metastases-whenever possible-may improve clinical outcomes and, perhaps, lengthen the patient's overall survival. Significant steps in understanding the genetic alterations linked to MPPGs and scientific progress made on cancers that share a similar pathogenesis are leading to the recognition of potential systemic therapeutic options. Data derived from clinical trials evaluating targeted therapies such as tyrosine kinase inhibitors, radiopharmaceuticals, immunotherapy, and combinations of these will likely improve the outcomes of patients with advanced and progressive MPPGs. Exemplary of this success is the recent approval in the United States of the high-specific-activity iodine131 meta-iodine-benzylguanidine (MIBG) for patients with unresectable and progressive MPPGs that express the noradrenaline transporter. This review will discuss the therapeutic approaches for patients with MPPGs.
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Affiliation(s)
- Sina Jasim
- The Division of Endocrinology, Metabolism and Lipid Research, Campus box 8127, Washington University, School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri 63110, USA
| | - Camilo Jimenez
- The Department of Endocrine Neoplasia and Hormonal Disorders at the University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, TX 77030, USA.
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17
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Predictors of recurrence of pheochromocytoma and paraganglioma: a multicenter study in Piedmont, Italy. Hypertens Res 2019; 43:500-510. [PMID: 31586159 DOI: 10.1038/s41440-019-0339-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/06/2019] [Accepted: 09/05/2019] [Indexed: 12/31/2022]
Abstract
The available data on the natural history of pheochromocytomas and paragangliomas after radical surgery are heterogeneous and discordant. The aim of our retrospective multicenter study was to find predictors of recurrence in patients with pheochromocytomas and sympathetic paragangliomas submitted to radical surgery in Piedmont (a region in northwest Italy). We collected data from 242 patients diagnosed between 1990 and 2016. Forty-two patients (17.4%) had disease recurrence. Multivariate analysis showed that genetic mutation (HR = 3.62; 95% CI 1.44-9.13; p = 0.006), younger age (HR = 0.97; 95% CI 0.95-0.99; p = 0.031) and larger tumor size (HR = 1.01; 95% CI 1.00-1.02; p = 0.015) were independently associated with a higher recurrence risk of pheochromocytoma and paraganglioma; in pheochromocytomas, genetic mutation (HR = 3.4; 95% CI 1.00-11.48; p = 0.049), younger age (HR = 0.97; 95% CI 0.94-0.99; p = 0.02), higher tumor size (HR = 1.01; 95% CI 1.00-1.03; p = 0.043) and PASS value (HR = 1.16; 95% CI 1.03-1.3; p = 0.011) were associated with recurrence. Moreover, tumor size was the only predictor of metastatic pheochromocytoma and paraganglioma (HR = 4.6; 95% CI 1.4-15.0; p = 0.012); tumor size (HR = 3.93; 95% CI 1.2-16.4; p = 0.026) and PASS value (HR = 1.27; 95% CI 1.06-1.53; p = 0.007) were predictors of metastatic pheochromocytoma. In conclusion, our findings suggest that the recurrence of pheochromocytoma and sympathetic paraganglioma develops more frequently in younger subjects, patients with a family history of chromaffin tissue neoplasms, mutations in susceptibility genes, larger tumors and higher values of PASS. We recommend genetic testing in all patients with PPGL and strict follow-up at least on an annual basis.
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18
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Pipola V, Boriani S, Bandiera S, Righi A, Barbanti Bròdano G, Terzi S, Ghermandi R, Tedesco G, Evangelisti G, Girolami M, Gasbarrini A. Paraganglioma of the spine: A twenty-years clinical experience of a high volume tumor center. J Clin Neurosci 2019; 66:7-11. [DOI: 10.1016/j.jocn.2019.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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19
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Malignant Pheochromocytomas/Paragangliomas and Ectopic Hormonal Secretion: A Case Series and Review of the Literature. Cancers (Basel) 2019; 11:cancers11050724. [PMID: 31137729 PMCID: PMC6563134 DOI: 10.3390/cancers11050724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Malignant pheochromocytomas (PCs) and paragangliomas (PGLs) are rare neuroendocrine neoplasms defined by the presence of distant metastases. There is currently a relatively paucity of data regarding the natural history of PCs/PGLs and the optimal approach to their treatment. We retrospectively analyzed the clinical, biochemical, imaging, genetic and histopathological characteristics of fourteen patients with metastatic PCs/PGLs diagnosed over 15 years, along with their response to treatment. Patients were followed-up for a median of six years (range: 1–14 years). Six patients had synchronous metastases and the remaining developed metastases after a median of four years (range 2–10 years). Genetic analysis of seven patients revealed that three harbored succinate dehydrogenase subunit B/D gene (SDHB/D) mutations. Hormonal hypersecretion occurred in 70% of patients; normetanephrine, either alone or with other concomitant hormones, was the most frequent secretory component. Patients were administered multiple first and subsequent treatments including surgery (n = 12), chemotherapy (n = 7), radionuclide therapy (n = 2) and radiopeptides (n = 5). Seven patients had stable disease, four had progressive disease and three died. Ectopic hormonal secretion is rare and commonly encountered in benign PCs. Ectopic secretion of interleukin-6 in one of our patients, prompted a literature review of ectopic hormonal secretion, particularly from metastatic PCs/PGLs. Only four cases of metastatic PC/PGLs with confirmed ectopic secretion of hormones or peptides have been described so far.
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20
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Falhammar H, Kjellman M, Calissendorff J. Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center. Endocrine 2018; 62:566-575. [PMID: 30220006 PMCID: PMC6244895 DOI: 10.1007/s12020-018-1734-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/21/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Many pheochromocytomas and paragangliomas (PPGLs) are nowadays diagnosed as incidentalomas or by screening. This may have changed outcomes. METHODS We reviewed 110 consecutive cases of PPGLs. Two cases with concurrent ectopic ACTH-syndrome were excluded. RESULTS Sixty-five percent had presented as incidentalomas, 30% as symptomatic PPGLs, and 5% had been screened (previously diagnosed MEN2A). Doxazosin was used in 79%, phenoxybenzamine in 18%, intravenous phentolamine in 1%, and no alpha-blockade in the rest. Laparoscopic surgery was performed in 70%, but 11% were converted to open surgery. Complications of surgery were seen in 20%, and length of stay after surgery was 4 days (2-8) with no correlation with alpha-blockade dose or time. In the whole cohort glycemic disturbances decreased by surgery (47% vs. 9%, P < 0.001). During 9.6 ± 7.2-year (median 8[4-13]) follow-up, 7% developed a new PPGL, 5% a PPGL-metastasis (KI67 > 2% n = 2; KI67 ≤ 1% n = 3; tumor size ≥ 95 mm n = 4), and 13% died (metastatic pheochromocytoma n = 2, hypertensive crisis n = 1, heart failure n = 2, other malignancies n = 5, and unclear n = 4). Surgery improved blood pressure and glycemic disturbances in the incidentaloma and the symptomatic PPGL. Recurrence was more common in the screening group. The symptomatic PPGL group was more likely to die of a PPGL-related cause. Surgery was more challenging in the paragangliomas, with less improvement in glycemic control than in the pheochromocytoma group. However, blood pressure and long-term outcomes were similar. CONCLUSION The outcomes seemed slightly better than previous studies. Long-term prognosis was similar between pheochromocytomas and paragangliomas.
