Pitfalls in Cytological Diagnosis of Extra Adrenal Paraganglioma and Pheochromocytoma: Experience From a Tertiary Care Center.
FNAC
adrenal
extra‐adrenal
paraganglioma
pheochromocytoma
Journal
Diagnostic cytopathology
ISSN: 1097-0339
Titre abrégé: Diagn Cytopathol
Pays: United States
ID NLM: 8506895
Informations de publication
Date de publication:
17 Aug 2024
17 Aug 2024
Historique:
revised:
03
07
2024
received:
28
04
2024
accepted:
24
07
2024
medline:
17
8
2024
pubmed:
17
8
2024
entrez:
17
8
2024
Statut:
aheadofprint
Résumé
Pheochromocytoma and extra-adrenal paragangliomas increasingly coming into light nowadays because of improved imaging techniques and biochemical investigations. There is sparse literature available regarding cytological findings of adrenal and extra-adrenal paragangliomas. We studied 16 cytological specimens retrospectively over a period of 3 years, where subsequent histological diagnosis of phaeochromocytoma or paraganglioma was available. A total of 16 cytology specimens were studied. Nine patients had adrenal SOLs and seven patients had extra-adrenal lesions. Age range was 12 to 60 years Majority of the cytology smears were cellular (87.5%). The smears were composed of small clusters as well as dispersed plasmacytoid cells with eccentric nuclei containing salt and pepper chromatin and moderate to abundant granular cytoplasm. Large cellular clusters mimicking the Zellballen pattern was present in one case. Anisonucleosis was mild to moderate, except in three cases where marked anisonucleosis posed diagnostic challenges. The background was hemorrhagic in all cases, however, two cases in addition had necroinflammatory background. All cases lacked mitotic activity and cytoplasm was delicate with indistinct cell borders. Bare oval nuclei were a frequent finding. Nuclear grooves or cytoplasmic vacuoles were absent. In 12 out of 16 cases, the initial cytological diagnosis correlated with final histological diagnosis, with an overall diagnostic accuracy of 75%. Four misdiagnosed cases had some atypical cytological features like marked anisonucleosis, necroinflammatory background, and presence of prominent nucleoli. Here we have highlighted some of the distinguishing cytological features that can help in cytological diagnosis of paragangliomas. Hemorrhagic background with plasmacytoid morphology, granular cytoplasm, naked nuclei, and absence of mitosis are useful clues.
Sections du résumé
BACKGROUND
BACKGROUND
Pheochromocytoma and extra-adrenal paragangliomas increasingly coming into light nowadays because of improved imaging techniques and biochemical investigations. There is sparse literature available regarding cytological findings of adrenal and extra-adrenal paragangliomas.
MATERIAL AND METHODS
METHODS
We studied 16 cytological specimens retrospectively over a period of 3 years, where subsequent histological diagnosis of phaeochromocytoma or paraganglioma was available.
RESULTS
RESULTS
A total of 16 cytology specimens were studied. Nine patients had adrenal SOLs and seven patients had extra-adrenal lesions. Age range was 12 to 60 years Majority of the cytology smears were cellular (87.5%). The smears were composed of small clusters as well as dispersed plasmacytoid cells with eccentric nuclei containing salt and pepper chromatin and moderate to abundant granular cytoplasm. Large cellular clusters mimicking the Zellballen pattern was present in one case. Anisonucleosis was mild to moderate, except in three cases where marked anisonucleosis posed diagnostic challenges. The background was hemorrhagic in all cases, however, two cases in addition had necroinflammatory background. All cases lacked mitotic activity and cytoplasm was delicate with indistinct cell borders. Bare oval nuclei were a frequent finding. Nuclear grooves or cytoplasmic vacuoles were absent. In 12 out of 16 cases, the initial cytological diagnosis correlated with final histological diagnosis, with an overall diagnostic accuracy of 75%. Four misdiagnosed cases had some atypical cytological features like marked anisonucleosis, necroinflammatory background, and presence of prominent nucleoli.
CONCLUSION
CONCLUSIONS
Here we have highlighted some of the distinguishing cytological features that can help in cytological diagnosis of paragangliomas. Hemorrhagic background with plasmacytoid morphology, granular cytoplasm, naked nuclei, and absence of mitosis are useful clues.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
M. Rangaswamy, S. P. Kumar, M. Asha, and G. Manjunath, “CT‐Guided Fine Needle Aspiration Cytology Diagnosis of Extra‐Adrenal Pheochromocytoma,” Journal of Cytology 27 (2010): 26–28.
Y. Gong, D. V. DeFrias, and R. Nayar, “Pitfalls in Fine Needle Aspiration Cytology of Extraadrenalparaganglioma. A Report of 2 Cases,” Acta Cytologica 47 (2003): 1082–1086.
U. Engzell, S. Franzén, and J. Zajicek, “Aspiration Biopsy of Tumors of the Neck: II. Cytologic Findings in 13 Cases of Carotid Body Tumor,” Acta Cytologica 15 (1971): 25–30.
J. J. Fite and Z. Maleki, “Paraganglioma: Cytomorphologic Features, Radiologic and Clinical Findings in 12 Cases,” Diagnostic Cytopathology 46 (2018): 473–481.
A. Mondal, M. Sengupta, S. Dey, et al., “Clinicopathological Study of Adrenal Pheochromocytoma and Extra‐Adrenal Paragangliomas With Reference to GAPP and PASS Scoring Systems,” Indian Journal of Pathology & Microbiology. Published ahead of print, June 4, 2024. https://doi.org/10.4103/ijpm.ijpm_859_23.
J. K. Mckenney, “Adrenal Gland and Other Paraganglia,” in Rosai and Ackermans Surgical Pathology, 11th ed., eds. J. R. Goldblum, L. W. Lamps, J. K. Mckenney, and J. L. Myers (Philadelphia: Elsevier, 2018), 1190.
D. E. Benn, B. G. Robinson, and R. J. Clifton‐Bligh, “15 Years of Paraganglioma: Clinical Manifestations of Paraganglioma Syndromes Types 1‐5,” Endocrine‐Related Cancer 22 (2015): T91–T103.
R. Puri, R. B. Thandassery, N. S. Choudhary, et al., “Endoscopic Ultrasound‐Guided Fine‐Needle Aspiration of the Adrenal Glands: Analysis of 21 Patients,” Clinical Endoscopy 48 (2015): 165–170.
P. Kaur, A. Soni, R. Tyagi, H. Kaur, and K. S. Selhi, “Spectrum of Adrenal Lesions on Fine‐Needle Aspiration Cytology: A Tertiary Care Centre Experience,” Journal of Laboratory Physicians 14 (2022): 231–236.
J. A. Jiménez‐Heffernan, B. Vicandi, P. López‐Ferrer, P. González‐Peramato, A. Pérez‐Campos, and J. M. Viguer, “Cytologic Features of Pheochromocytoma and Retroperitoneal Paraganglioma: A Morphologic and Immunohistochemical Study of 13 Cases,” Acta Cytologica 50 (2006): 372–378.
S. R. Orell and G. F. Sterett, “Walters MN‐I, Whitaker D: Kidney, Adrenal and Retroperitoneum Proper,” in Fine Needle Aspiration Cytology, Fourth ed. (Oxford: Elsevier Churchill Livingstone, 2005), 337–360.
J. F. Silverman and R. Katz, “FNA of the Adrenal Gland,” in Cytopathology Annual, ed. W. A. Schmidt (Baltimore: Williams &Wilkins, 1994), 149–173.
K. R. Geisinger, M. W. Stanley, S. S. Raab, J. F. Silverman, and A. Abati, Modern Cytopathology (Philadelphia: Churchill Livingstone, 2004), 619–642.
I. A. Buley, “Other Endocrine Organs,” in Diagnostic Cytopathology, Second ed., eds. W. Gray and G. T. McKee (Philadelphia: Churchill Livingstone, 2003), 603–613.
J. F. Silverman and K. R. Geisinger, Fine Needle Aspiration Cytology of the Thorax and Abdomen (New York: Churchill Livingstone, 1996), 197–217.
R. M. DeMay, Adrenal Glands. In the Art and Science of Cytopathology: Aspiration Cytology (Chicago: ASCP Press, 1996), 1115–1134.
K. D. Jashnani, R. D. Patil, and D. J. Balsarkar, “Loose Cell Clusters With Vascular Coats: Zellballen Pattern of Paraganglioma on Cytology,” Journal of Cytology 30 (2013): 278–279.
X. Huang, R. Nayar, and H. Zhou, “Primary Adrenal Gland Epithelioid Sarcoma: A Case Report and Literature Review,” Diagnostic Cytopathology 47 (2019): 918–921.
B. Kanjilal, M. Ghosh, A. Mitra, et al., “Cytological Diagnosis of Adrenocortical Carcinoma: A Report of 2 Cases in Children,” Diagnostic Cytopathology 46 (2018): 1064–1067.
S. Sharma, R. Singh, and K. Verma, “Cytomorphology of Adrenocortical Carcinoma and Comparison With Renal Cell Carcinoma,” Acta Cytologica 41 (1997): 385–392.
S. Mukherjee, M. Sengupta, R. N. Das, et al., “Diagnostic Utility of Cytology Smears and Cell Block in Adrenal Lesions,” Diagnostic Cytopathology 48 (2020): 1003–1012.
B. Kanjilal, R. N. Das, U. Chatterjee, M. Sengupta, R. Sarkar, and K. Saha, “Utility of Cell Block Preparation in Diagnosis of Paediatric Abdominal Neoplasms,” Diagnostic Cytopathology 49 (2021): 404–411.