Novel crystalloid structures in suprasellar paraganglioma

Area of Science:

• Neuro-oncology
• Endocrinology
• Pathology

Background:

• Suprasellar masses can present with diverse neurological and visual symptoms.
• Paragangliomas are rare neuroendocrine tumors typically found along the autonomic nervous system.
• Distinguishing between various suprasellar tumors is crucial for appropriate management.

Observation:

• A 52-year-old woman presented with a two-year history of abnormal behavior and declining visual acuity.
• MRI revealed a sizable suprasellar mass.
• Histopathological examination of the partially removed tumor showed an admixture of small cells and process-bearing cells with neuroendocrine markers.

Findings:

• The tumor was diagnosed as a paraganglioma with abortive architecture, positive for chromogranin A, synaptophysin, class III beta-tubulin, and neurofilament.
• Immunohistochemistry was negative for glial and pituitary markers.
• Ultrastructural analysis revealed dense-core vesicles and frequently observed crystalloids, a rare finding in intracranial paragangliomas.

Implications:

• This case highlights the importance of considering paraganglioma in the differential diagnosis of suprasellar tumors.
• The presence of crystalloids, though rare, adds to the histopathological spectrum of paragangliomas.
• Further research into the ultrastructural variations of paragangliomas may improve diagnostic accuracy.