Department of Pathology, IPGME&R, Kolkata, India.
Department of Urology, IPGME&R, Kolkata, India.
Diagn Cytopathol. 2024 Dec;52(12):747-755. doi: 10.1002/dc.25390. Epub 2024 Aug 17.
Pheochromocytoma and extra-adrenal paragangliomas increasingly coming into light nowadays because of improved imaging techniques and biochemical investigations. There is sparse literature available regarding cytological findings of adrenal and extra-adrenal paragangliomas.
We studied 16 cytological specimens retrospectively over a period of 3 years, where subsequent histological diagnosis of phaeochromocytoma or paraganglioma was available.
A total of 16 cytology specimens were studied. Nine patients had adrenal SOLs and seven patients had extra-adrenal lesions. Age range was 12 to 60 years Majority of the cytology smears were cellular (87.5%). The smears were composed of small clusters as well as dispersed plasmacytoid cells with eccentric nuclei containing salt and pepper chromatin and moderate to abundant granular cytoplasm. Large cellular clusters mimicking the Zellballen pattern was present in one case. Anisonucleosis was mild to moderate, except in three cases where marked anisonucleosis posed diagnostic challenges. The background was hemorrhagic in all cases, however, two cases in addition had necroinflammatory background. All cases lacked mitotic activity and cytoplasm was delicate with indistinct cell borders. Bare oval nuclei were a frequent finding. Nuclear grooves or cytoplasmic vacuoles were absent. In 12 out of 16 cases, the initial cytological diagnosis correlated with final histological diagnosis, with an overall diagnostic accuracy of 75%. Four misdiagnosed cases had some atypical cytological features like marked anisonucleosis, necroinflammatory background, and presence of prominent nucleoli.
Here we have highlighted some of the distinguishing cytological features that can help in cytological diagnosis of paragangliomas. Hemorrhagic background with plasmacytoid morphology, granular cytoplasm, naked nuclei, and absence of mitosis are useful clues.
由于影像学技术和生化研究的提高，嗜铬细胞瘤和肾上腺外副神经节瘤越来越受到关注。关于肾上腺和肾上腺外副神经节瘤的细胞学发现，文献报道较少。
我们回顾性研究了 3 年内的 16 例细胞学标本，这些标本随后的组织学诊断为嗜铬细胞瘤或副神经节瘤。
共研究了 16 例细胞学标本。9 例患者有肾上腺 SOL，7 例患者有肾上腺外病变。年龄范围为 12 至 60 岁，大多数细胞学涂片为细胞性（87.5%）。涂片由小簇和分散的浆细胞样细胞组成，具有偏心核，含有椒盐样染色质和中等至丰富的颗粒状细胞质。一个病例中存在类似于 Zellballen 模式的大细胞簇。除 3 例明显的核异型性导致诊断困难外，核异型性为轻度至中度。所有病例的背景均为出血性，但另外 2 例除出血外还有坏死性炎症背景。所有病例均缺乏有丝分裂活性，细胞质细腻，细胞边界不清晰。常可见裸卵圆核。核沟或细胞质空泡不存在。在 16 例中有 12 例的初始细胞学诊断与最终组织学诊断相符，总体诊断准确性为 75%。4 例误诊病例有一些不典型的细胞学特征，如明显的核异型性、坏死性炎症背景和明显的核仁。
在此，我们强调了一些有助于副神经节瘤细胞学诊断的特征性细胞学特征。出血性背景伴浆细胞样形态、颗粒状细胞质、裸核和无有丝分裂是有用的线索。