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Affiliation(s)
- Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Magnus Kjellman
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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21
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Asa SL, Ezzat S, Mete O. The Diagnosis and Clinical Significance of Paragangliomas in Unusual Locations. J Clin Med 2018; 7:E280. [PMID: 30217041 PMCID: PMC6162705 DOI: 10.3390/jcm7090280] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
Paragangliomas are neuroendocrine neoplasms, derived from paraganglia of the sympathetic and parasympathetic nervous systems. They are most commonly identified in the head and neck, being most frequent in the carotid body, followed by jugulotympanic paraganglia, vagal nerve and ganglion nodosum, as well as laryngeal paraganglia. Abdominal sites include the well-known urinary bladder tumors that originate in the Organ of Zuckerkandl. However, other unusual sites of origin include peri-adrenal, para-aortic, inter-aortocaval, and paracaval retroperitoneal sites, as well as tumors in organs where they may not be expected in the differential diagnosis of neuroendocrine neoplasms, such as thyroid, parathyroid, pituitary, gut, pancreas, liver, mesentery, lung, heart and mediastinum. The distinction of these lesions from epithelial neuroendocrine neoplasms is critical for several reasons. Firstly, the determination of clinical and biochemical features is different from that used for epithelial neuroendocrine tumors. Secondly, the genetic implications are different, since paragangliomas/pheochromocytomas have the highest rate of germline susceptibility at almost 40%. Finally, the characterization of metastatic disease is unique in these highly syndromic lesions. In this review, we summarize updated concepts by outlining the spectrum of anatomic locations of paragangliomas, the importance of morphology in establishing the correct diagnosis, the clinical implications for management, and the impact of genetics on the distinction between multifocal primary tumors compared with malignant disease.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Endocrine Oncology Site, Princess Margaret Cancer Center, Toronto, ON M5G 2MG, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Shereen Ezzat
- Endocrine Oncology Site, Princess Margaret Cancer Center, Toronto, ON M5G 2MG, Canada.
- Department of Medicine, Division of Endocrinology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada.
- Endocrine Oncology Site, Princess Margaret Cancer Center, Toronto, ON M5G 2MG, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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22
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Kimura N, Takekoshi K, Naruse M. Risk Stratification on Pheochromocytoma and Paraganglioma from Laboratory and Clinical Medicine. J Clin Med 2018; 7:jcm7090242. [PMID: 30150569 PMCID: PMC6162838 DOI: 10.3390/jcm7090242] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
Pheochromocytoma (PCC) and sympathetic paraganglioma (PGL) are rare neuroendocrine tumors characterized by catecholamine production in the adrenal medulla and extra-adrenal paraganglia. PCC and PGL (PPGL) with metastasis was termed malignant PPGL. However, the distinction between “benign” and “malignant” PPGLs has been debated. Currently, all PPGLs are believed to have some metastatic potential and are assigned malignant tumors (ICD-O/3) by the WHO Classification of Endocrine Organs (2017, 4th edition). Therefore, the previous categories benign and malignant PPGL have been eliminated in favor of risk stratification approach. The Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) is a tool for risk stratification for predicting metastasis and the prognosis of patients. At least 30% of PPGLs are hereditary, with 20 genes identified and genotype-phenotype correlations clarified. Of these genes, VHL, RET and NF1 have been well investigated and are the primary cause of bilateral PCC. In addition, mutation of succinate dehydrogenase gene subunits SDHB and SDHD are strongly correlated with extra-adrenal location, younger age, multiple tumors, metastasis and poor prognosis. Disease stratification by catecholamine phenotype and molecular profiling correlates with histological grading by GAPP. PPGLs should be understood comprehensively based on clinical, biochemical, molecular and pathological data for patient care. A flow chart for pathological diagnosis is included.
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Affiliation(s)
- Noriko Kimura
- Department of Clinical Research Pathology Division, Department of Diagnostic Pathology, National Hospital Organization Hakodate Hospital, Hakodate 041-8512, Hokkaido, Japan.
| | - Kazuhiro Takekoshi
- Division of Sports Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.
| | - Mitsuhide Naruse
- Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization, Kyoto Medical Center, Kyoto 612-8555, Japan.
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23
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Turchini J, Cheung VKY, Tischler AS, De Krijger RR, Gill AJ. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology 2018; 72:97-105. [PMID: 29239044 DOI: 10.1111/his.13402] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
Phaeochromocytoma and paraganglioma (PHEO/PGL) are rare tumours with an estimated annual incidence of 3 per million. Advances in molecular understanding have led to the recognition that at least 30-40% arise in the setting of hereditary disease. Germline mutations in the succinate dehydrogenase genes SDHA, SDHB, SDHC, SDHD and SDHAF2 are the most prevalent of the more than 19 hereditary genetic abnormalities which have been reported. It is therefore recommended that, depending on local resources and availability, at least some degree of genetic testing should be offered to all PHEO/PGL patients, including those with clinically sporadic disease. It is now accepted that that all PHEO/PGL have some metastatic potential; therefore, concepts of benign and malignant PHEO/PGL have no meaning and have been replaced by a risk stratification approach. Although there is broad acceptance that certain features, including high proliferative activity, invasive growth, increased cellularity, large tumour nests and comedonecrosis, are associated with an increased risk of metastasis, it remains difficult to predict the clinical behaviour of individual tumours and no single risk stratification scheme is endorsed or in widespread use. In this review, we provide an update on advances in the pathology and genetics of PHEO/PGL with an emphasis on the changes introduced in the WHO 2017 classification of endocrine neoplasia relevant to practising surgical pathologists.
