Gangliocytic paraganglioma. A case report and review of the literature

Gangliocytic paraganglioma is an uncommon and usually benign lesion although some cases with metastasis to regional lymph nodes have been described. It is usually located in the descending duodenum submucosa and more frequently arises in male patients. It comes to clinical attention for discomfort, gastrointestinal bleeding, incidental finding and rarely for obstructive jaundice when it involves the papilla. Even if its histologic and immunocytochemical features have been thoroughly described, its histogenesis is still debated although hyperplastic and amartoma-choristoma theories are well considered. We report a case of duodenal gangliocytic paraganglioma in 46 years old chronic alcoholic man who underwent previous upper endoscopy for discomfort without diagnosing the lesion. This one was observed during a second upper endoscopy that was made for hemathemesis. But it was only after an episode of melena that a third upper endoscopy showed the paraganglioma that still kept hemorrhage stigmata and no other lesions. We describe this case of duodenal gangliocytic paraganglioma with review of the literature.