Adrenal gland and paraganglia
Pheochromocytoma / paraganglioma
Features to report


Topic Completed: 1 January 2018

Minor changes: 12 May 2020

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PubMed Search: Pheochromocytoma paraganglioma features to report full text[sb]

Debra Zynger, M.D.
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Cite this page: Zynger D. Pheochromocytoma / paraganglioma - features to report. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/adrenalparagangliomareport.html. Accessed May 28th, 2020.
Pheochromocytoma of the adrenal gland scaled score (PASS)
  • The PASS score can be evaluated to determine malignant potential with a score ≥ 4 concerning for malignancy (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)
    • Marked nuclear pleomorphism (+2)
    • Cellular monotony (+2)
    • Large nests or diffuse growth (+2)
    • High cellularity (+2)
    • Capsular invasion (+1)
    • Vascular invasion (+1)
    • Hyperchromasia (+1)
Required features to report
  • The following items are recommended to be reported (there is currently no College of American Pathologists cancer protocol):
    • Size (greatest dimension)
    • Composite features (ganglioneuroma, MPNST, other)
    • 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:
    • Size (< 5 cm or ≥ 5 cm)
    • Tumor extent (into extra-adrenal adipose, liver, pancreas, spleen, kidney)
    • Regional lymph node status
    • Distant metastasis (if applicable)
Gross images

Contributed by Debra Zynger, M.D.

pT1 pheochromocytoma

pT2 pheochromocytoma

pT2 sympathetic
paraganglioma
Microscopic (histologic) images

Contributed by Debra Zynger, M.D.

PASS criteria


pT2 sympathetic
paraganglioma

pT3 pheochromocytoma
with extra-adrenal
adipose invasion

pT3 pheochromocytoma
with invasion
of the kidney
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