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Affiliation(s)
- John Turchini
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,University of Sydney, Sydney, NSW, Australia.,Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Veronica K Y Cheung
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Arthur S Tischler
- Department of Pathology and Laboratory Medicine Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ronald R De Krijger
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,University of Sydney, Sydney, NSW, Australia.,Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Zhao SH, Liang S, Luo J, Mo HD, Jiang Y, Zhang MM, Yuan J. Heart combined with adrenal multiple pheochromocytomas. J Nucl Cardiol 2018; 25:1040-1043. [PMID: 28593533 DOI: 10.1007/s12350-017-0860-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/14/2017] [Indexed: 12/25/2022]
Abstract
Pheochromocytoma is a kind of rare tumor, occurring at any site in the sympathoadrenal system. Main lesions occur within the adrenal gland; only 1%-2% occur within the chest, and most of these are located in the posterior mediastinum. Intrapericardial pheochromocytoma is extremely rare in clinic, only about 100 cases have been reported in total in both the domestic and foreignliterature since Besterman et al. first reported in 1974. It is often difficult to diagnose and locate these tumors. Hence, we present here a case of adrenal combined with heart multiple pheochromocytomas and discuss about techniques contributed to diagnosis and localization.
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Affiliation(s)
- Su-Hong Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China
| | - Shuang Liang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China
| | - Jing Luo
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China
| | - Hong-Dan Mo
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China
| | - Yu Jiang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China
| | - Mao-Mao Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China
| | - Jie Yuan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin, Heilongjiang Province, China.
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Streuli J, Harris AG, Cottiny C, Allagnat F, Daly AF, Grouzmann E, Abid K. Cellular effects of AP102, a somatostatin analog with balanced affinities for the hSSTR2 and hSSTR5 receptors. Neuropeptides 2018. [PMID: 29523357 DOI: 10.1016/j.npep.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Somatostatin analogs (SSAs) are first-line medical therapy for the treatment of acromegaly and neuroendocrine tumors that express somatostatin receptors (SSTR). Somatostatin suppresses secretion of a large number of hormones through the stimulation of the five SSTR. However, unbalanced inhibition of secretion as observed with the highly potent SSAs pasireotide causes hyperglycaemia mainly by inhibiting insulin secretion. In contrast, AP102 a new SSAs has neutral effect on blood glucose while suppressing GH secretion. Our objective was to establish the cellular effects of AP102 on SSTR2 and SSTR5 that may explain the differences observed between AP102 and other SSAs. METHODS We compared the binding and agonist activity of AP102 with somatostatin-14, octreotide and pasireotide in HEK293 cells transfected with human SSTR2 and SSTR5 receptors. SSAs signal transduction effects (cAMP concentrations) were measured in forskolin-treated cells in the presence of SSAs. Proliferation and apoptotic effects were determined and binding assays were performed using 125I- somatostatin-14. RESULTS AP102 has comparable affinity and agonist effect to octreotide at SSTR2 (IC50's of 112 pM and 244 pM, respectively; EC50's of 230 pM and 210 pM, respectively) in contrast to pasireotide that exhibits a 12-27 fold higher IC50 (3110 pM) and about 5-fold higher EC50 (1097 pM). At SSTR5, AP102 has much higher affinity and stimulating effect than octreotide (IC50's of 773 pM and 16,737 pM, respectively; EC50's of 8526 pM and 26,800 pM), and an intermediate affinity and agonist effect between octreotide and pasireotide. AP102, octreotide and pasireotide have variable anti-proliferative effects on HEK cells transfected with SSTR2 and SSTR5. CONCLUSION AP102 is a new SSA that better reduces signaling at SSTR2 than SSTR5 and prevents cell proliferation at both receptors. The euglycaemic effect of AP102 observed in preclinical studies may be related to this intermediate agonistic potency between pasireotide and octreotide at SSTR2 and SSTR5.
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Affiliation(s)
- Jeremy Streuli
- Service of Clinical Pharmacology, Catecholamine and Peptides Laboratory, Centre Hospitalier Universitaire Vaudois (CHUV), 1001 Lausanne, Switzerland
| | - Alan G Harris
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Cecilia Cottiny
- Service of Clinical Pharmacology, Catecholamine and Peptides Laboratory, Centre Hospitalier Universitaire Vaudois (CHUV), 1001 Lausanne, Switzerland
| | - Florent Allagnat
- Department of Vascular Surgery, CHUV, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Adrian F Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Eric Grouzmann
- Service of Clinical Pharmacology, Catecholamine and Peptides Laboratory, Centre Hospitalier Universitaire Vaudois (CHUV), 1001 Lausanne, Switzerland
| | - Karim Abid
- Service of Clinical Pharmacology, Catecholamine and Peptides Laboratory, Centre Hospitalier Universitaire Vaudois (CHUV), 1001 Lausanne, Switzerland.
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Dos Santos Borrego A, Carrilho Ferreira P, Pinto FJ. Acute type A aortic dissection in a patient with paraganglioma. Rev Port Cardiol 2017; 36:777.e1-777.e6. [PMID: 29050867 DOI: 10.1016/j.repc.2016.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/16/2016] [Indexed: 12/28/2022] Open
Abstract
Acute aortic dissection is the most common acute aortic syndrome. It is more prevalent in males and in the elderly, and has a high mortality. Hypertension is the main risk factor. Diagnosis is based on clinical features, laboratory tests and imaging exams. Treatment is usually surgical, although in some cases an endovascular approach is an alternative. Paraganglioma is an uncommon neuroendocrine tumor. Most produce catecholamines, and so usually manifest with hypertensive crisis, palpitations, headache and sweating. This tumor is diagnosed by measurement of plasma or urinary catecholamines and by computed tomography, magnetic resonance imaging and 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Surgery is the only potentially curative treatment.
