Ampullary gangliocytic paraganglioma with lymph node metastasis: A case report with literature review |
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Authors: | Hanlim Choi Jae-Woon Choi Dong Hee Ryu Sungmin Park Myung Jo Kim Kwon Cheol Yoo Chang Gok Woo |
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Affiliation: | aDepartment of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea;bDepartment of Surgery, Chungbuk National University Hospital, Cheongju, Korea;cDepartment of Pathology, Chungbuk National University Hospital, Cheongju, Korea. |
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Abstract: | Rationale:Gangliocytic paraganglioma (GP) is a rare tumor that mostly develops in the duodenum and is composed of the following 3 cell types: epithelioid endocrine, spindle-like, and ganglion-like cells. It manifests as symptoms such as abdominal pain, gastrointestinal bleeding, and weight loss; however, occasionally, it is incidentally detected on endoscopic or radiologic examinations. Although GP is usually benign, it can metastasize to the lymph nodes, and distant metastases have been reported in some cases.Patient concerns:A 46-year-old woman presented with anemia on health surveillance examination. She had no other specific symptoms, and her physical examination did not reveal any abnormal finding.Diagnosis:Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed, and the endoscopist obtained samples from the inner side of the ampullary mass. Pathological examination suggested GP or a neuroendocrine tumor.Interventions:Initially, we planned transduodenal ampullectomy with lymph node excision. However, there was severe fibrosis around the duodenum, and an examination of a frozen biopsy sample from the periduodenal lymph node showed atypical cells in the lymph node. Therefore, we performed pylorus-preserving pancreaticoduodenectomy with lymph node dissection.Outcomes:The final pathological diagnosis was GP located in the ampulla of Vater. The GP showed lymphovascular and perineural invasion and invaded the duodenal wall. Furthermore, 4 out of 18 harvested lymph nodes showed metastasis.Lessons:We described a case of GP confined to the ampulla with regional lymph node metastasis and reviewed published literature on ampullary GP with lymph node metastasis. |
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Keywords: | ampulla case report gangliocytic paraganglioma lymph node metastasis |
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