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Background: Extra-adrenal chromaffin related tumors are called Paraganglioma. These tumors constitute 18% of extra-adrenal pheochromocytomas and are exceptionally rare in the bladder accounting for < 0.06% of bladder tumors. Case Report: A 45-year-old female came with history of painless hematuria of 3 days duration. On MRI scan, she was found to have a bladder tumor arising from the posterior wall. Transurethral resection of the bladder tumor (TUR-BT) was done. During the procedure, the patient had a sudden increase in blood pressure with acute left ventricular failure and pulmonary edema. Multiple grey brown TUR-BT specimen bits on microscopy showed tumor cells in "Zellballen" pattern. These cells were round to polygonal with abundant granular cytoplasm, round, regular nuclei with stippled chromatin. Mitotic figures were seen occasionally. Immunohistochemistry for Chromogranin A showed strong positivity confirming the diagnosis to be paraganglioma of the bladder. Follow-up cystoscopy of the patient didn't show any evidence of the tumor, also her urinary and plasma vanillylmandelic acid (VMA) levels were within normal range post-operatively. Conclusion: Paraganglioma of the bladder is extremely rare. Our case presenting with only painless gross hematuria was a close mimicker of urothelial carcinoma. It has a benign coarse but has a very high recurrence rate. It is essential to differentiate it from its histological differentials for proper management and follow-up.

Introduction: A thorough morphological assessment plays a central role in evaluation of skin biopsies. Overlapping microscopic features pose additional diagnostic challenges in dermatopathological practice. More over skin biopsies are of small size and diagnostic findings may not be present in the initial section. Hence, step sectioning may have added value as in adjunct in contemplating the final diagnosis. Objective: The study was aimed to evaluate the diagnostic utility of step sectioning in dermatopathology. Materials and Methods: A total of 478 skin biopsies were received over a period of 2 years from January 2015 to December 2016 at the Department of Pathology, JJMMC. Two prospective step sections (A2, A3) were cut at an interval of 50µm from the original section (A1). The findings were evaluated by two pathologists independently. The results were analysed and evaluated statistically. Results: Majority of cases (n= 453, 94.7%) were diagnostic. Out of these, many cases (n= 400, 83.6%) showed no additional findings on step sections. In a few cases (n= 32, 6.7%), step section provided additional findings which contributed to the diagnosis. There were some cases (n= 14, 3%) in which findings were noted only on step section leading to the diagnosis. Some cases (n=7, 1.46%) were such that the step sections changed the diagnosis made on original section. Conclusion:Step sectioning enhances the diagnostic accuracy of morphological assessment in ermatopathology practice.