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Affiliation(s)
| | - Pedro Carrilho Ferreira
- Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal; Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Fausto J Pinto
- Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal; Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal; Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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Borrego A, Carrilho Ferreira P, Pinto FJ. Acute type A aortic dissection in a patient with paraganglioma. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Allison DB, McCuiston A, VandenBussche CJ. The presence of neuroendocrine features generates a broad differential diagnosis in the fine-needle aspiration of bone and soft tissue neoplasms. J Am Soc Cytopathol 2017; 6:185-193. [PMID: 31043241 DOI: 10.1016/j.jasc.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Biopsy of bone and soft tissue (BST) lesions occasionally yields neoplasms with neuroendocrine (NE) features. We identify a differential diagnosis for neoplasms containing NE features when encountered on fine-needle aspiration (FNA) of BST masses. MATERIALS AND METHODS The cytopathology archives of the Johns Hopkins Hospital were searched for any BST FNA specimen diagnosed as a neoplasm with NE features or in which NE immunohistochemical (IHC) markers were ordered. Specimen diagnoses were reviewed and specimens were excluded if neuroendocrine features were not considered at the time of original diagnosis. RESULTS A total of 179 specimens met the inclusion criteria. Of these, 64 (36%) and 115 (64%) neoplasms were primary and metastatic, respectively. A total of 29 distinct entities were identified. Sixteen were entities with established NE differentiation and 13 were entities not typically regarded as having an NE origin. The most commonly encountered neoplasms included small cell carcinoma of all primary locations (38), Ewing sarcoma (37), medullary thyroid carcinoma (24), Merkel cell carcinoma (23), and paraganglioma (10). NE IHC markers were ordered in 45% of cases; 86% were positive by at least one NE marker. Entities with established NE differentiation were more likely to be positive for NE IHC than those not typically regarded as having NE differentiation (100% and 59%, respectively). CONCLUSIONS A variety of BST lesions-including neoplasms not typically thought to have neuroendocrine differentiation-can possess NE cytomorphologic features and/or NE IHC marker positivity. The patient's clinical presentation and history can help narrow the differential diagnosis.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Austin McCuiston
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Osinga TE, Links TP, Dullaart RPF, Pacak K, van der Horst-Schrivers ANA, Kerstens MN, Kema IP. Emerging role of dopamine in neovascularization of pheochromocytoma and paraganglioma. FASEB J 2017; 31:2226-2240. [PMID: 28264974 DOI: 10.1096/fj.201601131r] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/07/2017] [Indexed: 01/11/2023]
Abstract
Dopamine is a catecholamine that acts both as a neurotransmitter and as a hormone, exerting its functions via dopamine (DA) receptors that are present in a broad variety of organs and cells throughout the body. In the circulation, DA is primarily stored in and transported by blood platelets. Recently, the important contribution of DA in the regulation of angiogenesis has been recognized. In vitro and in vivo studies have shown that DA inhibits angiogenesis through activation of the DA receptor type 2. Overproduction of catecholamines is the biochemical hallmark of pheochromocytoma (PCC) and paraganglioma (PGL). The increased production of DA has been shown to be an independent predictor of malignancy in these tumors. The precise relationship underlying the association between DA production and PCC and PGL behavior needs further clarification. Herein, we review the biochemical and physiologic aspects of DA with a focus on its relations with VEGF and hypoxia inducible factor related angiogenesis pathways, with special emphasis on DA producing PCC and PGL.-Osinga, T. E., Links, T. P., Dullaart, R. P. F., Pacak, K., van der Horst-Schrivers, A. N. A., Kerstens, M. N., Kema, I. P. Emerging role of dopamine in neovascularization of pheochromocytoma and paraganglioma.
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Affiliation(s)
- Thamara E Osinga
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karel Pacak
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Michiel N Kerstens
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Matsuda Y, Kimura N, Yoshimoto T, Sekiguchi Y, Tomoishi J, Kasahara I, Hara Y, Ogawa Y. Dopamine-Secreting Paraganglioma in the Retroperitoneum. Endocr Pathol 2017; 28:36-40. [PMID: 27743246 DOI: 10.1007/s12022-016-9457-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pheochromocytomas and paragangliomas, which exclusively produce dopamine, are very rare. Herein, we report for the first time a Japanese case of an exclusively dopamine-producing paraganglioma accompanied by detailed immunohistochemical analyses. A 70-year-old Japanese woman was referred to our hospital for functional examination of her left retroperitoneal mass. Her adrenal functions were normal, except for excessive dopamine secretion. After the tumorectomy, her dopamine level normalized. The histopathological diagnosis of the tumor was paraganglioma; this was confirmed by positive immunostaining of chromogranin A (CgA), tyrosine hydroxylase (TH), dopamine β-hydroxylase (DBH), and succinate dehydrogenase gene subunit B (SDHB). However, the immunostaining of CgA in the tumor cells showed peculiar dot-like staining located corresponding to Golgi complex in the perinuclear area, rather than the diffuse cytoplasmic staining usually observed in epinephrine- or norepinephrine-producing functional pheochromocytomas and paragangliomas. The immunohistochemical results suggested that the tumor cells had sparse neuroendocrine granules in the cytoplasm, resulting in inhibition of catecholamine synthesis from dopamine to norepinephrine in neurosecretory granules. This may be the mechanism responsible for exclusive dopamine secretion in the present case.
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Affiliation(s)
- Yusuke Matsuda
- Department of Endocrinology and Diabetology, Ome Municipal General Hospital, Tokyo, 198-0042, Japan
- Department of Diabetology, Endocrinology and Metabolism, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Noriko Kimura
- Department of Clinical Research Pathology Division, National Hospital Organization Hakodate Hospital, Hakodate, Hokkaido, 041-8512, Japan
| | - Takanobu Yoshimoto
- Department of Diabetology, Endocrinology and Metabolism, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yoshihiro Sekiguchi
- Department of Endocrinology and Diabetology, Ome Municipal General Hospital, Tokyo, 198-0042, Japan
| | - Junzo Tomoishi
- Department of Urology, Ome Municipal General Hospital, Tokyo, 198-0042, Japan
| | - Ichiro Kasahara
- Department of Pathology, Ome Municipal General Hospital, Tokyo, 198-0042, Japan
| | - Yoshihito Hara
- Department of Endocrinology and Diabetology, Ome Municipal General Hospital, Tokyo, 198-0042, Japan
| | - Yoshihiro Ogawa
- Department of Diabetology, Endocrinology and Metabolism, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Thomson N, Pacak K, Schmidt M, Palmer C, Salzman K, Champine M, Schiffman J, Cohen A. Leptomeningeal dissemination of a low-grade lumbar paraganglioma: case report. J Neurosurg Spine 2017; 26:501-506. [PMID: 28128698 DOI: 10.3171/2016.10.spine16948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Leptomeningeal dissemination of paraganglioma is rare, with only 2 prior cases in the literature. The authors present the case of a metastatic low-grade lumbar paraganglioma via leptomeningeal dissemination. This report emphasizes the utility of 3,4-dihydroxy-6-18F-fluoro-l-phenylalanine (18F-FDOPA) PET scanning for diagnosis, as well as the combination of radiation therapy and alkylating chemotherapeutic agents for the treatment of this rare phenomenon. The patient was a 61-year-old woman who presented with low-back pain and was found to have an isolated L-3 intrathecal tumor on MRI. Sixteen months after gross-total en bloc resection of the paraganglioma, the patient again became symptomatic with new neurological symptoms. MRI findings revealed enhancing leptomeningeal nodules throughout the spine. 18F-FDOPA PET/CT scanning was used to confirm the diagnosis of disseminated paraganglioma. Intrathecal thiotepa, radiation therapy, and systemic therapy with capecitabine and temozolomide have been used sequentially over a 2-year period, with each able to stabilize tumor growth for several months. The authors also summarize the 2 other reports of leptomeningeal dissemination of paragangliomas in the literature and compare the course and management of the 3 cases.
