Questions to be answered:
- Is this a paraganglioma?
- Is it malignant?
These specimens are handled exactly like a solitary tumor in the thyroid.
- Weigh, ink and measure.
- Make a cut to allow fixative to enter.
- Consider taking tissue for tissue banking.
- Fix in formalin.
- Photograph the cut surface; these lesions are relatively uncommon.
- Note any necrosis, hemorrhage, or heterogeneous areas.
- Take sections:
- Less than 2 cm: Submit in toto.
- Greater than 2 cm: Submit at least 1 block per cm of lesion, that examine the tumor edge (capsule) and any degenerating areas.
Review and SignoutEdit
While paraganglioma is synonymous with extra-adrenal pheochromocytoma, and the same features apply, the PASS score has not been as strongly validated outside the adrenal medulla. Nevertheless, clinicians may want the attributes of the PASS score in the report of paragangliomas.
Features of malignancy that are important to mention if present (probably in a comment) include extra-adrenal location, coarse nodularity/multinodularity, confluent necrosis, and absence of hyaline globules. 71% of malignant paragangliomas have two or three of these features, while 89% of benign tumors have none or one of them. (Note that this does not mean that two to three of the features imply a 71% chance of malignancy!)
1. Paraganglioma, site, resection:
2. Carotid body tumor, resection:
3. Para-aortic mass, resection:
Paraganglioma, ___ cm, encapsulated/invasive into surrounding tissue, with/without necrosis, (not) present at margin.
Malignant criteria: Lester, Manual of Surgical Pathology, 2nd ed, p. 546.
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