Malignant gangliocytic paraganglioma of the duodenum with distant metastases and a lethal course

Figure 3 Photomicrographs of the duodenal lesion. A: A low-power image of the duodenal lesion showed a mass occupying the submucosa and extending into muscularis propria with an infiltrative margin; B: At high-power fields, the lesion was composed of epithelioid cells arranged in a nested fashion, slender spindle-shaped cells and occasional ganglion-like cells; C, D: Occasional psammoma bodies could also be found in the lesion; The duodenal lesion exhibited a penetrative growth pattern with pancreatic infiltration (E) and regional lymph node metastasis (F). All three components of the tumor was found in effaced nodal architecture (A: HE staining with original magnification × 40; B-D: HE staining with original magnification × 400; E, F: HE staining with original magnification × 200). HE: Hematoxylin and eosin.