Korean J Radiol.  2008 Jul;9(Suppl):S18-S21. 10.3348/kjr.2008.9.s.s18.

A Case of Primary Paraganglioma that Arose in the Pancreas: the Color Doppler Ultrasonography and Dynamic CT Features

• Kim SY
• Byun JH
• Choi G
• Yu E
• Choi EK
• Park SH
• Lee MG

• KMID: 1100097
• DOI: http://doi.org/10.3348/kjr.2008.9.s.s18

Abstract

Paragangliomas rarely originate from the pancreas and they are characterized on imaging studies as well-marginated, hypervascular masses with cystic areas. We herein report on a case report of pancreatic paraganglioma in a 57-year-old woman, which was confirmed on pathology. Color Doppler ultrasonography and dynamic CT demonstrated a well-demarcated, extremely hypervascular mass with prominent intratumoral vessels and early contrast filling of the draining veins from the mass. Endoscopic retrograde cholangiopancreatography showed that the main pancreatic duct was displaced and mildly dilated.

Keyword

Pancreas, neoplasm; Pancreas, CT; Paraganglioma

MeSH Terms

Humans
Male
Middle Aged
Pancreatic Neoplasms/*diagnosis/pathology
Paraganglioma/*diagnosis/pathology
*Tomography, X-Ray Computed
*Ultrasonography, Doppler, Color

Figure

• 

  Fig. 1 57-year-old female with right flank discomfort of two months duration. A. Transabdominal color Doppler ultrasonogram demonstrates 6 x 7-cm, well-marginated, hypervascular mass (arrows) with intratumoral vessels (arrowheads) adjacent to pancreatic head. B, C. Axial contrast-enhanced CT scans during arterial phase (B) and portal venous phase (C) shows strong, persistently well-enhancing mass (arrows) and several intratumoral vessels (arrowheads in B). Extent of non-enhancing, tubular-shaped portions within mass is reduced during portal venous phase relative to arterial phase. There is early contrast filling of several prominent draining veins around mass (curved arrows). D. Axial contrast-enhanced CT scan during arterial phase at level cranial to that of B shows early contrast filling of several prominent draining veins (curved arrows) and main portal vein (P). E. Endoscopic retrograde cholangiopancreatography shows superior displacement of head portion of main pancreatic duct and diffuse mild dilatation of main pancreatic duct. There is multifocal parenchymal staining in pancreas head and neck. F. Photograph of gross specimen shows well-marginated mass with areas of intratumoral hemorrhage displacing common bile duct (arrow) and main pancreatic duct (arrowhead). Note location of normal amupulla of Vater (curved arrow). G. Photomicrograph of histologic specimen shows typical "Zell-ballen" pattern, which is composed of mild pleomorphic chief cells (arrows) and sustentacular cells (arrowheads) within tumor (Hematoxylin & Eosin staining, x 400). H. Photomicrograph of immunohistochemistrical staining shows strong positivity of chief cells (arrows) for synaptophysin (×400). I. Sustentacular cells (arrows) are well observed by immunohistochemistrical staining for S-100 protein (×400).

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