PMC7336227_01
Preoperative sagittal T2-weighted MRI showing 15.41 mm by 12.94 mm paraganglioma in the sellar and suprasellar region.
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T2 hyperintense homogeneous enhancing mass causing expansion of the sella turcica and extending into the suprasellar cistern compressing the optic chiasm and the right optic nerve (Figure 1). There was also extension into the medial aspect of the cavernous sinus.
Intraoperative T2-weighted MRI: (a) sagittal and (b) coronal views following resection of paraganglioma with the cross-sectional slice indicated by the vertical lines.
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Intraoperative MRI demonstrated a gross-total resection of the tumor (Figures 2(a) and 2(b)).
Paraganglioma with a distinct nested pattern of the tumor cells ("zellballen") in sections stained with hematoxylin-eosin (H&E) (a, c); the nested pattern was highlighted by a silver impregnation for reticulin fibers (b, d). Figures a and b 100x; figures b and c 400x.
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The tumor cells were arranged in relatively well-defined nests ("zellballen") (Figures 3(a) and 3(c)) surrounded by a delicate network of reticulin fibers. These were highlighted in the sections stained with the silver impregnation method (Figures 3(b) and 3(d)).
Strong immunoreactivity in principal cells for synaptophysin (a), chromogranin (c), CD56 (d), and neuron-specific enolase (e). Sustentacular cells with strong immunoreactivity for S-100 protein (b). Focally, the tumor cells were also positive for AE1/AE3 (cytokeratin) (f); figures a-f, 200x.
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By immunohistochemistry, the tumor cells were positive for synaptophysin (Figure 4(a)), chromogranin (Figure 4(c)), NCAM (neural cell adhesion molecule, CD56) (Figure 4(d)), and neuron-specific enolase (Figure 4(e)). The sustentacular cells were strongly immunoreactive for S100 protein (Figure 4(b)). Focally, the tumor cells were also positive of cytokeratin (AE1/AE3) (Figure 4(f)).