Multiple paragangliomas diagnosed in head, neck, and mediastinum: a case report

Fig. 1. CT angiography of the aorta showing a mass in the aortopulmonary prevascular space

Fig. 2. Histopathological examination of the mass (x40, x100, x400)

Fig. 3. Biopsy specimen: Histological sections stained with hematoxylin and eosin (H&E); A-B (At magnification x40 and x400 respectively); The biopsy sections consist of fragments of tumor tissue composed predominantly of semi-nested and loosely cohesive clusters of polygonal epithelioid chief cells. These cells exhibit moderate amounts of granular eosinophilic to amphophilic cytoplasm and round to oval nuclei with finely granular chromatin and some inconspicuous nucleoli and a delicate fibrovascular stroma. No significant mitotic activity, necrosis, or hemorrhage is observed

Fig. 4. Immunohistochemistry (IHC) staining (At magnification x400); A: Synaptophysin, Positive, B: Chromogranin, Positive, C: GATA3, Positive, D: S100, Positive, E: Cytokeratin, Negative, F: Inhibin, Negative, G: Calretinin, Negative. IHC results are consistent with paraganglioma

Fig. 5. Resection specimen: Histological sections stained with hematoxylin and eosin (H&E); A-C (At magnification x40, x100 and x400 respectively); sections show the tumor is composed of well-defined nests (Zellballen pattern) of polygonal to round epithelioid chief cells with abundant granular eosinophilic cytoplasm. These nests are separated by a prominent, delicate fibrovascular stroma rich in thin-walled capillaries. The chief cells typically exhibit round to oval nuclei with finely granular (“salt and pepper”) chromatin and inconspicuous nucleoli. Occasional nuclear pleomorphism and rare mitotic figures is also seen