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Pathology for Urologists

Pheochromocytoma (Adrenal Paraganglioma)


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Image B
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  • Occurs 70% in adrenal gland and 30% are extra-adrenal in location.
  • 10% are familial and usually bilateral and multifocal.
  • Occurs mostly in adults; rare in children.
  • Clinical: Classically associated with paroxysmal sweating attacks, headaches, and tachycardia; hypertension may be intermittent or sustained; these tumors may secrete epinephrine and/ or norepinephrine, ACTH, or parathormone; urinary vanillylmandelic acid (VMA) is elevated in up to 90% of cases.
  • Gross: encapsulated yellow-white to red-brown, soft, fleshy tumor (image A).

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Image D
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  • Histology:
    • Well-defined nests (zellballen) of polygonal cells surrounded by a delicate fibrovascular stroma
      (image B) & (image C).
    • Cells have considerable variation in size and shape, and often demonstrate faintly basophilic (blue) finely granular cytoplasm.
    • Pleomorphism, hyperchromasia, and mitotic figures may be present and do not necessarily indicate malignancy (image D).
    • Eosinophilic globules (PAS positive) can be seen.
    • The only definitive evidence of malignancy is metastatic disease.
  • Immunohistochemistry: synaptophysin+, chromogranin+ and S100+ (+ only in sustentacular cells intermingled with malignant chromaffin cells).

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