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MRI through the base of skull demonstrates an irregular mass located at the jugular foramen. It is of intermediate signal intensity on T1 and T2 weighted images with punctate regions of signal void (best seen on T2). Following administration of contrast there is vivid contrast enhancement.
The mass contact the internal carotid artery anteriorly almost encasing it, and posteriorly appears to have eroded into the posterior fossa.
Sections of the submitted cervical lymph nodes show nodal tissue adjacent to fat. The nodes show prominent sinus histiocytosis. No focal deposits of metastatic tumour are seen.
Sections of the tumor itself show a nested pattern of cells having an organoid appearance with nuclear pleomorphism and hyperchromatic nuclei. There are large blood vessels associated with the tumor some of which contain embolic material. Trichrome analastic stains show that some of these vessels are very thin walled and do not possess internal elastic lamina. others are clearly arterial in nature as they possess internal elastic lamina.
Reticulin staining of the tumor shows outlining of the nests of cells. Occasional cells are positive for chromogranin and many cells are positive for synaptophysin. The s-100 stain highlights the sustentacular cells surrounding the tumor nests.
Final diagnosis: Paraganglioma
Features are consistent with histologically proven (recurrent) glomus jugulare.