Fine-needle aspiration cytology of malignant retroperitoneal paraganglioma

Abstract

The cytologic findings in a fine‐needle aspiration sample are described from a large retroperitoneal mass in a 56‐yr‐old male. The aspiration was performed under CT guidance using a 22‐gauge needle, maintaining negative pressure. For cytologic study, on‐site smears were prepared and stained by the Papanicolaou method. Additionally, cytospin, filter preparations, cell blocks from the aspirate, histology, and electron microscopy of the tumor tissue were performed. Also, immunodiagnostic staining for neuron‐specific enolase (NSE), chromogranin, S‐100 protein, vimentin, HMB45, cytokeratin, and Grimelius preparation was performed on cytologic and histologic material. The cytologic material was characterized by cords, suggestive acinar structures, and small follicle‐like clusters of cells, while cell blocks from the aspirate showed oval or spindle‐shaped nuclei with a somewhat fasciculated appearance. However, sections from the tumor tissue showed an organoid “zellballen” pattern. The nuclei were round, oval, spindly, and epithelioid, with moderate to scanty cytoplasm, smooth nuclear membranes, fine, evenly dispersed chromatin, slight hyperchromasia, and mild pleomorphism. No intranuclear vacuoles were seen. Positive immunohistochemical staining for NSE, chromogranin, and Grimelius preparation was noted in the tumor cells, while staining for vimentin, HMB45, and cytokeratin was negative. Electron microscopy of the tumor tissue revealed the presence of variable numbers of round, membrane‐bound, electron‐dense neurosecretory granules. The cytohistologic and ultrastructural findings are presented, as well as the results of immunodiagnostic staining which helped in the diagnosis of retroperitoneal paraganglioma, an infrequently reported tumor. Diagn. Cytopathol. 1998;18:287–290. © 1998 Wiley‐Liss, Inc.

A Comparative Review of Melanocytic Neoplasms

“…16), or spindle form (Figs. 11b, 17a-d), 9,79,104,238,255 with agreement reported to be 78% in one study. 41 Although, just as in histologic classification, cytomorphology is highly variable, a few generalizations can be made.…”

Cytomorphologic spectrum in aspirates of extra-adrenal paraganglioma

“…[12] In renal cell carcinoma, the cytoplasm is less fragile with more prominent vacuolization and cell borders are well-defined. Adrenal cortical tumors show a lipid background and are comparatively less pleomorphic with tiny lipid droplets in the cytoplasm.…”

“…Occasionally, hepatocellular carcinoma, neurogenic tumors, sarcomas and melanoma may also enter into the differential diagnosis. [1214] Ancillary techniques are helpful in making a confirmatory diagnosis of EAP. It shows immunoreactivity for chromogranin, synaptophysin, neuron-specific enolase and S-100.…”

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

“…They are mostly slow-growing tumors; nevertheless, there is a risk of metastasis especially regarding extra-adrenal paragangliomas, which is correlated with the molecular profile of mutated genes. 5,6 Herein, we present a rare case of paraganglioma that constituted a diagnostic challenge, in which final diagnosis was highly suggested by FNA cytology preoperatively. 3,4 Consequently, an accurate preoperative diagnosis is of critical significance, so that the proper treatment is timely implemented.…”