Paraganglioma of the duodenum: a case report with radiological findings and literature review

Abstract

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).

Duodenal gangliocytic paraganglioma treated with endoscopic hemostasis and resection

“…Imai et al 3 reported that the incidence of ulceration in these lesions was approximately 40% in the patients previously reported in other countries. Smithline et al 6 reported that ultrasonic endoscopy showed at heterogeneous solid echo continuing from the submucosal layer, and indicated that endoscopic ultrasonography was useful for preoperative differential diagnosis.…”

“…The incidence was slightly higher in males. Five patients had digestive tract hemorrhage related to tumor ulceration, while 5 patients had 3 summarized patients previously reported in countries other than Japan, and reported that the incidences of digestive tract hemorrhage and abdominal pain were 47% and 33%, respectively. In the 25 patients previously reported in Japan, the tumor size ranged from 10 mm to 65mm, with a mean of 28.9mm.…”

“…In Japan, only 26 patients, including our patient, have been reported (Table 2). [2][3][4] In these patients, ages ranged from 17 to 79 years, with a mean of 54 years. These patients consisted of 19 males and 7 females.…”

Endoscopic Resection of Nonadenomatous Ampullary Neoplasms

“…The mean age of patients in a case series from Japan was 54 years, with a slight male predominance. 31,32 Gastrointestinal bleeding and abdominal pain are common presenting symptoms. 32 Because the tumor is submucosal, mucosal biopsies are often negative and endoscopic or surgical resection is needed for the diagnosis.…”

“…31,32 Gastrointestinal bleeding and abdominal pain are common presenting symptoms. 32 Because the tumor is submucosal, mucosal biopsies are often negative and endoscopic or surgical resection is needed for the diagnosis. EUS may be useful in confirming the submucosal location of these tumors.…”