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Africa G, Plutino FM, Filotico M. A rare neurendocrine tumor of the lung: sclerosing paraganglioma. A neoplasm that is difficult to diagnose and a source of dangerous pitfalls. A case report and literature review. Pathologica 2021; 112:191-194. [PMID: 33393521 PMCID: PMC8183351 DOI: 10.32074/1591-951x-23-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
An endobronchial obstructing neoformation was found in a 58-year-old man. The histology and immunohistochemical profile oriented the authors towards a diagnosis of paraganglioma, sclerosing variant. This very difficult diagnosis, especially in a pulmonary localization, may lead to erroneous conclusions both in terms of histogenetic interpretation and that of its biological behavior. The pulmonary localization of the paraganglioma is very rare and even more rare the sclerosing variant, recently reported. Differential diagnosis and literature are discussed.
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Affiliation(s)
- Giovanni Africa
- Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Francesca M Plutino
- Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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2
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Dermawan JK, Mukhopadhyay S, Shah AA. Frequency and extent of cytokeratin expression in paraganglioma: an immunohistochemical study of 60 cases from 5 anatomic sites and review of the literature. Hum Pathol 2019; 93:16-22. [PMID: 31442521 DOI: 10.1016/j.humpath.2019.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
The absence of cytokeratin expression in paraganglioma helps to differentiate it from other neuroendocrine neoplasms such as carcinoid tumor. Although rare cytokeratin positive paragangliomas have been reported, there are no large systematic studies of this phenomenon. The aim of this study was to determine the frequency and extent of cytokeratin expression in paragangliomas using a large cohort of cases from multiple anatomic sites. Immunohistochemical staining for keratin AE1/AE3 (mouse monoclonal, MAB3412; Millipore) and CAM 5.2 (mouse monoclonal, 349 205; Becton-Dickinson) was performed on whole-tissue sections from 60 resected paragangliomas from the head and neck (36), thorax (10), abdomen (8), intradural/epidural spine (5) and bone, left iliac (1). Cytokeratin expression was identified in only 2/60 (3.3%) cases. One was a mediastinal paraganglioma with moderate to strong expression of keratin AE1/AE3 and CAM 5.2 in <5% tumor cells. The other was a lumbar intradural paraganglioma positive for CAM 5.2 (moderate to strong, 80% of tumor cells) but negative for keratin AE1/AE3. All other paragangliomas (58/60, 96.7%) were negative for keratin AE1/AE3 and CAM 5.2. This study - the largest series of cytokeratin-stained whole-tissue sections of paragangliomas to date - supports the dictum that most paragangliomas are cytokeratin negative. Rare exceptions may be site-related.
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Affiliation(s)
- Josephine Kamtai Dermawan
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Sanjay Mukhopadhyay
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Akeesha Alia Shah
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
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3
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Abstract
Primary pulmonary paraganglioma is a rare type of extra-adrenal paragangliomas arising from neuroectodermal-derived paraganglionic tissue. We report herein the case of a 49-year-old woman with a round-like well-defined nodule in the right middle lobe detected by chest CT. FDG PET/CT also revealed this homogeneous nodule with increased FDG accumulation. Finally, the patient underwent right middle lobe resection, and the pathological findings demonstrated the diagnosis of pulmonary paraganglioma.
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4
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Geoffrion TR, DeKeyzer L, Shah G, Nair SJ, Pirolli TJ, Kernstine K. Pulmonary paraganglioma in a 10-year-old: a case report and review of the literature. J Surg Case Rep 2018; 2018:rjy047. [PMID: 29644036 PMCID: PMC5887388 DOI: 10.1093/jscr/rjy047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
Paraganglioma is a rare extra-adrenal tumor of the paraganglia often found in association with sympathetic and parasympathetic nerves. The case presented is of a 10-year-old boy with hemoptysis who was found to have an obstructive bronchial mass. He underwent surgical resection and biopsy confirmed primary pulmonary paraganglioma. He was subsequently found to have an associated genetic syndrome. This is the first case report describing a primary pulmonary paraganglioma in a child.
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Affiliation(s)
- Tracy R Geoffrion
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linde DeKeyzer
- Department of Pulmonary Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gopi Shah
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center Dallas, TX, USA
| | - Suja J Nair
- Department of Pulmonary Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center Dallas, TX, USA
| | - Timothy J Pirolli
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center Dallas, TX, USA
| | - Kemp Kernstine
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ibraheem T, ElGhazaly H, Madkour A, Elnori A. Primary paraganglioma of the lung: A case report. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2014. [DOI: 10.4103/1687-8426.137357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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den Bakker MA, Thunnissen FBJM. Neuroendocrine tumours--challenges in the diagnosis and classification of pulmonary neuroendocrine tumours. J Clin Pathol 2013; 66:862-9. [PMID: 23685279 DOI: 10.1136/jclinpath-2012-201310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pulmonary neuroendocrine (NE) proliferations are a diverse group of disorders which share distinct cytological, architectural and biosynthetic features. Tumours composed of NE cells are dispersed among different tumour categories in the WHO classification of tumours and as such do not conform to a singular group with regards to treatment and prognosis. This is reflected by the highly variable behaviour of NE proliferations, ranging from asymptomatic, for instance in diffuse idiopathic pulmonary NE cell hyperplasia and tumourlets, to highly malignant cancers such as small cell lung cancer and large cell NE carcinoma. In this review NE proliferations are described as distinct entities ranging from low grade lesions to high grade cancers. The differential diagnoses are considered with each of the entries. Finally, mention is made of tumours which may show some NE features.
