Recurrent Episodes of Acute Pancreatitis Due to Duodenal Gangliocytic Paraganglioma: Report of a Case
Context Gangliocytic paraganglioma is a rare tumor, almost always located in the second portion of the duodenum, and manifested with upper gastrointestinal bleeding and abdominal pain. To date, only one case of duodenal gangliocytic paraganglioma presented with recurrent acute pancreatitis has been reported in the literature. Case report We present a 72-year-old woman admitted to the hospital due to recurrent episodes of acute pancreatitis. Paraclinical examinations showed a polypoid mass in the second portion of duodenum which was removed surgically by local excision. The preoperative differential diagnosis was suggestive with gastrointestinal stromal tumor or adenoma. The histopathology examination revealed a duodenal gangliocytic paraganglioma. After a follow up period of seventeen months the patient remained without clinical evidence of tumor recurrence. Conclusion Our case report draws attention to the need for including in our differential diagnosis of recurrent acute pancreatitis the mechanical obstruction of the pancreatic duct due to this tumor.
Image: Proximal view of gangliocytic paraganglioma (Figure 2)
Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors. 5th ed. Mosby Elsevier; 2008. p. 1008-9.
Dahl EV, Waugh JM, Dahlin DC. Gastrointestinal ganglioneuromas: brief review with report of a duodenal ganglioneuroma. Am J Pathol 1957; 33:953–966. [PMID:13458330]
Taylor HB, Helwig EB. Benign nonchromaffin paragangliomas of the duodenum. Virchows Arch Pathol Anat Physiol Klin Med 1962; 335:356–366. [PMID: [PMID: 13919963]
Sundararajan V, Robinson-Smith TM, Lowy AM. Duodenal gangliocytic paraganglioma with lymph node metastasis: a case report and review of the literature. Arch Pathol Lab Med 2003; 127:139- 41. [PMID:12653602]
Dookhan D, Miettinen M, Finkel G, Gibas Z. Recurrent duodenal gangliocytic paraganglioma with lymph node metastases. Histopathology 1993; 22:399- 401. [PMID:8514287]
Nwakakwa V, Kahaleh M, Bennett A, Berg C, Brock A, Wick MR, et al. EMR of ampullary gangliocytic paragangliomas. Gastrointest Endosc 2005; 62:318-22. [PMID:16047009]
Lytras D, Kalaitzakis E, Hatfield AR, Vyas S, Imber CJ, Webster GJ, et al. Recurrent acute pancreatitis as primary manifestation of gangliocytic paraganglioma of the ampulla. Pancreas 2011; 40:985-6. [PMID:21765340]
Buscaglia JM, Kalloo AN. Pancreatic sphincterotomy: Technique, indications, and complications. World J Gastroenterol 2007; 13(30):4064-4071. [PMID:17696223]
Wong A, Miller AR, Metter J, Thomas CR Jr. Locally advanced duodenal gangliocytic paraganglioma treated with adjuvant radiation therapy: case report and review of the literature. World J Surg Oncol 2005; 3:15. [PMID:15740625]
Nagai T, Torishima R, Nakashima H, Tanahashi J, Iwata M, Ookawara H, et al. Duodenal gangliocytic paraganglioma treated with endoscopic hemostasis and resection. J Gastroenterol 2004; 39:277-83. [PMID:15065006]
Okubo Y, Wakayama M, Nemoto T, Kitahara K, Nakayama H, Shibuya K, et al. Literature survey on epidemiology and pathology of gangliocytic paraganglioma. BMC Cancer 2011, 11:187. [PMID:21599949]
Witkiewicz A, Galler A, Yeo CJ, Gross SD. Gangliocytic paraganglioma: case report and review of the literature. J Gastrointest Surg. 2007; 11:1351-1354. [PMID:17653595]
Loew BJ, Lukens FJ, Navarro F, Roy M, Mattia A, Howell DA. Successful endoscopic resection of a gangliocyticc paraganglioma of the minor papilla in a patient with pancreas divisum and pancreatitis. Gastrointest Endosc 2007; 65:547-50. [PMID:17145056]
Copyright (c) 2014 Natalia I Asimakopoulou, Panteleimon E Papakonstantinou, Konstantinos G Lasithiotakis, Ioannis A Mouzas, Maria E Daskalogiannaki, Maria N Tzardi, George E Chalkiadakis
This work is licensed under a Creative Commons Attribution 4.0 International License.As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.