Paraganglioma of the gastrointestinal tract is an uncommon, usually benign neoplasm. It usually occurs in the second section of the duodenum. A review of the literature reveals 73 reported cases. We studied a case of paraganglioma by hypotonic duodenography (HDG), computed tomography (CT), angiography and histological examination. The rare occurrence of this neoplasm and the first comparative study using HDG, CT and angiography justify this case report. A 65-year-old Japanese woman had been in excellent health until she presented to her physician with tarry stool. The bleeding site was not determined. Seven months later, she visited another physician because of general fatigue, and was found to be anaemic and bleeding from the gastrointestinal tract. She was referred to the Kawasaki Medical School Hospital for further evaluation. On admission, she was moderately anaemic but not jaundiced. The abdomen was flat and soft without rebound tenderness. A slightly rough-surfaced, gooseegg sized mass was palpable in the right upper quadrant of the abdomen which moved with respiration but was not tender. Routine laboratory examination showed no abnormalities except anaemia. A hypotonic duodenogram showed a relatively smoothedged filling defect with a deep and irregular niche on the lateral wall of the second portion of the duodenum (Fig. 1). Contrast-enhanced CT revealed an inhomogeneous mass of soft-tissue density along the lateral aspect of the duodenum. This study was carried out with Gastrografin so that the mass could be easily demonstrated (Fig. 2).

Background: This study was undertaken to assess the efficacy and suitability of an arterial embolization technique for the control of bleeding in advanced head and neck malignancies. Methods: Embolization was performed on 6 patients with advanced head and neck malignancy using various embolic materials for the control of bleeding. The primary tumors were located in the nasopharynx, hypopharynx (n = 2), oral base, face, and external auditory canal. All of these patients had severe anemia and 5 had massive regional hemorrhages. Results:All bleeding was well controlled by the arterial embolization; 2 patients were cured of hypovolemic shock. None of the patients died as a direct result of tumor bleeding, and there were no massive rebleeding cases in our series. Conclusion: Arterial embolization offers an effective, safe, and fast method for controlling bleeding from advanced head and neck malignancies. A good working relationship between the surgeon and the interventional radiologist provides the greatest chance for success in such cases.IntJ Clin Onco11998;3:228-232