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Affiliation(s)
- M A den Bakker
- Department of Pathology, Maasstad Hospital, , Rotterdam, The Netherlands
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Zhang JJ, Liu T, Peng F. Primary paraganglioma of the lung: a case report and literature review. J Int Med Res 2013; 40:1617-26. [PMID: 22971515 DOI: 10.1177/147323001204000442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Only 22 cases of primary pulmonary paraganglioma have been reported previously. This report presents a case of paraganglioma that arose in the lung of a 38-year-old woman who presented with chest pain and paroxysmal cough with little sputum. Positron emission tomography-computed tomography scan demonstrated two homogeneous masses in the left lower lobe accompanied by multiple mediastinal lymph node metastases. After resection, gross pathological examination confirmed two solid masses, which had a yellow-grey complexion and decreased blood supply and that invaded the mediastinum. Immunohistochemical analysis confirmed the presence of several biological tumour markers. This is the first known report to describe the computed tomography imaging characteristics of a paraganglioma, thereby improving understanding of its morphological features and helping in the differential diagnosis of lung tumours.
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Affiliation(s)
- J-J Zhang
- Department of Radiology, Zhejiang Hospital, Hangzhou, China
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8
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Braham E, Smati B, Ayadi-Kaddour A, Ismaïl O, Jrad-Hannachi S, El Mezni F. [An unusual pulmonary tumor]. Ann Pathol 2008; 28:54-6. [PMID: 18538718 DOI: 10.1016/j.annpat.2007.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Emna Braham
- Service d'anatomie et de cytologie pathologiques, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie.
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da Silva RA, Gross JL, Haddad FJ, Toledo CAB, Younes RN. Primary pulmonary paraganglioma: case report and literature review. Clinics (Sao Paulo) 2006; 61:83-6. [PMID: 16532231 DOI: 10.1590/s1807-59322006000100015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dahir KM, Gonzalez A, Revelo MP, Ahmed SR, Roberts JR, Blevins LS. Ectopic adrenocorticotropic hormone hypersecretion due to a primary pulmonary paraganglioma. Endocr Pract 2005; 10:424-8. [PMID: 15760790 DOI: 10.4158/ep.10.5.424] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a rare case of primary paraganglioma of the lung, which caused the syndrome of ectopic adrenocorticotropic hormone (ACTH) hypersecretion. METHODS The clinical, biochemical, and imaging findings in this case are described, and the pathologic features of the resected tumor tissue are depicted. In addition, the related literature on paragangliomas is reviewed. RESULTS In a 39-year-old woman with hypertension, weight gain, and easy bruising, laboratory studies showed hypercortisolemia, high plasma ACTH levels, and suppression of cortisol by high-dose dexamethasone. An indium-labeled octreotide whole-body scan disclosed a tumor in the left lower lung field. Thoracoscopic wedge resection of the pulmonary mass was performed. Postoperative microscopic findings and immunohistochemical stains revealed nests of rounded and polyhedral cells and S-100 protein-positive sustentacular (supporting) cells, charac- CONCLUSION This unusual case of Cushing's syndrome was attributable to an ACTH-secreting primary pulmonary paraganglioma.
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11
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Abstract
There are few reported cases of primary pulmonary paraganglioma in the pathology literature. Given the historical confusion surrounding bronchial tumors, widespread use of the term "chemodectoma" and classification of these lesions as paraganglioma in an outdated World Health Organization classification of lung tumors, the recognition of tumors arising from paraganglia within the lung has not been accepted by leading authorities. We present a well-documented case of a primary pulmonary paraganglioma with typical morphologic features and a supporting immunohistochemical profile. The 0.9 cm endobronchial tumor was submucosal and composed of nests of ovoid cells with abundant eosinophilic cytoplasm, cytoplasmic vacuoles, round to oval nuclei with speckled chromatin, and occasional conspicuous nucleoli. The nests of cells were surrounded by thin-walled vascular channels and stellate spindle cells. The ovoid cells showed strong diffuse staining for chromogranin A, synaptophysin, and faint staining for S-100; they were negative for cytokeratin AE1/AE3, Cam 5.2, and epithelial membrane antigen. The stellate spindle cells stained intensely positive for S-100 protein. A critical review of reported cases of pulmonary chemodectomas and paragangliomas in the English literature features few, if any, well-documented examples. While this exceedingly rare tumor should be discerned from carcinoid tumor, it remains unknown if primary pulmonary paragangliomas behave aggressively like intra-abdominal extra-adrenal paragangliomas, or in a more indolent manner observed with extra-adrenal paragangliomas in other locations.
