A case of juxtapapillary gangliocytic paraganglioma treated with endoscopic resection / 대한내과학회지

Gangliocytic paraganglioma is a rare tumor that is usually seen in the duodenum. This neoplasm generally behaves in a benign fashion, although instances of recurrence and lymph node metastasis have been described. We experienced a case of incidentally found gangliocytic paraganglioma treated with endoscopic resection. A 61-year-old man was referred because of submucosal tumor adjacent to the major papilla. Endoscopic biopsy revealed paraganglioma. Abdominal CT showed that there was no evidence of a duodenal mass or lymphadenopathy. This tumor was resected endoscopically by electrosurgical snare polypectomy. The excised tumor measured 1.0 cm in diameter. Histopathological examination revealed a benign gangliocytic paraganglioma and the resection margins were free of tumor. At the 6-month follow-up, the patient was still asymptomatic and no residual tumor was detected at the resection site.

Ampullary Carcinoid Tumor

The ampullary carcinoid tumor is a rare lesion accounting for less than 0.3% of all carcinoid tumors of the gastrointestinal tract. We recently experienced a case of an ampullary carcinoid tumor at our institution. A 70-year-old man was admitted to our hospital on January 2006 for right upper quadrant pain with jaundice. He underwent a pyloruspreserving pancreaticoduodenectomy for an ampullary carcinoid tumor. Abdominal computed tomography showed an oval shaped mass at the ampulla of Vater with abrupt obstruction of the distal end of the common bile duct. The patient underwent a percutaneous transhepatic bile drainage for a cholangiogram, in which was noted a filling defect with a smooth margin at the ampullary portion. During surgery, a firm, grayish-pink, and fairly well circumscribed tumor measuring 2.5 cm was found in the ampulla of Vater. Histopathologically, the tumor with invasion to the muscular layers consisted of cells with an eosinophillic cytoplasm and uniform, oval hyperchromatic nuclei. Immunohistochemical staining of the tumor was positive for chromogranin, synaptophysin and neuron-specific enolase. The patient had an unremarkable hospital course. Carcinoids of the ampulla of Vater are very rare. Only 105 cases have been reported in the literature, most as single case reports. We report here a case of an ampullary carcinoid tumor with a discussion based on the literature.