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Skull base surgery. 1995 July; 5(3): 149–156.
PMCID: PMC1656495

Studies for Estimating the Biologic Behavior and Prognosis of Paragangliomas in the Head and Neck

Abstract

Despite a large number of histopathologic and immunohistochemical studies, the biologic behavior and prognosis of paragangliomas (glomus tumors) of the head and neck still remain uncertain. In the present study 36 specimens from 32 patients who underwent surgery for a paraganglioma were examined. The examinations included routine histology, quantitative DNA analysis based on image cytometry, immunohistochemical detection of the proliferating cell nuclear antigen (PCNA) along with visualization of nucleolar organizer regions (AgNOR). According to LeCompte, the paragangliomas were histologically divided into three subcategories: 16 patients had a paragangliomatous tumor. 14 patients had an adenomatous tumor, and 6 patients had an angiomatous tumor. Quantitative DNA analysis revealed three categories of tumors with characteristical DNA pattern; DNA type I tumors were pure diploid, DNA type II tumors had stemlines at 2c and 4c and were therefore recognized as diploid-tetraploid. Aneuploid cells were not apparent in these two groups. DNA type III tumors had stemline ploidies exceeding 2c and 4c. Aneuploid cells were present in all of these tumors. The biologic behavior of these lesions therefore must be recognized as suspicious. DNA type III tumors and adenomatous tumors showed the highest values for the PCNA scores, indicating a higher proliferation rate and a more rapid growth pattern in these lesions. Twenty patients could be followed over a period of up to 110 months. Five of these patients developed a recurrent tumor. All of them had DNA type III tumors. The DNA indices showed significantly higher values in the recurrent tumor group. The 2c deviation index (DI) and the entropy value had the highest prognostic significance. No correlation to clinical follow-up was found for the AgNOR score. Based on these results, prognostic indices for paragangliomas were developed: patients with a tumor having a 2c DI exceeding 2.0, entropy value of more than 4.0. 5c exceeding rate more than 8.0, and a PCNA score more than 20.0% can be recognized as being at high-risk for developing recurrent disease.

