Challenging differential diagnosis of an extra‐adrenal paraganglioma; the role of fine needle aspiration cytology

Abstract

Paragangliomas are rare neoplasms that arise from neural crest cells of the autonomous system. Herein, we present a case of a 37-year-old patient with a history of retroperitoneal paraganglioma and tuberculous infection presenting with a paraganglioma of the neck that was initially misdiagnosed as metastatic tumor originating from the lungs. Cytological features from fine needle aspiration and immunocytochemistry pointed to the right diagnosis. However, distinguishing between primary and metastatic site of a paraganglioma can be very challenging due to the overlapping features of these entities. Furthermore, this case underlines the value of a detailed medical history in the era of modern diagnostic modalities. Diagn. Cytopathol. 2017;45:565-568. © 2017 Wiley Periodicals, Inc.

Paraganglioma of the Tongue in a Chow Chow Dog: A Comparison With the Human Counterpart and Literature Review

“…Paragangliomas of the tongue in human patients are histologically similar to those observed in other tissues (2,(15)(16)(17)19) and also in domestic animals (5,6,(9)(10)(11)(12). The low number of mitosis in the tumoral mass of the tongue was also reported in benign and malignant paragangliomas of dogs (5,6,8).…”

“…In human patients, there are different cytological presentations of paragangliomas of the head ( 19 , 20 ), including similar morphological features such as observed in the dog. Cytological diagnosis of paragangliomas of the tongue has never been conducted in human patients ( 14 – 18 ).…”

“…Cytological features of the ulcerated lingual lesion in the Chow Chow dog, such as acinar-like configuration or loose clusters of cells with round to oval nuclei within stippled chromatin, moderate anisocytosis and anisokaryosis, and some naked nuclei ( 19 – 21 ), provided the pre-surgical suspicion of a neuroendocrine origin tumor. Similar cytological findings were also reported in a cat with renal paraganglioma ( 12 ).…”

Cuando la piel avisa

“…Las MC en general no afectan epidermis y pueden tener un patrón histológico similar al primario que les dio origen 3,7,13 . La IHQ es un complemento de gran importancia en estos tumores puesto que es positiva para cromogranina, sinaptofisina y enolasa neuronal específica 3,4,7,10,13,14 . Recientemente se describió la metoxitramina plasmática 3 como biomarcador de paragangliomas metastásicos, pero no contamos con tal en nuestro medio y tampoco fue realizada en los casos publicados con anterioridad.…”

“…En nuestro caso se propuso sarcoidosis, amiloidosis sobre cicatriz quirúrgica, sarcoma y la tuberculosis cutánea. Sin embargo, también se puede considerar otros mencionados en la literatura como quiste epidérmico, tumores anexiales, carcinoma de Merkel, carcinoma basocelular, y melanoma 5,14 , los cuales deben contextualizarse según cada paciente. El tratamiento para los paragangliomas cutáneos primarios y metastásicos es la resección quirúrgica, pudiendo ser curativa según cada caso.…”