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Affiliation(s)
- Nick Thomson
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Arizona
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Meic Schmidt
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah,Huntsman Cancer Institute, Salt Lake City, Utah
| | - Cheryl Palmer
- Department of Pathology, Division of Anatomic Pathology, University of Utah, Salt Lake City, Utah,Huntsman Cancer Institute, Salt Lake City, Utah
| | - Karen Salzman
- Department of Radiology, Division of Neuroradiology, University of Utah, Salt Lake City, Utah,Huntsman Cancer Institute, Salt Lake City, Utah
| | - Marjan Champine
- Huntsman Cancer Institute, Salt Lake City, Utah,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Joshua Schiffman
- Department of Pediatrics and Oncological Sciences, University of Utah, Salt Lake City, Utah,Huntsman Cancer Institute, Salt Lake City, Utah
| | - Adam Cohen
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah,Huntsman Cancer Institute, Salt Lake City, Utah
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Duan K, Mete O. Algorithmic approach to neuroendocrine tumors in targeted biopsies: Practical applications of immunohistochemical markers. Cancer Cytopathol 2016; 124:871-884. [DOI: 10.1002/cncy.21765] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Kai Duan
- Department of Pathology; University Health Network; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
| | - Ozgur Mete
- Department of Pathology; University Health Network; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre; Toronto Ontario Canada
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On-line preconcentration of fluorescent derivatives of catecholamines in cerebrospinal fluid using flow-gated capillary electrophoresis. J Chromatogr A 2016; 1450:112-20. [DOI: 10.1016/j.chroma.2016.04.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 12/18/2022]
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Khudaish EA, Al-Nofli F, Rather JA, Al-Hinaai M, Laxman K, Kyaw HH, Al-Harthy S. Sensitive and selective dopamine sensor based on novel conjugated polymer decorated with gold nanoparticles. J Electroanal Chem (Lausanne) 2016. [DOI: 10.1016/j.jelechem.2015.12.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Salesov E, Boretti FS, Sieber-Ruckstuhl NS, Rentsch KM, Riond B, Hofmann-Lehmann R, Kircher PR, Grouzmann E, Reusch CE. Urinary and plasma catecholamines and metanephrines in dogs with pheochromocytoma, hypercortisolism, nonadrenal disease and in healthy dogs. J Vet Intern Med 2015; 29:597-602. [PMID: 25818214 PMCID: PMC4895504 DOI: 10.1111/jvim.12569] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 11/27/2014] [Accepted: 02/03/2015] [Indexed: 01/07/2023] Open
Abstract
Background Diagnosis of pheochromocytoma (PC) is based on a combination of clinical suspicion, finding an adrenal mass, increased plasma, and urine concentrations of catecholamine metabolites and is finally confirmed with histopathology. In human medicine, it is controversial whether biochemically testing plasma is superior to testing urine. Objectives To measure urinary and plasma catecholamines and metanephrines in healthy dogs, dogs with PC, hypercortisolism (HC), and nonadrenal diseases (NAD) and to determine the test with the best diagnostic performance for dogs with PC. Animals Seven PC dogs, 10 dogs with HC, 14 dogs with NAD, 10 healthy dogs. Methods Prospective diagnostic clinical study. Urine and heparin plasma samples were collected and stored at −80°C before analysis using high‐pressure liquid chromatography (HPLC) coupled to electrochemical detection or tandem mass spectrometry were performed. Urinary variables were expressed as ratios to urinary creatinine concentration. Results Dogs with PC had significantly higher urinary normetanephrine and metanephrine : creatinine ratios and significantly higher plasma‐total and free normetanephrine and plasma‐free metanephrine concentrations compared to the 3 other groups. There were no overlapping results of urinary normetanephrine concentrations between PC and all other groups, and only one PC dog with a plasma normetanephrine concentration in the range of the dogs with HC and NAD disease. Performances of total and free plasma variables were similar. Overlap of epinephrine and norepinephrine results between the groups was large with both urine and plasma. Conclusion and clinical importance Measurement of normetanephrine is the preferred biochemical test for PC and urine was superior to plasma.
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Affiliation(s)
- E Salesov
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Testa JR, Malkin D, Schiffman JD. Connecting molecular pathways to hereditary cancer risk syndromes. AMERICAN SOCIETY OF CLINICAL ONCOLOGY EDUCATIONAL BOOK. AMERICAN SOCIETY OF CLINICAL ONCOLOGY. ANNUAL MEETING 2015. [PMID: 23714463 DOI: 10.1200/edbook_am.2013.33.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An understanding of the genetic causes and molecular pathways of hereditary cancer syndromes has historically informed our knowledge and treatment of all types of cancers. For this review, we focus on three rare syndromes and their associated genetic mutations including BAP1, TP53, and SDHx (SDHA, SDHB, SDHC, SDHD, SDHAF2). BAP1 encodes an enzyme that catalyzes the removal of ubiquitin from protein substrates, and germline mutations of BAP1 cause a novel cancer syndrome characterized by high incidence of benign atypical melanocytic tumors, uveal melanomas, cutaneous melanomas, malignant mesotheliomas, and potentially other cancers. TP53 mutations cause Li-Fraumeni syndrome (LFS), a highly penetrant cancer syndrome associated with multiple tumors including but not limited to sarcomas, breast cancers, brain tumors, and adrenocortical carcinomas. Genomic modifiers for tumor risk and genotype-phenotype correlations in LFS are beginning to be identified. SDH is a mitochondrial enzyme complex involved in the tricarboxylic acid (TCA) cycle, and germline SDHx mutations lead to increased succinate with subsequent paragangliomas, pheochromocytomas, renal cell carcinomas (RCCs), gastrointestinal stromal tumors (GISTs), and other rarer cancers. In all of these syndromes, the molecular pathways have informed our understanding of tumor risk and successful early tumor surveillance and screening programs.
