How do I install the Ppgl Copps Score Application skill?

Run npx skillmds@latest add dromlakhani/ppgl-copps-score-application 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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Which AI agents work with Ppgl Copps Score Application?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ppgl Copps Score Application free to use?

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Who published Ppgl Copps Score Application?

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

Ppgl Copps Score Application by dromlakhani

Name: Ppgl Copps Score Application
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Ppgl Copps Score Application

Applies the COPPS score to predict metastasis risk in PPGL by integrating tumor size, necrosis, vascular invasion, and SDHB/S100 immunostaining. Triggered when a PPGL pathology specimen is available for scoring, when calculating metastatic risk index from histology, or when determining need for adjuvant therapy based on tumor biology.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

COPPS Score Application for PPGL Metastasis Risk Prediction

STEP 1 — Gather Information

Collect tumor size (largest dimension in cm), assess necrosis (present/absent), assess vascular invasion (present/absent), perform SDHB immunostaining (positive/negative), perform S100 immunostaining (positive/negative).

STEP 2 — Rule In / Rule Out

If tumor size ≤5 cm, no necrosis, no vascular invasion, SDHB retained, and S100 retained → rule out high metastasis risk (low risk) and proceed to routine follow‑up; otherwise, proceed to score calculation.

STEP 3 — Classify or Stratify

Calculate COPPS score: 1 point each for tumor size > 5 cm, necrosis present, vascular invasion present, SDHB loss, S100 loss. Classify as low risk (score 0‑2) or high risk (score ≥ 3).

STEP 4 — Decide

For high risk (score ≥ 3), discuss adjuvant therapy options, recommend genetic testing, and plan intensified surveillance (imaging every 6‑12 months); for low risk (score 0‑2), recommend standard postoperative follow‑up per guideline.

Clinical Guardrails / Mimics / Pitfalls

Ensure SDHB loss is complete in tumor cells with retained internal control (e.g., stromal cells) to avoid false‑negative interpretation.
Do not apply the score to non‑PPGL neoplasms; verify chromogranin A positivity and cytokeratin negativity first.
Focal necrosis or focal vascular invasion still counts as present; avoid under‑sampling.
S100 loss interpretation requires adequate controls; weak focal staining should be considered retained.
Score does not replace clinical judgment; integrate with biochemical and imaging findings.

Concrete Clinical Example

A 48‑year‑old with an adrenal mass measuring 6 cm shows focal necrosis, focal vascular invasion, SDHB‑negative immunostaining, and S100‑positive immunostaining. COPPS score = 1 (size) + 1 (necrosis) + 1 (vascular invasion) + 1 (SDHB loss) + 0 (S100 retained) = 4 → high risk. Recommend adjuvant therapy discussion, SDHB genetic testing, and surveillance imaging every 6 months.

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

TODO: consider adding scripts/calc.py for the ppgl-copps-score-application calculator

---name: ppgl-copps-score-applicationdescription: Applies the COPPS score to predict metastasis risk in PPGL by integrating tumor size, necrosis, vascular invasion, and SDHB/S100 immunostaining. Triggered when a PPGL pathology specimen is available for scoring, when calculating metastatic risk index from histology, or when determining need for adjuvant therapy based on tumor biology.---# COPPS Score Application for PPGL Metastasis Risk Prediction## STEP 1 — Gather InformationCollect tumor size (largest dimension in cm), assess necrosis (present/absent), assess vascular invasion (present/absent), perform SDHB immunostaining (positive/negative), perform S100 immunostaining (positive/negative).## STEP 2 — Rule In / Rule OutIf tumor size ≤5 cm, no necrosis, no vascular invasion, SDHB retained, and S100 retained → rule out high metastasis risk (low risk) and proceed to routine follow‑up; otherwise, proceed to score calculation.## STEP 3 — Classify or StratifyCalculate COPPS score: 1 point each for tumor size > 5 cm, necrosis present, vascular invasion present, SDHB loss, S100 loss. Classify as low risk (score 0‑2) or high risk (score ≥ 3).## STEP 4 — DecideFor high risk (score ≥ 3), discuss adjuvant therapy options, recommend genetic testing, and plan intensified surveillance (imaging every 6‑12 months); for low risk (score 0‑2), recommend standard postoperative follow‑up per guideline.## Clinical Guardrails / Mimics / Pitfalls- Ensure SDHB loss is complete in tumor cells with retained internal control (e.g., stromal cells) to avoid false‑negative interpretation. - Do not apply the score to non‑PPGL neoplasms; verify chromogranin A positivity and cytokeratin negativity first. - Focal necrosis or focal vascular invasion still counts as present; avoid under‑sampling. - S100 loss interpretation requires adequate controls; weak focal staining should be considered retained. - Score does not replace clinical judgment; integrate with biochemical and imaging findings.## Concrete Clinical ExampleA 48‑year‑old with an adrenal mass measuring 6 cm shows focal necrosis, focal vascular invasion, SDHB‑negative immunostaining, and S100‑positive immunostaining. COPPS score = 1 (size) + 1 (necrosis) + 1 (vascular invasion) + 1 (SDHB loss) + 0 (S100 retained) = 4 → high risk. Recommend adjuvant therapy discussion, SDHB genetic testing, and surveillance imaging every 6 months.**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> **TODO:** consider adding scripts/calc.py for the ppgl-copps-score-application calculator

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