Aspiration cytology and immunohistochemistry of a pheochromocytoma-ganglioneuroma of the adrenal gland.

The results of fine needle aspiration (FNA) cytology, immunohistochemical staining and electron microscopy of combined pheochromocytoma-ganglioneuroma are presented. The cytologic findings included clusters of neoplastic cells with features of a neuroendocrine tumor and aggregates of spindle-shaped cells with interspersed ganglionlike cells. Aspirated material was tested for a panel of hormones by the peroxidase-antiperoxidase method. The neoplastic cells showed positive staining for neuron-specific enolase (NSE) and vasoactive intestinal polypeptide (VIP). Electron microscopy demonstrated granules similar to those of a pancreatic VIPoma in the nerve processes of the ganglioneuroma component. This appears to be the first description of the FNA cytology of a combined pheochromocytoma-ganglioneuroma. The value of immunohistochemical staining in the study of FNA material for making a specific diagnosis and the clinical implications of a preoperative diagnosis in the management of this lesion are discussed.