title: Cytologic features of malignant cystic pheochromocytoma: a case report.
abstract: BACKGROUND
  Image-guided fine needle aspiration (FNA) biopsy of deep-seated lesions (e.g., retroperitoneal) has aided preoperative diagnosis and treatment planning. Fine needle aspiration biopsy of pheochromocytomas traditionally has been contraindicated by many authors because of possible hypertensive crisis and fatal hemorrhage. Cytologic features are described for a malignant pheochromocytoma (greater percentage of smaller cells and absence of hyaline globules) with extensive cystic degeneration that was later confirmed by histopathologic, immunohistochemical and ultrastructural studies.
  
  
  METHODS
  An elderly man was diagnosed with renal cell carcinoma based on clinical examination and ultrasonography. FNA performed on the mass revealed interesting features of pheochromocytoma with an abundance of small cells.
  
  
  CONCLUSIONS
  The cytopathologist should be aware of the cytologic features of pheochromocytoma so as to detect a clinically unsuspected lesion. An increased percentage of smaller cells may be indicative of aggressive tumors.
authors.affiliation: Department of Pathology, Kempegowda Institute of Medical Sciences, Bangalore, India. srniveditha@hotmail.com
authors.forename: Shankaran Rukmini
authors.initials: SR
authors.lastname: Niveditha
authors.forename: Belur Venugopal
authors.initials: BV
authors.lastname: Suguna
authors.lastname: Krishnamurthy
authors.lastname: Rajnikanth
authors.forename: Kudupadi Ganesh Sudharshan
authors.initials: KG
authors.lastname: Babu
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Shukla
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D000313:Adrenal Medulla / Q000473:pathology*; D044963:Biopsy, Fine-Needle; D002292:Carcinoma, Renal Cell / Q000175:diagnosis*; D003560:Cysts / Q000473:pathology*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010235:Paraganglioma / Q000175:diagnosis*; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests