The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) can be used to separate benign from malignant tumors. The author is from the Armed Forces Institute of Pathology (AFIP) in Washington, DC.
Parameters:
(1) large nests or diffuse growth
(2) necrosis
(3) cellularity
(4) cellular monotony
(5) spindle cells
(6) mitotic rate
(7) atypical mitoses
(8) extension into adjacent tissue
(9) vascular invasion
(10) capsular invasion
(11) nuclear pleomorphism
(12) nuclear hyperchromasia
|
Parameter |
Finding |
Points |
|---|---|---|
|
large nests or diffuse growth |
> 10% of tumor volume |
2 |
|
|
<= 10% of tumor volume |
0 |
|
tumor necrosis (not degenerative change) |
central (middle of large nest), or confluent |
2 |
|
|
absent |
0 |
|
cellularity |
high |
2 |
|
|
low to moderate |
0 |
|
cellular monotony |
present |
2 |
|
|
absent |
0 |
|
tumor cell spindling |
present (any, even if focal) |
2 |
|
|
absent |
0 |
|
mitotic rate |
> 3 in 10 high power fields (hpf) |
2 |
|
|
0 – 3 in 10 hpf |
0 |
|
atypical mitotic figures |
present |
2 |
|
|
absent |
0 |
|
extension into adipose tissue |
present |
2 |
|
|
absent |
0 |
|
vascular invasion |
present |
1 |
|
|
absent |
0 |
|
capsular invasion |
present |
1 |
|
|
absent |
0 |
|
nuclear pleomorphism |
profound |
1 |
|
|
none to moderate |
0 |
|
nuclear hyperchromasia |
present |
1 |
|
|
absent |
0 |
PASS =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
|
Score |
Behavior |
|---|---|
|
0 – 3 |
benign |
|
4 – 20 |
malignant |
Performance:
• Some of the terms (like nuclear hyperchromasia) should show interobserver variability. The original article has good color photographs illustrating the specific findings.
• The score needs to be validated in a larger series.
Purpose: To evaluate an adrenal pheochromocytoma using the Pheochromocytoma of the Adrenal Gland Scaled Score (PASS).
Specialty: Hematology Oncology, Surgery, general, Endocrinology
Objective: clinical diagnosis, including family history for genetics
ICD-10: C74,
