Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2013; 5(10): 195-197
Published online Oct 15, 2013. doi: 10.4251/wjgo.v5.i10.195
Obstructive jaundice due to a rare periampullary tumor
Anjana Sathyamurthy, Abhishek Choudhary, Dennis Ng, Shuaib Okponobi, Alberto Diaz-Arias, Ajitinder Grewal, Ghassan M Hammoud
Anjana Sathyamurthy, Abhishek Choudhary, Dennis Ng, Ajitinder Grewal, Ghassan M Hammoud, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MI 65212, United States
Shuaib Okponobi, Alberto Diaz-Arias, Department of Pathology and Anatomical Sciences, University of Missouri Health Sciences Center, Columbia, MI 65212, United States
Author contributions: Sathyamurthy A wrote the manuscript; Choudhary A, Ng D and Grewal A were involved in reviewing the literature; Okponobi S and Diaz-Arias A provided pathology slides and interpretation; Hammoud GM Corresponding author, edited and revised the manuscript.
Correspondence to: Ghassan M Hammoud, MD, MPH, Associate Professor of Clinical Medicine, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, One Hospital Drive, CS and E Building, CE405, Columbia, MI 65212, United States.
Telephone: +1-573-8828586 Fax: +1-573-8844595
Received: June 20, 2013
Revised: August 30, 2013
Accepted: September 3, 2013
Published online: October 15, 2013

Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes. A 92-year-old female presented with obstructive jaundice. On exam she had pale conjunctiva and icteric sclera. Abdominal examination revealed tenderness in the upper abdomen. Laboratory data was consistent with obstructive jaundice. Computed tomography of the abdomen revealed a dilated gall bladder and a common bile duct (CBD) with no evidence of liver lesions or pancreatic head mass. Endoscopic ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area, dilated CBD (9 mm), a prominent pancreatic duct (4.1 mm) and a hydropic gall bladder with no stones. Endoscopic retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare resection. Histopathology analyses with immunohistochemical stains were positive for cytokeratin, synaptophysin, S-100 protein, neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic paraganglioma. Periampullary gangliocytic paraganglioma is a rare benign tumor of the small bowel. Common presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive jaundice. Endoscopic resection is a curative therapy in the absence of local invasion or distant metastasis.

Keywords: Gangliocytic paraganglioma, Periampullary tumor, Spindle-shaped, Epitheloid, Ganglion cells, Jaundice, Duodenum, Endoscopic mucosal resection

Core tip: This case report shed some light on a rare cause of obstructive jaundice in elderly patients. The disease is rare but should be considered in the differential diagnosis of biliary obstruction. The literature provided summarizes several outcomes of case presentation with this disorder and provide input on some of the aggressive feature of this disorder.