Adrenal gland & paraganglia
General
Features to report-pheochromocytoma / paraganglioma
Author: Debra L. Zynger, M.D.
Editorial Board Member: Bonnie Choy, M.D.
Deputy Editor-in-Chief: Maria Tretiakova, M.D., Ph.D.
Last author update: 25 May 2023
Last staff update: 25 May 2023
Copyright: 2002-2025, PathologyOutlines.com, Inc.
PubMed Search: Pheochromocytoma paraganglioma features to report
Table of Contents
Definition / general | Required features to report | Pheochromocytoma of the adrenal gland scaled score (PASS) | Gross images | Microscopic (histologic) images | Board review style question #1 | Board review style answer #1Cite this page: Zynger DL. Features to report-pheochromocytoma / paraganglioma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalparagangliomareport.html. Accessed January 3rd, 2025.
Definition / general
- Features to report by organization
- There is currently no College of American Pathologists cancer protocol
- International Collaboration on Cancer Reporting
- The Royal College of Pathologists of Australasia
- The Royal College of Pathologists (United Kingdom)
Required features to report
- The following items are recommended to be included in the pathology report (there is currently no College of American Pathologists cancer protocol)
- Size (greatest dimension)
- Composite features (ganglioneuroma, ganglioneuroblastoma, neuroblastoma or peripheral nerve sheath tumors)
- Lymphovascular invasion
- Tumor extent (into capsule, extra-adrenal tissue or adjacent organs)
- Margins
- Regional lymph node status
- Distant metastasis (if applicable)
- pTNM stage
- The following items are necessary to establish the 8th edition AJCC pTNM stage (note that parasympathetic paragangliomas are not staged)
- Size (< 5 cm or ≥ 5 cm)
- Invasion into surrounding tissue (ex: extra-adrenal adipose, liver, pancreas, spleen, kidney)
- Regional lymph node status
- Distant metastasis (if applicable)
- The following items are 8th edition AJCC registry data collection variables
- Primary tumor size
- Primary tumor location
- Regional lymph node metastases
- Location of distant metastases
- Hormone function
- Chromogranin A
- Mitotic count
- Germline mutation status
- Plasma methoxytyramine
- Reference: Amin: AJCC Cancer Staging Manual, 8th Edition, 2017
Pheochromocytoma of the adrenal gland scaled score (PASS)
- The PASS score can be evaluated to determine malignant potential with a score of ≥ 4 concerning for malignancy (it is not required to report each criteria but may be helpful to assess and report if concern for malignancy is identified) (Am J Surg Pathol 2002;26:551)
- Periadrenal adipose invasion (+2)
- > 3 mitosis per 10 high powered fields (+2)
- Atypical mitoses (+2)
- Necrosis (+2)
- Cellular spindling (+2)
- Cellular monotony (+2)
- Large nests or diffuse growth (+2)
- High cellularity (+2)
- Marked nuclear pleomorphism (+1)
- Capsular invasion (+1)
- Vascular invasion (+1)
- Hyperchromasia (+1)
Gross images
Contributed by Debra L. Zynger, M.D.
pT1
pheochromocytoma
pT2
pheochromocytoma
pT3 pheochromocytoma
pT2 sympathetic
paraganglioma
Microscopic (histologic) images
Contributed by Debra L. Zynger, M.D.
Capsular invasion
Vascular, capsular and adipose invasion
Cellular spindling
Nuclear pleomorphism
Mitosis
pT2 sympathetic
paraganglioma
pT3 pheochromocytoma
with extra-adrenal
adipose invasion
pT3 pheochromocytoma
with invasion
of the kidney
Board review style question #1
For a pheochromocytoma, which of the following tumor characteristics is needed in order to establish the pT category of the tumor?
- Cellularity
- Mitotic rate
- Presence of necrosis
- Size
- Weight
Board review style answer #1
D. Size. Tumor parameters that determine the pT category for pheochromocytoma are tumor size (< 5 cm versus ≥ 5 cm) and tumor extent (organ confined versus extra-adrenal invasion). Other parameters can be associated with risk of aggressive behavior but are not used to determine the pT category.
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Reference: Features to report-pheochromocytoma / paraganglioma
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Reference: Features to report-pheochromocytoma / paraganglioma
