[Pathology] Atlas of Mediastinal Paraganglioma

These are pictures of Mediastinal Paraganglioma. This is a part in the Atlas of Anatomic Pathology book

Mediastinal Paraganglioma  

Fig. 3.101 Paragangliomas may arise from displaced paraganglia in the 

mediastinum. The tumors are distinguished grossly from neuroendocrine 

carcinomas by their good circumscription and encapsulation

Fig. 3.102 Cut section of a paraganglioma shows a well- circumscribed

and encapsulated tumor with a homogeneous tan color and soft cut 

surface with foci of stromal hemorrhage  

Fig. 3.103 The histologic hallmark of mediastinal paraganglioma is a
nested (“tzellballen”) pattern of growth. Unlike neuroendocrine carcinomas 

of the thymus, paragangliomas do not show trabecular, diffuse,
microacinar, or ribbon-like patterns of growth  

Fig. 3.104 One of the distinguishing features of paraganglioma is the
presence of endocrine atypia, characterized by scattered large, atypical
cells with nucleomegaly in the absence of mitotic activity  

Fig. 3.105 The cells in mediastinal paragangliomas are most often
characterized by abundant eosinophilic cytoplasm, but in some
instances, they can be composed predominantly of cells with abundant
clear cytoplasm  

Fig. 3.106 Rare cases of mediastinal paraganglioma can also show
prominent spindling of the tumor cells, which is most often a focal phenomenon. 

The diagnosis can be made by identifying the more conventional components of the lesion  

Fig. 3.107 Mediastinal paragangliomas sometimes can undergo
regressive changes of the stroma, including stromal sclerosis and angiectatic vessels. 

These changes can sometimes be so extensive that they
obscure the lesion, and ample sampling to identify the more conventional

 tumor component is required for the correct diagnosis  

Fig. 3.108 An unusual variant of mediastinal paraganglioma is characterized 

by extensive stromal sclerosis that sometimes can obscure the
underlying tumor  

Fig. 3.109 Most mediastinal paragangliomas are characterized by
strong expression of neuroendocrine markers. This image shows cytoplasmic 

positivity for chromogranin in a mediastinal paraganglioma.
Unlike primary neuroendocrine carcinomas of the thymus, however,
these tumors are negative for cytokeratin  

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