Obstructive jaundice due to a rare periampullary tumor

Figure 1 Endoscopic images of periampullary tumor prior and after endoscopic mucosal resection. A: A 1 cm × 1.5 cm isoechoic, submucosal nodule near the major ampulla (arrows); B: Periampullary submucosal nodule with a normal overlying mucosa; C: Lesion post endoscopic mucosal resection.

Figure 2 Histologic characteristics of the gangliocytic paragangliomas. A: Submucosal location of the peri-ampullary tumor (H and E, original magnification × 2); Epitheliod cells (black arrow) with surrounding spindle cells (white arrow). Ganglion-like cells present (arrow heads) (H and E, original magnification × 20); B: Immunohistochemistry of tumor showing positivity for cytokeratin in the epitheliod cells (original magnification × 4); C: Immunohistochemistry of tumor showing S-100 positivity of the spindle cell component (original magnification × 10).