title: Cytologic features of pheochromocytoma and retroperitoneal paraganglioma: a morphologic and immunohistochemical study of 13 cases.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Hospital Universitario Guadalajara, Spain. jjheffernan@yahoo.com
authors.forename: José A
authors.initials: JA
authors.lastname: Jiménez-Heffernan
authors.forename: Blanca
authors.initials: B
authors.lastname: Vicandi
authors.forename: Pilar
authors.initials: P
authors.lastname: López-Ferrer
authors.forename: Pilar
authors.initials: P
authors.lastname: González-Peramato
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez-Campos
authors.forename: José M
authors.initials: JM
authors.lastname: Viguer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D003593:Cytoplasm / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000473:pathology*; D012186:Retroperitoneal Neoplasms / Q000473:pathology*; D016708:Synaptophysin / Q000378:metabolism
chemical_list: D016708:Synaptophysin