Duodenal gangliocytic paraganglioma: A very rare cause for upper gastrointestinal bleeding: Case report with review of literature

Abstract

Highlights Gangliocytic paraganglioma is an exceedingly rare tumors that is mainly arises from the second part of the duodenum. The tumor was first described by Dahl et al. in 1957. The tumor has a characteristic 3 distinct types of cells: spindle cells, epithelial cells, and ganglion cells. The tumor must be differentiated from other tumors. Although it is a benign tumor but some cases have lymphatic or distant organ metastases.

Duodenal Gangliocytic Paragangliomas—Case Series and Literature Review

“…Usually, GP is diagnosed as an incidental finding on sectional imaging, by endoscopic studies, or by autopsy, being rather asymptomatic. GPs can rarely present with abdominal pain or jaundice due to mechanical distal biliary obstruction, with only five cases described so far in the literature, and slightly more frequently with upper gastrointestinal bleeding or anemia due to mucosal ulceration [ 4 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Out of 51 GPs cases included in the study of Burke and Helwig, only one presented with biliary obstruction [ 12 ].…”

Endoscopic papillectomy combined with endoscopic retrograde cholangio-pancreatography for duodenal gangliocytic paraganglioma: A case report

“…Considering the traumatic and risky nature of surgery near the jugular abdominal region, and the fact that many studies have supported that the risk of LNM and distant metastasis of DGP is relatively low, coupled with the development of endoscopic diagnostic and therapeutic technology, more and more scholars are employing endoscopic techniques (e.g., EMR/endoscopic submucosal dissection [ESD]/EP) to manage DGP after adequate preoperative evaluation to rule out metastatic signs and have achieved good results. Palomino-Martinez et al [ 11 ] and Ebi et al [ 12 ] successfully resected DGP near the nipple using EMR; Manglekar et al [ 13 ] successfully resected DGP near the nipple using ESD; Sanchez-Pobre et al [ 14 ] successfully managed DGP near the nipple after gastrectomy using endoscopic resection + EST; Arif et al [ 15 ] and Papaconstantinou et al [ 16 ] used duodenotomy to locally resect DGP near the nipple, and all of the above reports achieved satisfactory results, but some of them had postoperative complications such as cholangitis or pancreatitis. In the present case, postoperative complications were effectively prevented while the papillary DGP was managed by EP combined with endoscopic retrograde cholangiopancreatography technique.…”

Endoscopic Treatment of a Gangliocytic Paraganglioma Presenting With Upper Gastrointestinal Bleeding

“…Repeat endoscopic retrograde cholangiopancreatography 3 months later revealed no residual tissue at the papillectomy site, and biopsies returned negative for neoplasia.Gangliocytic paraganglioma is a rare tumor with 3 distinct types of cells: spindle cells, epithelial cells, and ganglion cells. 1,2 The tumor is predominantly seen in middle-aged individuals and affects men slightly more than women. Patients may be asymptomatic or symptoms may include abdominal pain, biliary obstruction, and gastrointestinal bleeding secondary to ulceration, 2,3 as was seen with this case.…”