|
Gangliocytic paraganglioma: case report and review of the
literature.J
Gastrointest Surg. 2007 Oct;11(10):1351-4. Epub 2007 Jul 25.
Gangliocytic
paraganglioma is a rare tumor, which occurs nearly exclusively in
the second portion of the duodenum. Generally, this tumor has a
benign clinical course, although rarely, it may recur or metastasize
to regional lymph nodes. Only one case with distant metastasis has
been reported. We present a case of duodenal gangliocytic
paraganglioma treated first by local resection followed by
pylorus-preserving pancreaticoduodenectomy. Examination of the first
specimen revealed focal nuclear pleomorphism and mitotic activity,
in addition to the presence of three characteristic histologic
components: epithelioid, ganglion, and spindle cell. In the
subsequent pancreaticoduodenectomy specimen, there was no residual
tumor identified in the periampullary area, but metastatic
gangliocytic paraganglioma was present in two of seven lymph nodes.
This case report confirms the malignant potential of this tumor. We
review the published literature on gangliocytic paragangliomas
pursuing a malignant course. We conclude that surgical therapy of
these neoplasms should not be limited to local resection, as disease
recurrence, lymph node involvement, and rarely distant metastasis
may occur.
Emergency catheter
probe endoscopic sonography (CP-EUS): an effective procedure in the
assessment of a bleeding gangliocytic paraganglioma.Dig
Liver Dis. 2006 Feb;38(2):134-7. Epub 2006 Jan 18.
Catheter
probe endoscopic sonography is a relatively rapid and safe
procedure, carried out during standard endoscopy, capable of
distinguishing solid from cystic lesions and vascular from avascular
masses. Herein we discuss the role of catheter probe endoscopic
sonography in the emergency assessment of a patient with recent and
severe bleeding from an ulcerated polyp, arising from the papilla.
During the endoscopy, catheter probe endoscopic sonography showed
the solid and submucosal nature of the lesion, suggesting its
localised and benign nature and, most importantly, demonstrating the
high risk of rebleeding from vascular structures communicating with
the ulcer. Because of this finding three metallic endoclips were
positioned. The lesion was not removed endoscopically because of its
difficult position and the high risk of haemorrhage. The mass,
removed through a duodenotomy, was shown to be a gangliocytic
paraganglioma, an uncommon tumour, frequently resulting in surgery
because of abdominal pain and gastrointestinal bleeding. |
