Case Report


Duodenal gangliocytic paraganglioma: A case report

,  ,  ,  ,  ,  

1 MD, Surgery Department, Al-Zahraa Hospital UMC, Beirut, Lebanon

2 MD, Surgery Department, Lebanese University, Beirut, Lebanon

3 MD, Hematology Oncology, Lebanese University, Beirut, Lebanon

4 MD, Senior Director Project Management at Biorasi, LLC, Miami, Florida, USA

5 MD, Head of Hematology Oncology Department at the Lebanese University, Beirut, Lebanon

6 MD, Surgery Department, Longjumeau Hospital, Longjumeau, France

Address correspondence to:

Mohamad Rakka

MD, Surgery Department, Lebanese University, Beirut,

Lebanon

Message to Corresponding Author


Article ID: 101396Z01HB2023

doi: 10.5348/101396Z01HB2023CR

Access full text article on other devices

Access PDF of article on other devices

How to cite this article

Bitar HE, Rakka M, Chbat M, Ibrahim R, Matar B, Karaa A. Duodenal gangliocytic paraganglioma: A case report. Int J Case Rep Images 2023;14(1):123–128.

ABSTRACT


Introduction: Duodenal gangliocytic paraganglioma (DGP) is a benign tumor that only warrants a surgical resection in the majority of cases.

Case Report: We are reporting a case of 42-year-old man who consulted for significant weight loss, fatigue, anemia, and an on–off obstructive jaundice. Imageries showed a 5 cm peri-ampullary duodenal mass. We couldn’t have a diagnosis by endoscopic ultrasound (EUS), so we did a laparoscopic transduodenal tumorectomy and removed the entire mass, which came back as gangliocytic paraganglioma on pathology and immunohistochemistry. Gangliocytic paraganglioma is a benign tumor that most commonly occurs in men and is localized in duodenum. Neuroendocrine tumor, ganglioneuroma, paraganglioma, and schwannoma are the differential diagnoses. Histologic diagnosis is difficult to make. Immunohistochemistry is indispensable for the diagnosis. Often than not, we cannot make diagnosis by a simple biopsy, because the tumor has a submucosal location and three types of cells need to be present for diagnosis: spindle cells, ganglion cells, and epithelial cells. That’s why en-bloc resection of the tumor is frequently needed for accurate diagnosis. Endoscopic resection or laparoscopy is used depending on the characteristics of the tumor. In our case, the 5 cm peri-ampullary tumor warranted a laparoscopic resection. Generally, there is no role for adjuvant therapy in duodenal gangliocytic paraganglioma (DGP). But sometimes, radiotherapy, surgery, somatostatin analog are used for treatment depending on the features of DGP. There is no consensus on follow-up management, but experts agree on the necessity of frequent follow-ups.

Conclusion: We believe it is important to include gangliocytic paraganglioma (GP) as a differential diagnosis in patients who present with duodenal masses, weight loss, and general state alteration.

Keywords: Benign tumor, Gangliocytic paraganglioma, Neuroendocrine tumor

SUPPORTING INFORMATION


Author Contributions

Houssam Eddine Bitar - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Mohamad Rakka - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Maureen Chbat - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Rim Ibrahim - Acquisition of data, Drafting the article, Final approval of the version to be published

Bassam Matar - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Aziz Karaa - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2023 Houssam Eddine Bitar et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.