Author: Nat Pernick, M.D. (see Authors page)

Revised: 3 December 2015, last major update February 2012

Copyright: (c) 2003-2015,, Inc.

PubMed Search: chromogranin[title]
Cite this page: Chromogranin. website. Accessed October 28th, 2016.
Definition / General
  • Granin protein located in secretory vesicles of neurons and endocrine cells (Clin Invest Med 1995;18:47, Endocr Rev 2011;32:755)
  • Immunostain is specific but not sensitive for neuroendocrine cells; more sensitive in well differentiated vs. poorly differentiated tumors
  • Antibody binds acidic glycoproteins in the soluble fraction of neurosecretory granules
  • Serum levels may not be useful for diagnosis (Biomarkers 2012;17:186), but changes in levels may reflect response to therapy or recurrence (Folia Biol (Praha) 2011;57:173)
  • Typically refers to Chromogranin A, or parathyroid secretory protein 1 (gene name CHGA)
  • Chromogranin B is not commonly used, and has a different distribution (Mod Pathol 2000;13:140)
Uses by Pathologists
  • Commonly used neuroendocrine marker (also synaptophysin and CD56) for normal cells and neuroendocrine tumors
  • Helps differentiate pheochromocytoma (almost always positive) from adrenocortical carcinoma (almost always negative, Am J Surg Pathol 2010;34:423)
Micro Images

Images hosted on Pathout server:

Bladder: paraganglioma

Breast: neuroendocrine carcinomas

Kidney: carcinoid tumor

Parathyroid gland: ectopic tissue

Thyroid: medullary carcinoma

Images hosted on other servers:

Adrenal medulla: pheochromocytoma

Ampulla: neuroendocrine carcinoma

Breast: small cell carcinoma

Gallbladder: paraganglioma (figure 2A)

Heart: metastatic pheochromocytoma (right side)

Lung: primary sclerosing neuroendocrine carcinoma

Nasal cavity: gangliocytic paraganglioma

Neuroblastoma metastatic to bone marrow (figure C)

Pancreas: pancreatic endocrine neoplasm

Pancreas: solid papillary neoplasm (may be focally positive)

Prostate: neuroendocrine carcinomas

Prostate: small cell carcinoma

Images hosted on
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Breast: colloid carcinoma (lower left)

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Breast: neuroendocrine carcinomas

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Esophagus: carcinoid tumor

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Pancreas: malignant islet cell tumor with sarcomatous differentiation

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Rectum and chromogranin A: left-normal mucosa; right-carcinoid

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Rectum and chromogranin B: left-normal mucosa; right-carcinoid

Positive Staining - Normal
  • Neuroendocrine and ganglion cells in adrenal medulla (chromaffin cells), heart AV node, pancreas (islets), parathyroid (chief cells), thyroid (C cells), other tissues
  • Also bile ductules-reactive and pancreatic acinar cells (occasional, Am J Surg Pathol 2009;33:66)
Positive Staining - Disease
  • Neuroendocrine and ganglion cell tumors (carcinoid, Merkel cell carcinoma-lung, neuroblastoma, neuroendocrine carcinoma, paraganglioma, small cell carcinoma)
  • Desmoplastic small cell tumor, middle ear adenoma (Mod Pathol 2002;15:543), parathyroid cyst, pituitary adenoma
  • Many fetal-type tumors (hepatoblastoma, lung adenocarcinoma-fetal type)
  • Note: granular cytoplasmic pattern in small cell carcinoma reflects neurosecretory granules
Negative Staining
  • Tumors without neuroendocrine components including adrenocortical tumors, chordoma, Ewing's sarcoma/PNET
  • Alveolar rhabdomyosarcoma (may have rare positive cells, Mod Pathol 2008;21:795), pancreatic solid pseudopapillary neoplasm (occasionally focal staining)