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      CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma

      case-report

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          Abstract

          Pheochromocytoma is a rare tumor, accounting for <0.1% of the hypertensive population. Extra-adrenal pheochromocytomas (EAPs) are rarer still, accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT) as soft tissue masses closely associated with the entire length of the abdominal aorta. Here, we present a rare case of EAP in a 45-year-old male hypertensive patient diagnosed by CT-guided fine needle aspiration cytology. The smears showed loosely cohesive tumor cells with prominent anisokaryosis and abundant eosinophilic, granular cytoplasm. The diagnosis was later confirmed by histopathology. The present case also highlights the fact that fine needle aspiration of pheochromocytoma is not necessarily contraindicated.

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          Pitfalls in fine needle aspiration cytology of extraadrenal paraganglioma. A report of 2 cases.

          Fine needle aspiration (FNA) is commonly used as an initial diagnostic tool in the evaluation of mass lesions. However, extraadrenal paragangliomas (EAPs) are not commonly seen on FNA and, when encountered, can pose a diagnostic challenge since they have a wide variety of morphologic patterns. Two intraabdominal EAPs were misdiagnosed as an anaplastic adenocarcinoma of the pancreas with giant cell features and papillary adenocarcinoma of the pancreas. The sources of the pitfalls were inaccurate radiologic localization, misinterpretation of vascular-rich tissue fragments as papillary structures, presence of acinarmicroglandular structures, marked cellular pleomorphism (including multinucleation), prominent nucleoli and some cells with "squamoid" cytoplasm. The cytologic features of EAP, although suggestive, are not specific. A high index of suspicion and knowledge of clinical information, exact anatomic location and cytologic morphology combined with appropriate ancillary studies are the key to an accurate diagnosis.
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            Cytologic features of pheochromocytoma and retroperitoneal paraganglioma: a morphologic and immunohistochemical study of 13 cases.

            To review the cytologic features and potential pitfalls of pheochromocytoma and retroperitoneal paraganglioma and to evaluate complications of the aspiration procedure and the diagnostic utility of immunocytochemistry. We reviewed 15 cytologic specimens from 12 patients with 13 tumors (1 bilateral case). Ten were adrenal (pheochromocytomas) and 3 extraadrenal paragangliomas. Eleven specimens were from fine needle aspiration (FNA) procedures that were performed in collaboration with radiologists using 23-25-gauge needles. In 3 patients the cytologic material was obtained during intraoperative diagnosis. Immunocytochemistry was performed on alcohol-fixed smears. Two aspirates were hypocellular, while the remainder were cellular. Cells were distributed singly or formed discohesive groups. When present, cytoplasm was abundant and ill defined. Most cells had an eccentric nucleus and plasmacytoid morphology. Nuclear pleomorphism, binucleation and multinucletaion, naked nuclei and intranuclear preudoinclusions were common findings. In 2 cases a lipid background was seen focally. Evident cytoplasmic immunoexpression of synaptophysin or chromogranin was detected in the 10 cases analyzed. One patient developed a hypertensive episode during the FNA procedure. It was controlled medically without complications. When adequate cytologic material is present, the recognition of pheochromocytoma and extraadrenal paraganglioma is possible. Together with morphology, immunocytochemical studies allow a specific preoperative diagnosis. Scarce material can be a source of diagnostic errors. FNA of pheochromocytomas is not necessarily contraindicated. When analytic data are not diagnostic, FNA may follow. Aspiration must be performed in an area equipped with the therapeutic tools necessary to control a pheochromocytoma crisis.
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              Extra-adrenal pheochromocytoma - A case report

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                Author and article information

                Journal
                J Cytol
                JCytol
                Journal of Cytology / Indian Academy of Cytologists
                Medknow Publications (India )
                0970-9371
                0974-5165
                January 2010
                : 27
                : 1
                : 26-28
                Affiliations
                Department of Pathology, JSS Medical College, JSS University, Mysore, India
                Author notes
                Address for correspondence: Dr. Rangaswamy M, Door No. 202, JSS Hospital Quarters, Fort Mohalla, Near Srikanteshwara Choultry, Mysore - 570 004, India. E-mail: rangaswamymaggad@ 123456gmail.com
                Article
                JCytol-27-26
                10.4103/0970-9371.66689
                2964848
                21042531
                7ad1f127-a9e7-44ed-a5fb-df0cef53bfa6
                © Journal of Cytology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Pathology
                pheochromocytoma,paraganglia,ct-guided fnac,retroperitoneal
                Pathology
                pheochromocytoma, paraganglia, ct-guided fnac, retroperitoneal

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