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Selected References

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  • Lack EE, Cubilla AL, Woodruff JM, Farr HW. Paragangliomas of the head and neck region: a clinical study of 69 patients. Cancer. 1977 Feb;39(2):397–409. [PubMed]
  • Lack EE, Cubilla AL, Woodruff JM. Paragangliomas of the head and neck region. A pathologic study of tumors from 71 patients. Hum Pathol. 1979 Mar;10(2):191–218. [PubMed]
  • Capella C, Riva C, Cornaggia M, Chiaravalli AM, Frigerio B, Solcia E. Histopathology, cytology and cytochemistry of pheochromocytomas and paragangliomas including chemodectomas. Pathol Res Pract. 1988 Apr;183(2):176–187. [PubMed]
  • Kliewer KE, Wen DR, Cancilla PA, Cochran AJ. Paragangliomas: assessment of prognosis by histologic, immunohistochemical, and ultrastructural techniques. Hum Pathol. 1989 Jan;20(1):29–39. [PubMed]
  • Barnes L, Taylor SR. Carotid body paragangliomas. A clinicopathologic and DNA analysis of 13 tumors. Arch Otolaryngol Head Neck Surg. 1990 Apr;116(4):447–453. [PubMed]
  • Linnoila RI, Keiser HR, Steinberg SM, Lack EE. Histopathology of benign versus malignant sympathoadrenal paragangliomas: clinicopathologic study of 120 cases including unusual histologic features. Hum Pathol. 1990 Nov;21(11):1168–1180. [PubMed]
  • Kliewer KE, Cochran AJ. A review of the histology, ultrastructure, immunohistology, and molecular biology of extra-adrenal paragangliomas. Arch Pathol Lab Med. 1989 Nov;113(11):1209–1218. [PubMed]
  • Martinez-Madrigal F, Bosq J, Micheau C, Nivet P, Luboinski B. Paragangliomas of the head and neck. Immunohistochemical analysis of 16 cases in comparison with neuro-endocrine carcinomas. Pathol Res Pract. 1991 Sep;187(7):814–823. [PubMed]
  • LeCOMPTE PM. Tumors of the carotid body. Am J Pathol. 1948 Mar;24(2):305–337. [PubMed]
  • Delgado R, Mikuz G, Hofstädter F. DNA-Feulgen-cytophotometric analysis of single cells isolated from paraffin embedded tissue. Pathol Res Pract. 1984 Sep;179(1):92–94. [PubMed]
  • Hedley DW, Friedlander ML, Taylor IW. Application of DNA flow cytometry to paraffin-embedded archival material for the study of aneuploidy and its clinical significance. Cytometry. 1985 Jul;6(4):327–333. [PubMed]
  • Böcking A, Adler CP, Common HH, Hilgarth M, Granzen B, Auffermann W. Algorithm for a DNA-cytophotometric diagnosis and grading of malignancy. Anal Quant Cytol. 1984 Mar;6(1):1–8. [PubMed]
  • Böcking A, Auffermann W. Algorithm for DNA-cytophotometric diagnosis and grading of malignancy. Anal Quant Cytol Histol. 1986 Dec;8(4):363–363. [PubMed]
  • Stenkvist B, Strande G. Entropy as an algorithm for the statistical description of DNA cytometric data obtained by image analysis microscopy. Anal Cell Pathol. 1990 Apr;2(3):159–165. [PubMed]
  • Bravo R, Frank R, Blundell PA, Macdonald-Bravo H. Cyclin/PCNA is the auxiliary protein of DNA polymerase-delta. Nature. 1987 Apr 2;326(6112):515–517. [PubMed]
  • Waseem NH, Lane DP. Monoclonal antibody analysis of the proliferating cell nuclear antigen (PCNA). Structural conservation and the detection of a nucleolar form. J Cell Sci. 1990 May;96(Pt 1):121–129. [PubMed]
  • Hall PA, Levison DA, Woods AL, Yu CC, Kellock DB, Watkins JA, Barnes DM, Gillett CE, Camplejohn R, Dover R, et al. Proliferating cell nuclear antigen (PCNA) immunolocalization in paraffin sections: an index of cell proliferation with evidence of deregulated expression in some neoplasms. J Pathol. 1990 Dec;162(4):285–294. [PubMed]
  • Yu CC, Woods AL, Levison DA. The assessment of cellular proliferation by immunohistochemistry: a review of currently available methods and their applications. Histochem J. 1992 Mar;24(3):121–131. [PubMed]
  • Hsu SM, Raine L, Fanger H. Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem. 1981 Apr;29(4):577–580. [PubMed]
  • Crocker J, Egan MJ. Correlation between NOR sizes and numbers in non-Hodgkin's lymphomas. J Pathol. 1988 Nov;156(3):233–239. [PubMed]
  • Rüschoff J, Plate K, Bittinger A, Thomas C. Nucleolar organizer regions (NORs). Basic concepts and practical application in tumor pathology. Pathol Res Pract. 1989 Dec;185(6):878–885. [PubMed]
  • Ploton D, Menager M, Jeannesson P, Himber G, Pigeon F, Adnet JJ. Improvement in the staining and in the visualization of the argyrophilic proteins of the nucleolar organizer region at the optical level. Histochem J. 1986 Jan;18(1):5–14. [PubMed]
  • van der Mey AG, Cornelisse CJ, Hermans J, Terpstra JL, Schmidt PH, Fleuren GJ. DNA flow cytometry of hereditary and sporadic paragangliomas (glomus tumours). Br J Cancer. 1991 Feb;63(2):298–302. [PMC free article] [PubMed]
  • Jovanovic R, Hacker GW, Falkmer UG, Falkmer S, Mendel L, Graf AH, Hög A, Kanjuh V, Silfverswärd C, Grimelius L. Paragangliomas: neuroendocrine features and cytometric DNA distribution patterns. A clinico-pathological study of 22 cases. Virchows Arch A Pathol Anat Histopathol. 1991;419(6):455–461. [PubMed]
  • Sauter ER, Hollier LH, Bolton JS, Ochsner JL, Sardi A. Prognostic value of DNA flow cytometry in paragangliomas of the carotid body. J Surg Oncol. 1991 Mar;46(3):151–153. [PubMed]
  • Milewski C, Dienes HP, Collo D. Immunhistologische Befunde bei Paragangliomen im Kopf-Hals-Bereich. Laryngol Rhinol Otol (Stuttg) 1988 Aug;67(8):385–388. [PubMed]
  • Milewski C. Morphologie und Klinik der Paragangliome im Kopf-Hals-Bereich. HNO. 1993 Nov;41(11):526–531. [PubMed]
  • Gee MS, Kliewer KE, Hinton DR. Nucleolar organizer regions in paragangliomas of the head and neck. Arch Otolaryngol Head Neck Surg. 1992 Apr;118(4):380–383. [PubMed]

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