RETROPERITONEAL PARAGANGLIOMAS - ROLE OF IMMUNOHISTOCHEMISTRY IN THE DIAGNOSIS OF MALIGNANCY AND IN ASSESSMENT OF PROGNOSIS

Objective: To present our experience of 10 patients with extra-adrenal retroperitoneal paragangliomas, and assess prognostic tests. Design: Restrospective study of casenotes. Setting: University hospital, Italy . Subjects: 10 Patients who presented with paragangliomas between 1970 and 1991.Main outcome measures: Histological and immunohistochemical results, and outcome. Results: All tumours were completely resected an d there was no operative mortality. Of the 8 patients who had no metas tases at presentation 3 died of recurrence 3, 5, and 10 years later, r espectively; 4 were alive and flee of disease 2-7 years after diagnosi s. The 2 patients with synchronous bone metastases at presentation die d 1 and 4 years later. Immunohistochemical analysis of type I cells (c hromogranin A and neurone-specific enolase) showed little correlation with progression of disease, but there was a correlation between the p resence of type II cells (S100 protein) and good prognosis. Conclusion s: Excision is the treatment of choice for paraganglioma. Immunohistoc hemical techniques may provide useful information about prognosis, in particular about those patients who are at increased risk of recurrenc e. Long term follow up is essential, because successful management of recurrence is dependent on early recognition.