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Affiliation(s)
- Cheri L Aubertine
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, NY 10021, USA
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12
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Abstract
Although neural and neuroendocrine tissues are distributed virtually ubiquitously throughout the body, the occurrence of selected neoplasms related to those lineages is extremely uncommon in some topographic sites. This review considers the clinicopathologic characteristics of heterotopic pituitary adenomas; neuroendocrine carcinomas in non-organ-based locations; ectopic (extraneuraxial) meningiomas and gliomas; visceral neuroblastic neoplasms and primitive neuroectodermal tumors; and paragangliomas arising outside the sympathoadrenal neural network. Practical approaches to differential diagnosis are emphasized.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology & Cytopathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908-0214, USA.
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Shibahara J, Goto A, Niki T, Tanaka M, Nakajima J, Fukayama M. Primary Pulmonary Paraganglioma: Report of a Functioning Case With Immunohistochemical and Ultrastructural Study. Am J Surg Pathol 2004; 28:825-9. [PMID: 15166677 DOI: 10.1097/01.pas.0000116832.81882.0b] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe a case of primary pulmonary paraganglioma, a tumor that has not been reported in sufficient detail in previous literature. The patient was a 55-year-old woman with hypertension accompanied by an elevated serum norepinephrine level (2651 pg/mL; normal 100-450 pg/mL). Computed tomography revealed a well-circumscribed solid mass, 3.5 cm in diameter, located in the lower lobe of the left lung. In the lobectomy specimen, the tumor had invaded the B8 bronchus and hilar lymph nodes with microscopic metastasis to the mediastinal nodes. The tumor showed histologic, immunohistochemical, and ultrastructural features of paraganglioma: argyrophilic cells arranged in a nesting (Zellballen) or anastomosing trabecular pattern within an arcuate vascular network. Neoplastic chief cells positive for neuroendocrine markers (CD56, synaptophysin, chromogranin A) were surrounded by sustentacular cells positive for S-100 protein. Neurofilament protein was positively stained, but cytokeratins were totally negative. On electron microscopy, chief cells possessed abundant dense core granules with an eccentric halo ("norepinephrine-type" granules). The patient's blood pressure began to decline soon after the resection, and her serum norepinephrine promptly returned to almost normal. On the basis of our experience, our case is a bona fide primary pulmonary paraganglioma, a tumor heretofore subject to considerable skepticism.
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Affiliation(s)
- Junji Shibahara
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Saeki T, Akiba T, Joh K, Inoue K, Doi N, Kanai M, Takeyama H, Takemura T, Ogoshi E, Ushigome S, Yamazaki Y. An extremely large solitary primary paraganglioma of the lung: report of a case. Surg Today 1999; 29:1195-200. [PMID: 10552341 DOI: 10.1007/bf02482272] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present herein the case of a 38-year-old woman found to have an extremely large solitary primary paraganglioma of the lung. The patient presented with chest pain on exertion and a mass was discovered in the left lower lobe of the lung by chest X-rays and computed tomography (CT). As no other neoplasms were detected elsewhere, a left lower lobectomy was performed. The patient has remained well without any evidence of recurrence for 5 years since her operation. The tumor, measuring 13 x 12 x 7 cm, was composed of ovoid cells (Zellballen), which were positive for Fontana-Masson and Grimelius stains, and sustentacular cells. Immunohistochemically, the ovoid cells were positive for neuron-specific enolase, S-100, CAM5.2, Leu7, and chromogranin A, and negative for carcinoembryonic antigen and epithelial membrane antigen. The sustentacular cells were positive for S-100 protein and CAM5.2, and negative for glial fibrillary acid protein. Therefore, the tumor was diagnosed as a paraganglioma. The tumor from our patient is the largest of the 17 solitary primary pulmonary paragangliomas reported thus far in the English-language literature.
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Affiliation(s)
- T Saeki
- Department of Surgery I, The Jikei University School of Medicine, Tokyo, Japan
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Silistreli E, Acikel U, Oto O, Catalyurek H, Sariosmanoglu N, Narin C, Sagol O, Kargi A, Ucan ES. Primary Pulmonary Paraganglioma. Asian Cardiovasc Thorac Ann 1998. [DOI: 10.1177/021849239800600421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 2-cm nodular mass was detected by thoracic computed tomography in the peripheral region of the right middle lobe of the lung in a 60-year-old female with a 5-year history of cough and respiratory distress. The resected tumor was diagnosed as a primary paraganglioma on pathologic examination.
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Affiliation(s)
| | | | | | | | | | | | - Ozgul Sagol
- Department of Pathology Dokuz Eylul Medical Faculty İzmir, Turkey
| | - Aydanur Kargi
- Department of Pathology Dokuz Eylul Medical Faculty İzmir, Turkey
| | - Eyup Sabri Ucan
- Department of Pulmonary Medicine Dokuz Eylul Medical Faculty İzmir, Turkey
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