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Affiliation(s)
- Joseph R Testa
- From the Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, PA; Division of Hematology/Oncology, University of Toronto, and Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada; High Risk Pediatric Cancer Clinic, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Abstract
OBJECTIVE The diagnosis of pheochromocytoma/paraganglioma (PPGL) involves detection of elevated levels of plasma and/or 24-h urine catecholamines and/or their metabolites, including metanephrines. Although these tests are reasonably sensitive, false-positive results are often encountered. Follow-up tests can provide additional information to correctly diagnose PPGL. In this regard, the utility of the urinary clonidine suppression test (UCST) remains unknown. METHODS To assess the diagnostic accuracy of the UCST in confirming or excluding PPGL, we conducted a retrospective analysis of all patients who underwent a UCST between 2000 and 2013 (n = 59; 15 PPGLs) at a single centre. Twelve-hour urine catecholamines and metanephrines were assessed before and after clonidine administration, and examined in relation to final diagnosis, PPGL or non-PPGL. Receiver operating characteristic analyses were used to identify optimal positivity cut-offs. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Clonidine significantly decreased urine creatinine-corrected norepinephrine and normetanephrine in patients without PPGL (P < 0.001 pairwise) but not in patients with PPGL. Epinephrine and metanephrine levels were not significantly reduced in either group. Receiver operating characteristic (ROC) area under the curve was 0.955 [95% confidence interval (95% CI) 0.906-1.000, P < 0.001] and 0.823 (95% CI 0.706-0.940, P < 0.001) for norepinephrine and normetanephrine, respectively. Optimal cut-offs were established at 50 and 15% reductions in norepinephrine and normetanephrine, respectively, which provided high sensitivities (93.3% for both) and negative predictive values (97.4 and 96.3%). When both were concordant, higher diagnostic accuracy was achieved (100% sensitivity, 92.0% specificity). Results were similar in subgroups of individuals with borderline initial testing (n = 40) or on interfering drugs (n = 25). CONCLUSION The UCST appears to be a highly accurate test for PPGL. Further prospective studies are needed to validate these results before routine use is encouraged.
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RE: Anesthetic Management for Resection of Hepatic Paraganglioma Metastatic From the Donor Organ in an Orthotopic Liver Transplant Recipient: A Case Report. Transplant Proc 2015; 47:2072-3. [PMID: 26293099 DOI: 10.1016/j.transproceed.2015.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kimura N. A pathologist's view: molecular profiles for diagnosing pheochromocytomas and paragangliomas. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytomas (PCC) and paragangliomas (PGL) are catecholamine (CA)-producing tumors classified into well (WD)-, moderately (MD)- or poorly differentiated (PD) types by the Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP). Seventy percent of PCCs/PGLs are WD type with 4% metastasis, the rest are MD with 60% and PD are with 88% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type), intermediate grade (MD type) and high-grade malignancies (PD types). MD/PD types are with 70% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type) and high-grade malignancies (MD/PD types) using GAPP. Hereditary PCCs/PGLs have been previously classified into cluster 1 or cluster 2 based on genetic mutations involved and types of catecholamine produced by the tumors. GAPP revealed that tumors in cluster 1 and cluster 2 correspond to MD type and WD type, respectively. Susceptible genes for high-grade malignancy (PD type) are currently unknown.
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Affiliation(s)
- Noriko Kimura
- Department of Clinical Research, Pathology Division, National Hospital Organization Hakodate Hospital, Hakodate, Japan
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Tischler AS, deKrijger RR. 15 YEARS OF PARAGANGLIOMA: Pathology of pheochromocytoma and paraganglioma. Endocr Relat Cancer 2015; 22:T123-33. [PMID: 26136457 DOI: 10.1530/erc-15-0261] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 01/17/2023]
Abstract
Pathologists using their routine diagnostic tools can contribute both to the care of patients with pheochromocytoma/paraganglioma and to understanding the pathobiology of the tumors. They can document details of tissue organization and cytology that are accessible only by microscopy and can characterize admixtures of cell types that are morphologically distinct or show differential expression of immunohistochemical markers. Current roles and challenges for pathologists include differential diagnosis, identifying clues to the presence of hereditary disease, and effective communication of pathology information for clinical and research purposes. Future roles will increasingly involve risk stratification, identification of actionable targets for personalized therapies, and aiding the interpretation of molecular tests by helping characterize genetic variants of unknown significance. It remains to be determined to what extent the need for pathology input will be overshadowed by the availability of genetic testing and other molecular analyses at ever-decreasing cost, together with very effective clinical paradigms for risk stratification and patient care.
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Affiliation(s)
- Arthur S Tischler
- Department of Pathology and Laboratory MedicineTufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 802, Boston, Massachusetts 02111, USADepartment of PathologyErasmus MC University Medical Center, Rotterdam, The NetherlandsDepartment of PathologyReinier de Graaf Hospital, Delft, The Netherlands
| | - Ronald R deKrijger
- Department of Pathology and Laboratory MedicineTufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 802, Boston, Massachusetts 02111, USADepartment of PathologyErasmus MC University Medical Center, Rotterdam, The NetherlandsDepartment of PathologyReinier de Graaf Hospital, Delft, The Netherlands Department of Pathology and Laboratory MedicineTufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 802, Boston, Massachusetts 02111, USADepartment of PathologyErasmus MC University Medical Center, Rotterdam, The NetherlandsDepartment of PathologyReinier de Graaf Hospital, Delft, The Netherlands
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Oleaga-Alday A, Goñi-Goicoechea F, Calles-Romero L, Pérez de Ciriza-Cordeu M, Paja-Fano M. Paraganglioma and cyanotic congenital heart disease: The role of tisular hipoxia. ACTA ACUST UNITED AC 2015; 62:413-4. [PMID: 26112697 DOI: 10.1016/j.endonu.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Amelia Oleaga-Alday
- Servicio de Endocrinología y Nutrición, Hospital Universitario Basurto, Bilbao, Vizcaya, España.
