Aspiration biopsy of osseous metastasis of retroperitoneal paraganglioma. Report of a case with cytologic features and differential diagnostic considerations.
BACKGROUND
Paragangliomas are uncommon tumors, only 10% of which are malignant, as evidenced by metastatic disease. It is rare for paraganglioma to present with symptomatic osseous metastases.


METHODS
A retroperitoneal paraganglioma presented in a 52-year-old man as painful metastases in the rib and vertebrae. Fine needle aspiration (FNA) of a lumbar vertebral lesion showed cells arranged singly and in loose clusters with fragile, vacuolated or finely granular cytoplasm, marked anisonucleosis and mitoses. Rare zellballen-type structures and intranuclear inclusions were present. Immunohistochemical studies of a subsequent FNA core biopsy of the retroperitoneal mass showed strong immunoreactivity with chromogranin and negative staining for keratin; that was helpful in differentiating this tumor from others in the differential diagnosis.


CONCLUSIONS
The cytologic diagnosis of paraganglioma is difficult as these tumors exhibit a plethora of features that overlap those of many other neoplasms. The diagnosis can be confirmed with appropriate immunohistochemical studies of corresponding core biopsies.
Absher
K J
KJ
Department of Pathology, Baylor College of Medicine and Methodist Hospital, Houston, Texas, USA.
Witte
D A
DA
Truong
L D
LD
Ramzy
I
I
Mody
D R
DR
Ostrowski
M L
ML
D014408:Biomarkers, Tumor / Q000378:metabolism; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000556:secondary*; D002277:Carcinoma / Q000175:diagnosis; D002864:Chromogranins / Q000378:metabolism; D003937:Diagnosis, Differential; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis; D008875:Middle Aged; D010235:Paraganglioma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000556:secondary*; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D012509:Sarcoma / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; D002864:Chromogranins