Table 1.
Pheochromocytoma of the Adrenal Gland Scaled Score (PASS)(10) and Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP) (12) Scoring Criteria
| Characteristic | Score |
|---|---|
| PASS | |
| Large nests or diffuse growth | 2 |
| Central or confluent tumor necrosis | 2 |
| High cellularity | 2 |
| Cellular monotony | 2 |
| Tumor cell spindling | 2 |
| Mitotic figures >3/10 HPF | 2 |
| Atypical mitotic figure(s) | 2 |
| Extension into adipose tissue | 2 |
| Vascular invasion | 1 |
| Capsular invasion | 1 |
| Profound nuclear pleomorphism | 1 |
| Nuclear hyperchromasia | 1 |
| Total | 20 |
| GAPP | |
| Pattern | |
| Zellballen | 0 |
| Large and irregular-sized nest | 1 |
| Pseudorosette forming | 1 |
| Cellularity | |
| Low (<150/62.5 mm2) | 0 |
| Moderate (150-250/62.5 mm2) | 1 |
| High (>250/62.5 mm2) | 2 |
| Coagulation necrosis | |
| Presence | 2 |
| Absence | 0 |
| Vascular/capsular invasion | |
| Presence | 2 |
| Absence | 0 |
| Ki-67 immunoreactivity | |
| >3% or 50 cells/MPF | 2 |
| >1% or 20 cells/MPF | 1 |
| Few cells | 0 |
| Types of catecholamine | |
| Norepinephrine | 1 |
| Epinephrine | 0 |
| Nonfunctioning | 0 |
| Total | 10 |
Abbreviations: HPF, High-powered field; MPF, medium-powered field (magnification at 20× with objective lens and 10× ocular lens).