| | | | - Laura Calles-Romero
- Servicio de Endocrinología y Nutrición, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | | | - Miguel Paja-Fano
- Servicio de Endocrinología y Nutrición, Hospital Universitario Basurto, Bilbao, Vizcaya, España
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Bagchi A, Dushaj K, Shrestha A, Leytin AL, Bhuiyan SA, Radparvar F, Topchik S, Tuli SS, Kim P, Bakshi S. Urinary bladder paraganglioma presenting as micturition-induced palpitations, dyspnea, and angina. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:283-6. [PMID: 25965060 PMCID: PMC4444169 DOI: 10.12659/ajcr.891388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sympathetic urinary bladder paragangliomas are rare catecholamine-secreting neuroendocrine tumors arising from neural crest cells. They are uncommon urinary bladder neoplasms. Symptoms classically include micturition-related or unrelated palpitations and syncope with hypertension, headaches, diaphoresis, and hematuria. Other than being attributable to vasovagal reactions, micturition-induced cardiovascular symptoms should prompt a search for catecholamine-secreting tumors such as a urinary bladder paraganglioma, as in this case. CASE REPORT A 45-year-old asthmatic African-American female presented with episodic hematuria that began 4 years ago and episodes of micturition-induced palpitations, dyspnea, substernal tightness, sweating, and throbbing headaches. Computed tomography with contrast revealed an enhancing mass along the anterior urinary bladder wall, measuring 2.4×3.5 cm. On Positron emission Tomography with [18F] fluorodeoxyglucose integrated with computed tomography (18F-FDG PET/CT), the urinary bladder mass was 18F-FDG avid. Serum normetanephrine and supine plasma norepinephrine were significantly elevated and there was mild elevation of supine plasma epinephrine. Transurethral resection of the bladder mass revealed a neoplasm with microscopic features and immunohistochemical profile positive for synaptophysin and chromogranin, with negative screening cytokeratin AE1/AE3, suggesting a paraganglioma. Following resection of the paraganglioma, there was complete resolution of micturition-induced cardiovascular symptoms on long-term follow-up. CONCLUSIONS Micturition-related cardiovascular symptoms are commonly attributed to vasovagal reactions. However, urinary bladder pathologies must be ruled out as a cause, as in this rare case of a urinary bladder paraganglioma exhibiting catecholaminergic symptoms.
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Affiliation(s)
- Arindam Bagchi
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Kola Dushaj
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Anup Shrestha
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Anatoly L Leytin
- Department of Pathology, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Shamsul A Bhuiyan
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Farshid Radparvar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, USA
| | - Shlomo Topchik
- Department of Nuclear Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Sandeep Singh Tuli
- Department of Radiology, Ichan School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Paul Kim
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Sanjiv Bakshi
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
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Hernandez KG, Ezzat S, Morel CF, Swallow C, Otremba M, Dickson BC, Asa SL, Mete O. Familial pheochromocytoma and renal cell carcinoma syndrome: TMEM127 as a novel candidate gene for the association. Virchows Arch 2015; 466:727-32. [DOI: 10.1007/s00428-015-1755-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/21/2015] [Accepted: 03/09/2015] [Indexed: 12/30/2022]
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46
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Vascular pattern analysis for the prediction of clinical behaviour in pheochromocytomas and paragangliomas. PLoS One 2015; 10:e0121361. [PMID: 25794004 PMCID: PMC4368716 DOI: 10.1371/journal.pone.0121361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/31/2015] [Indexed: 01/18/2023] Open
Abstract
Pheochromocytomas (PCCs) are neuroendocrine tumors arising from chromaffin cells of the adrenal medulla. Related tumors that arise from the paraganglia outside the adrenal medulla are called paragangliomas (PGLs). PCC/PGLs are usually benign, but approximately 17% of these tumors are malignant, as defined by the development of metastases. Currently, there are no generally accepted markers for identifying a primary PCC or PGL as malignant. In 2002, Favier et al. described the use of vascular architecture for the distinction between benign and malignant primary PCC/PGLs. The aim of this study was to validate the use of vascular pattern analysis as a test for malignancy in a large series of primary PCC/PGLs. Six independent observers scored a series of 184 genetically well-characterized PCCs and PGLs for the CD34 immunolabeled vascular pattern and these findings were correlated to the clinical outcome. Tumors were scored as malignant if an irregular vascular pattern was observed, including vascular arcs, parallels and networks, while tumors with a regular pattern of short straight capillaries were scored as benign. Mean sensitivity and specificity of vascular architecture, as a predictor of malignancy was 59.7% and 72.9%, respectively. There was significant agreement between the 6 observers (mean κ = 0.796). Mean sensitivity of vascular pattern analysis was higher in tumors >5 cm (63.2%) and in genotype cluster 2 tumors (100%). In conclusion, vascular pattern analysis cannot be used in a stand-alone manner as a prognostic tool for the distinction between benign and malignant PCC, but could be used as an indicator of malignancy and might be a useful tool in combination with other morphological characteristics.
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Kasem K, Lam AKY. Adrenal oncocytic phaeochromocytoma with putative adverse histologic features: a unique case report and review of the literature. Endocr Pathol 2014; 25:416-21. [PMID: 25252620 DOI: 10.1007/s12022-014-9333-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Oncocytic phaeochromocytomas are exceedingly rare tumours. To date, there are three reported cases in the literature. This report describes a case of adrenal oncocytic phaeochromocytoma with unique features and malignant potential in a 68-year-old man. The patient presented with an incidental non-functional mass discovered on routine radiological investigation, which was subsequently excised. Histologically, the tumour cells showed oncocytic features with high-grade nuclear abnormalities and foci of extension to the peri-adrenal fat. Immunohistochemistry performed was positive for chromogranin, CD56, S-100 and p53 and negative for inhibin, HMB-45, EMA, AE1/AE3, Cam 5.2 and calretinin. Electron microscopy showed electron dense granules of neurosecretory type, which confirmed the diagnosis. The malignant potential of the tumour was assessed on available histologic scoring systems, which demonstrated a high malignant potential. However, no recurrence was detected after 5 years of follow-up. Compared to all the previously reported cases of oncocytic phaeochromocytoma, this patient was the oldest on presentation, was the only case with identified high malignant potential and has the longest follow-up. A review of the literature showed that all the oncocytic phaeochromocytomas reported were non-functional, non-metastasizing and were described in women. To conclude, oncocytic phaeochromocytoma should be in the differential diagnoses of oncocytic tumours of the adrenal gland. Additional studies are needed to predict the behaviour of this entity.
