Adrenal gland and paraganglia
Pheochromocytoma / paraganglioma
Features to report


Topic Completed: 01 January 2018

Revised: 2 January 2019

Copyright: (c) 2002-2019, PathologyOutlines.com, Inc.

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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 January 19th, 2019.
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 tumor < 5 cm

pT2 tumor ≥ 5 cm

Microscopic (histologic) images

Contributed by Debra Zynger, M.D.

PASS criteria


pT3 tumor with extra-adrenal adipose invasion

pT3 tumor with invasion of the kidney