Journal of Cytology
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LETTER TO EDITOR  
Year : 2012  |  Volume : 29  |  Issue : 1  |  Page : 100
Response to "CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma"


Department of Endocrine Surgery, Mamata Medical College and Hospital (MMC/MGH) Khammam, Andhra Pradesh, India

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Date of Web Publication27-Feb-2012
 

How to cite this article:
Bhargav P. Response to "CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma". J Cytol 2012;29:100

How to cite this URL:
Bhargav P. Response to "CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma". J Cytol [serial online] 2012 [cited 2020 Sep 19];29:100. Available from: http://www.jcytol.org/text.asp?2012/29/1/100/93234


Sir,

The authors have done a laudable work in re-addressing the issue of fine needle aspiration cytology (FNAC) role in extra-adrenal paraganglioma (EAP) in their article. [1] I have few comments to put forth in this regard. First, paraganglioma and pheochromocytoma are clinically, biochemically, and pathologically similar, except for unique phenyl-ethanolamine N-methyl transferase (PNMT) expression and epinephrine synthesis in the former. [2] Second, the diagnosis of catecholamine secreting tumors (CST) relies on demonstration of elevated plasma/urinary metanephrines, [3] and not preoperative cytology. FNAC of these tumors are highly non-specific due to significant overlap with other pathologies and degenerative changes such as cystic, hemorrhagic, and necrotic changes. [4]

Third, the statement that "FNAC is not necessarily contraindicated" for the diagnosis of paraganglioma, in my view is fallacious. Evidence suggests that FNAC in a known case of CST is contraindicated and indeed it has to be ruled out before contemplating FNAC. [3] Moreover, FNAC apart from the risk of hemorrhage can lead to hypertensive crises, which can be fatal if not dealt with or anticipated. [5] Fourth, the phenomenon of capsular breach and metastatic spread after FNAC of EAP is possible, in view of high rate of malignancy in EAP. [5] Finally, diagnosis of EAP on FNAC is more incidental and not an intentional event. In view of above facts, FNAC has a limited role of suggesting a neuro-endocrine tumor in an undiagnosed and unsuspected retroperitoneal mass and not recommended in routine practice.

 
   References Top

1.Rangaswamy M, Kumar SP, Asha M, Manjunath G. CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma. J Cytol 2010;27:26-8.  Back to cited text no. 1
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2.Lloyd RV, Sisson JC, Shapiro B, Verhofstad AA. Immunohistochemical localization of epinephrine, norepinephrine, catecholamine synthesizing enzymes and chromogranin in neuroendocrine-cells and tumors. Am J Pathol 1986;125:45-54.  Back to cited text no. 2
    
3.NIH state-of-the-science statement on management of the clinically inapparent adrenal mass ("incidentaloma"). NIH Consens State Sci Statements 2002;19:1-25.  Back to cited text no. 3
    
4.Gong Y, DeFrias DV, Nayar R. Pitfalls in fine needle aspiration cytology of extraadrenal paraganglioma. A report of 2 cases. Acta Cytol 2003;47:1082-6.  Back to cited text no. 4
    
5.Vanderveen KA, Thompson SM, Callstrom MR, Young WF Jr, Grant CS, Farley DR, et al. Biopsy of pheochromocytomas and paragangliomas: potential for disaster. Surgery 2009;146:1158-66.  Back to cited text no. 5
    

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Correspondence Address:
PRK Bhargav
Department of Endocrine Surgery, Mamata Medical College and Hospital (MMC/MGH), Khammam, Andhra Pradesh 507 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.93234

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