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When present in prostate needle biopsies, paraganglia must be distinguished from high-grade prostatic adenocarcinoma. Features favoring paraganglion include absence of benign prostatic glands around them; no prominent nucleoli; nuclear atypia when present is degenerative type; prominent vascular pattern; close association with nerves; lack of immunoreactivity for PSA and PSAP; strong immunoreactivity for neuroendocrine markers (image shows positivity for Synaptophysin); and the presence of sustentacular cells with S-100 protein. Kawabata K. Arch Pathol Lab Med. 1997;121:515-516