Pathological grading for predicting metastasis in phaeochromocytoma and paraganglioma

  1. The Phaeochromocytoma Study Group in Japan†
  1. Pathology Division, Department of Clinical Research, National Hospital Organization, Hakodate Hospital, Postal cord 041-8512, 18-16 Kawahara, Hakodate, Hokkaido, Japan
    1Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
    2Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
    3Third Department of Internal Medicine (Diabetes Endocrine and Metabolism), School of Medicine, Kyorin University, Tokyo, Japan
    4Department of Medicine, Metabolism and Endocrinology, School of Medicine, St Marianna University, Kawasaki, Japan
    5Department of Urology, Miyagi Cancer Center, Natori, Japan
    6Department of Geriatric Medicine and Nephrology, Graduate School of Medicine, Osaka University, Osaka, Japan
    7Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University Itabashi Hospital, Tokyo, Japan
    8Department of Endocrinology and Metabolism, Tokyo Women's Medical University, Tokyo, Japan
    9Department of Endocrinology and Metabolism, School of Medicine, Hirosaki University, Hirosaki, Japan
    10Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, School of Medicine, Tohoku University, Sendai, Japan
    11Council Member Examination Committee of Social Insurance, Ministry of Health, Labour and Welfare, Tokyo, Japan
    12Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
  1. Correspondence should be addressed to N Kimura; Email: kimura-path{at}
  1. Figure 1

    Representative images of histological features. (1) Histological pattern. (1, A) Regular zellballen pattern, (1, B) regular zellballen pattern, (1, C) large irregular zellballen pattern and (1, D) pseudorosette pattern (×100). (2) Cellularity. The grid in the circle on the left corner shows the area used to count cellularity. These images were taken under the same magnification (×400). (3) Comedo-type necrosis. Arrows indicate foci of coagulation necrosis (×200). (4) Ki67 labelling index (×200). Arrow indicates Ki67-positive nuclei of tumour cells.

  2. Figure 2

    Comparison of GAPP scores between non-metastatic (A) and metastatic (B) PHEO/PGL groups. GAPP scores were 2.08±0.17 in the non-metastatic group and 5.33±0.43 in the metastatic group (mean±s.e.m.). There was a significant difference between these two groups (P<0.001).

  3. Figure 3

    Correlation between GAPP scores of metastatic tumours and years to metastasis after initial operation. Tumours with high GAPP scores metastasised sooner than those with low scores (correlation coefficient: r=−0.438, P<0.01).

  4. Figure 4

    Histological grading and survival probability. Correlation between GAPP grading of the tumours and patient survival as shown by Kaplan–Meier survival curves. There are significant differences between groups A and B (P<0.001), groups B and C (P<0.05), and groups A and C (P<0.001) (log rank test). A, well-differentiated (n=111); B, moderately differentiated (n=36); C, poorly differentiated (n=16); and total (n=163).

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