Paraganglioma with Radiographic Dye. An Interesting Histopatholological Finding

Extra-adrenal paraganglia make up a dispersed neuroendocrine system having a centripetal and roughly symmetrical distribution with extension from the base of the skull down to the pelvic floor. Paragangliomas have been found in practically every site in which normal paraganglia are known to occur. Our case was a 40-year-old lady with a slow-growing painless mass in the lateral side of the neck that appeared 3 years previously. Computed tomography showed a mass attached to the carotid artery. Before the surgery, arteriography confirmed the presence of a vascular tumor attached to the common carotid artery. The tumor was completely excised. Microscopically, the tumor cells were arranged in an organoid pattern referred to as “zellballen.” These tumor cells had eosinophilic and faintly granular cytoplasm with indistinct borders. In one area of the tumor some ribbon-like amorphous amphophilic material was present that seemed to be precipitation of angiographic dye in the tissue. The sections were immunostained by the sterpavidin-biotin method with the following panel of antibodies: the individual tumor cells were intensely positive for chromogranin, synaptophysin, and NSE with S100 positive sustentacular cells in fibrovascular septa. This case was a carotid body paraganglioma (chemodectoma). The material was neither a crystal nor a light-reflecting particle. Substances such as phosphoglyceride, calcium pyrophosphate dehydrate, or urate are present as crystal in tissue sections. No similar report was found in a review of the English literature.