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Duodenal gangliocytic paraganglioma.

A 70-year-old woman was admitted with a history of recurrent abdominalpain for several months. The pain was localized in the upper abdomen andradiated to the back. Endoscopy showed multiple gastric ulcers and a poly-poid mass in the second portion of the duodenum, near the ampulla of Vater(Fig. 1). Multiple biopsy specimens were obtained; histologic examination ofthese showed only inflammatory changes. Thoracoabdominal computedtomography (CT) and magnetic resonance imaging (MRI) did not identifyany associated lesions. The pancreatic and biliary tracts were unaffected.Because the lesion could not be resected endoscopically, a surgical approachwas necessary. Through an anterior duodenotomy, the mucosa was infiltratedwith epinephrine, and the mass was completely resected. Tissue at the mar-gins was tumour-free. On pathological examination, the tumour measured 19 × 10 mm. Histo-logically, epithelioid, spindle and ganglion cells were found (Fig. 2). Immuno-histochemical analysis showed that epithelioid cells were positive to chromo-granine, AE1–3 cytokeratins and neurofilaments. Spindle cells were positive toS-100 protein and glial fibrillary acidic protein. The final diagnosis was duo-denal gangliocytic paraganglioma. The patient’s postoperative course was uncomplicated, and she left the hos-pital 7 days after surgery. At 4-year follow-up, she remained asymptomaticand without evidence of recurrence or metastatic disease.