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Affiliation(s)
- Kais Kasem
- Cancer Molecular Pathology and Griffith Health Institute, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
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48
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Williams MD, Rich TA. Paragangliomas Arising in the Head and Neck: A Morphologic Review and Genetic Update. Surg Pathol Clin 2014; 7:543-57. [PMID: 26837554 DOI: 10.1016/j.path.2014.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Seventy percent of parasympathetic paragangliomas arise in the head and neck and are nonsecretory. Awareness of the differential diagnosis based on location, overlapping morphology, and immunohistochemical profiles aids in the correct diagnosis, particularly on limited tissue samples. Moreover, 30% to 40% of head and neck paragangliomas are known to be associated with hereditary syndromes, with the succinate dehydrogenase enzyme family comprising the most frequent association. The pathologist's role is becoming increasing critical for facilitating optimal patient care beyond the initial tissue diagnosis of paraganglioma to include screening and documenting potential hereditary tumors requiring further patient counseling and testing.
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Affiliation(s)
- Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 085, Houston, TX 77030, USA.
| | - Thereasa A Rich
- Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, 1400 Hermann Pressler Drive, Unit 444, Houston, TX 77230, USA
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Richter S, Peitzsch M, Rapizzi E, Lenders JW, Qin N, de Cubas AA, Schiavi F, Rao JU, Beuschlein F, Quinkler M, Timmers HJ, Opocher G, Mannelli M, Pacak K, Robledo M, Eisenhofer G. Krebs cycle metabolite profiling for identification and stratification of pheochromocytomas/paragangliomas due to succinate dehydrogenase deficiency. J Clin Endocrinol Metab 2014; 99:3903-11. [PMID: 25014000 PMCID: PMC4184070 DOI: 10.1210/jc.2014-2151] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mutations of succinate dehydrogenase A/B/C/D genes (SDHx) increase susceptibility to development of pheochromocytomas and paragangliomas (PPGLs), with particularly high rates of malignancy associated with SDHB mutations. OBJECTIVE We assessed whether altered succinate dehydrogenase product-precursor relationships, manifested by differences in tumor ratios of succinate to fumarate or other metabolites, might aid in identifying and stratifying patients with SDHx mutations. DESIGN, SETTING, AND PATIENTS PPGL tumor specimens from 233 patients, including 45 with SDHx mutations, were provided from eight tertiary referral centers for mass spectrometric analyses of Krebs cycle metabolites. MAIN OUTCOME MEASURE Diagnostic performance of the succinate:fumarate ratio for identification of pathogenic SDHx mutations. RESULTS SDH-deficient PPGLs were characterized by 25-fold higher succinate and 80% lower fumarate, cis-aconitate, and isocitrate tissue levels than PPGLs without SDHx mutations. Receiver-operating characteristic curves for use of ratios of succinate to fumarate or to cis-aconitate and isocitrate to identify SDHx mutations indicated areas under curves of 0.94 to 0.96; an optimal cut-off of 97.7 for the succinate:fumarate ratio provided a diagnostic sensitivity of 93% at a specificity of 97% to identify SDHX-mutated PPGLs. Succinate:fumarate ratios were higher in both SDHB-mutated and metastatic tumors than in those due to SDHD/C mutations or without metastases. CONCLUSIONS Mass spectrometric-based measurements of ratios of succinate:fumarate and other metabolites in PPGLs offer a useful method to identify patients for testing of SDHx mutations, with additional utility to quantitatively assess functionality of mutations and metabolic factors responsible for malignant risk.
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Affiliation(s)
- Susan Richter
- Institute of Clinical Chemistry and Laboratory Medicine (S.R., M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany; Department of Experimental and Clinical Biomedical Sciences "Mario Serio" (E.R., M.M.), University of Florence and Istituto Toscano Tumori, Viale Pieraccini 6, 50139 Florence, Italy; Department of Medicine (J.W.L., J.U.R., H.J.T.), Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 8, 6525GA, Nijmegen, The Netherlands; Department of Medicine III (J.W.L., G.E.), University Hospital Dresden, Fetscherstrasse 74, 01307 Dresden, Germany; Hereditary Endocrine Cancer Group (A.A.C., M.R.), CNIO, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (A.A.C., M.R.), C/Melchor Fernández Almagro 3, 28029 Madrid, Spain; Veneto Institute of Oncology IRCCS (F.S., G.O.), Via Gattamelata 64, 35128 Padova, Italy; Medizinische Klinik and Poliklinik IV (F.B.), Ludwig-Maximilians-Universität München, Ziemssenstrasse 1, D-80336 Munich, Germany; Clinical Endocrinology (M.Q.), Campus Mitte, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.P.), National Institutes of Health, 10 Center Drive, MSC-1109, Bethesda, Maryland 20892-1109
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50
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Millar AC, Mete O, Cusimano RJ, Fremes SE, Keshavjee S, Morgan CD, Asa SL, Ezzat S, Gilbert J. Functional cardiac paraganglioma associated with a rare SDHC mutation. Endocr Pathol 2014; 25:315-20. [PMID: 24402737 DOI: 10.1007/s12022-013-9296-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Paragangliomas are catecholamine-secreting tumors external to the adrenal glands, most commonly arising in the head and neck, followed by the abdominal and thoracic cavities. The heart is a rare location for paragangliomas to originate from, with fewer than 50 cases as described in the literature. Functional paragangliomas of the right atrium are even more unusual, with only five cases reported to date. The investigations and therapies of a 41-year-old male presenting with a clinically functional cardiac paraganglioma are discussed. We performed a detailed pathology review of the primary cardiac tumor and a lung nodule to examine morphologic changes, along with an immunohistochemical profile (chromogranin A, tyrosine hydroxylase, MIB-1, and succinate dehydrogenase subunit B (SDHB)) of both tumors. Genetic testing of germline mutations in SDH genes was also completed. Both the 9.5-cm cardiac mass and 0.5-cm lung nodule were positive for chromogranin A and tyrosine hydroxylase and showed a global loss of SDHB expression. The MIB-1 labeling index of the smaller lesion and the bulk of the larger lesion was <5 %, but there were cellular foci of the larger lesion that had a labeling index of 10%. Genetic testing yielded an intronic frameshift mutation in the SDHC gene, c.IVS 5 + 1, G > A. We report the first case of a functional cardiac paraganglioma associated with an intronic frameshift SDHC gene mutation.
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Affiliation(s)
- Adam C Millar
- Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada,
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