How do I install the Ata Ppgl Histopathological Confirmation skill?

Run npx skillmds@latest add dromlakhani/ata-ppgl-histopathological-confirmation in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Is Ata Ppgl Histopathological Confirmation free to use?

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Who published Ata Ppgl Histopathological Confirmation?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Ppgl Histopathological Confirmation by dromlakhani

Name: Ata Ppgl Histopathological Confirmation
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ata Ppgl Histopathological Confirmation

This skill confirms pheochromocytoma and paraganglioma (PPGL) diagnosis on histopathology by requiring immunostaining positive for Chromogranin A and negative for cytokeratin in tumor tissue, with SDHB negativity indicating SDHx pathogenic variants that predict metastasis or recurrence. It is triggered when a clinician asks 'How do I confirm pheochromocytoma diagnosis on pathology?' or encounters resected adrenal or paraganglioma tissue needing a definitive diagnosis.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Confirm pheochromocytoma and paraganglioma diagnosis on histopathology

STEP 1 — Gather Information

Obtain resected adrenal or paraganglioma tissue; perform hematoxylin and eosin (HE) staining to assess tumor architecture, then run immunohistochemistry for Chromogranin A (CgA), cytokeratin (CAM5.2/AE1/AE3), and SDHB.

STEP 2 — Rule In / Rule Out

If tumor cells show Chromogranin A positivity and cytokeratin negativity, rule in PPGL; if either Chromogranin A is negative or cytokeratin is positive, rule out PPGL and consider adrenal cortical neoplasm or metastatic carcinoma.

STEP 3 — Classify or Stratify

Assess SDHB immunostaining: loss of SDHB staining indicates SDHx pathogenic variants associated with higher metastasis and recurrence risk; retained SDHB staining suggests lower risk.

STEP 4 — Decide

For Chromogranin A+/cytokeratin- cases with SDHB loss, diagnose PPGL with high metastatic potential and recommend SDHx genetic testing and intensified postoperative surveillance; for SDHB-retained cases, diagnose PPGL with standard risk and advise routine follow-up per postoperative protocol.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on HE staining alone; false-negative Chromogranin A or false-positive cytokeratin can occur in poorly differentiated tumors. SDHB negativity predicts increased risk but does not confirm metastasis; avoid overcalling malignancy based solely on SDHB loss. Mimics include adrenal cortical tumors (positive for melan-A, inhibin) and cytokeratin-positive metastases (e.g., renal cell carcinoma). GATA3 positivity may appear in breast cancer metastases; interpret in clinical context.

Concrete Clinical Example

A 48‑year‑old woman with a resected left adrenal mass shows HE‑stained zellballen pattern, Chromogranin A strong positivity, cytokeratin negativity, and complete SDHB loss; diagnosis: PPGL with SDHB‑related pathogenic variant, prompting SDHB genetic testing and scheduled 6‑month imaging surveillance.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI:10.1507/endocrj.EJ25-0165

---name: ata-ppgl-histopathological-confirmationdescription: This skill confirms pheochromocytoma and paraganglioma (PPGL) diagnosis on histopathology by requiring immunostaining positive for Chromogranin A and negative for cytokeratin in tumor tissue, with SDHB negativity indicating SDHx pathogenic variants that predict metastasis or recurrence. It is triggered when a clinician asks 'How do I confirm pheochromocytoma diagnosis on pathology?' or encounters resected adrenal or paraganglioma tissue needing a definitive diagnosis.---# Confirm pheochromocytoma and paraganglioma diagnosis on histopathology## STEP 1 — Gather InformationObtain resected adrenal or paraganglioma tissue; perform hematoxylin and eosin (HE) staining to assess tumor architecture, then run immunohistochemistry for Chromogranin A (CgA), cytokeratin (CAM5.2/AE1/AE3), and SDHB.## STEP 2 — Rule In / Rule OutIf tumor cells show Chromogranin A positivity and cytokeratin negativity, rule in PPGL; if either Chromogranin A is negative or cytokeratin is positive, rule out PPGL and consider adrenal cortical neoplasm or metastatic carcinoma.## STEP 3 — Classify or StratifyAssess SDHB immunostaining: loss of SDHB staining indicates SDHx pathogenic variants associated with higher metastasis and recurrence risk; retained SDHB staining suggests lower risk.## STEP 4 — DecideFor Chromogranin A+/cytokeratin- cases with SDHB loss, diagnose PPGL with high metastatic potential and recommend SDHx genetic testing and intensified postoperative surveillance; for SDHB-retained cases, diagnose PPGL with standard risk and advise routine follow-up per postoperative protocol.## Clinical Guardrails / Mimics / PitfallsDo not rely on HE staining alone; false-negative Chromogranin A or false-positive cytokeratin can occur in poorly differentiated tumors. SDHB negativity predicts increased risk but does not confirm metastasis; avoid overcalling malignancy based solely on SDHB loss. Mimics include adrenal cortical tumors (positive for melan-A, inhibin) and cytokeratin-positive metastases (e.g., renal cell carcinoma). GATA3 positivity may appear in breast cancer metastases; interpret in clinical context.## Concrete Clinical ExampleA 48‑year‑old woman with a resected left adrenal mass shows HE‑stained zellballen pattern, Chromogranin A strong positivity, cytokeratin negativity, and complete SDHB loss; diagnosis: PPGL with SDHB‑related pathogenic variant, prompting SDHB genetic testing and scheduled 6‑month imaging surveillance.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI:10.1507/endocrj.EJ25-0165

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