The patient is an 80 year old female with neck mass.

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Chemodectoma/Carotid Body Tumor/Cervical Paraganglioma/ ExtraAdrenal Pheochromocytoma. With focal nuclear pleomorphism & Vascular invasion.Advised IHC for chief cells in zell ballen pattern with Chromogranin,Synaptophysin and S100 for sustentacular cells,spindle cells surrounding the chief cell islands.

Malignant tumour as vascular and capsular invasion noted. Cell morphology and arrangements also location wise the possibility may be 1. Carotid body paraganglioma 2.a alveolar soft part sarcoma 3. Metastatic carcinoma 4. Carcinoid tumour

Zell-Ballen Pattern Nuclear stippling Vascular and capsular invasion Malignant Neurendocrine tumour - Paraganglioma

Neuroendocrine Tumor most likely Paraganglioma

Carotid Body Tumor ( Paraganglioma) with vascular invasion. Behaviour still unpredictable.

Carotid body tumor- paraganglioma with vascular invasion

Paraganglioma with vascular thrombus

Malignant paraganglioma
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paraganglioma

paraganglioma

Nuroendocrine carcinoma. Adv synaptophysin& s

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