Tumor immunohistochemistry for the succinate dehydrogenases, especially the investigation of SDHB is indicated, as the loss of its expression suggests a germline PV in the SDHB gene and implies greater aggressiveness; this analysis is part of COOPS (Composite Pheochromocytoma/Paraganglioma Prognostic Score) system, in which necrosis (focal or confluent), loss of S100 expression, vascular invasion, loss of SDHB expression and size greater than 7 cm are evaluated. This evidence concerns the gene SDHB and neoplasm.