Korean J Gastroenterol.  2014 Feb;63(2):114-119. 10.4166/kjg.2014.63.2.114.

Endoscopic Resection as a Possible Radical Treatment for Duodenal Gangliocytic Paraganglioma: A Report of Four Cases

• Park SJ
• Kim DH
• Lim H
• Lee JH
• Choi KD
• Song HJ
• Lee GH
• Jung HY
• Kim JH
• Park JY

• KMID: 1730918
• DOI: http://doi.org/10.4166/kjg.2014.63.2.114

Abstract

Gangliocytic paraganglioma (GP) is a rare, benign tumor which is usually found in the duodenum. We here report four recent cases of GP, with successful endoscopic resection in three cases, including a lesion on the ampulla of Vater. In all cases, each lesion had a stalk that facilitated removal using an endoscopic approach. Endoscopic mucosal resection is a feasible and safe treatment if the location, depth, and lymph node status are all favorable and is also helpful for definite diagnosis of unknown duodenal mass. To avoid morbidity resulting from open surgical resection, careful inspection for the peduncle of the GP will help determine the feasibility of endoscopic resection.

Keyword

Paraganglioma; Duodenum

MeSH Terms

Aged
Ampulla of Vater/pathology
Chromogranin A/metabolism
Colonoscopy
Duodenal Neoplasms/pathology/*surgery
Endoscopy, Gastrointestinal
Female
Humans
Immunohistochemistry
Intestinal Mucosa/pathology/surgery
Male
Middle Aged
Neuroendocrine Tumors/pathology/surgery
Paraganglioma/pathology/*surgery
S100 Proteins/metabolism
Synaptophysin/metabolism
Tomography, X-Ray Computed
Chromogranin A
S100 Proteins
Synaptophysin

Figure

• 

  Fig. 1. (A) Case 1. Endoscopic view of the duodenal tumor with an ulcerated surface and stalk. (B) Case 2. Huge duodenal mass with a large stalk. (C) Case 3. Duodenoscope side view showing a short stalk. (D) Case 4. Endoscopic view of the subepithelial tumor of the duodenum with a stalk.

• 

  Fig. 2. Photomicrographs showing key features of the gangliocytic paraganglioma in case 1 (H&E). (A) Epithelioid cell nests are located in the submucosal area (×40). (B) Epithelioid cells are arranged in nests or trabeculae (×100). (C) Epithelioid cells are large, polygonal or fusiform with an abundant eosinophilic granular cytoplasm (×400). (D) The ganglion cells (arrow) are scattered throughout (×400).

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  Fig. 3. Photomicrographs showing representative immunohistochemistry of the gangliocytic paraganglioma in case 1. (A) Epithelioid cells showed positive staining for synaptophysin (×200). (B) Epithelioid cells showed positive staining for CD56 (×200). (C) Epithelioid cells are negative for chromogranin (×200). (D) Spindle cells encompassing the epithelioid nests are highlighted by S-100 protein (×200).

Reference

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