Fig. 4

Microscopic pictures representative of the patient’s tumor. a: Hematoxylin and eosin stain (H&E) 20X of the frontal lobe tumor showing organoid nests of tumor cells separated by vascular septa. The tumor cells are cuboidal and have granular eosinophilic cytoplasm. b: Higher power view (H&E, 40X) illustrating the tumor nests surrounded by sustentacular cells; hyperchromasia and nuclear pleomorphism are evident. One atypical mitosis is seen at the center of the picture. c: Immunostain for S-100 protein showing positive brown staining that highlights the sustentacular cells (40X). d: Imunostain for synaptophysin showing brown cytoplasmic staining in the tumor cells (40X). e: Metastatic paranglioma seen from this lung lesion. Normal pulmonary alveoli are seen at the right side of the picture, and paraganglioma, similar to the primary frontal lobe mass, is seen on the right side of the picture (H&E; 40X)