Li T, Yi RQ, Xie G, Wang DN, Ren YT, Li K. Pancreatic paraganglioma with multiple lymph node metastases found by spectral computed tomography: A case report and review of the literature. World J Clin Cases 2022; 10(31): 11638-11645 [PMID: 36387819 DOI: 10.12998/wjcc.v10.i31.11638]
Corresponding Author of This Article
Kang Li, MD, Chief Doctor, Professor, Department of Radiology, Chongqing General Hospital, No. 118 Xingguang Avenue, Liangjiang New Area, Chongqing 401147, China. lkrmyydoctor@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2022; 10(31): 11638-11645 Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11638
Pancreatic paraganglioma with multiple lymph node metastases found by spectral computed tomography: A case report and review of the literature
Ting Li, Rong-Qi Yi, Gang Xie, Dan-Ni Wang, Yi-Tao Ren, Kang Li
Ting Li, Gang Xie, Department of Medical Imaging, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Rong-Qi Yi, Kang Li, Department of Radiology, Chongqing General Hospital, Chongqing 401147, China
Dan-Ni Wang, Yi-Tao Ren, Department of Medical Imaging, Chongqing Medical University, Chongqing 400016, China
Author contributions: Li T and Yi RQ contributed to manuscript writing and editing, and data collection; Xie G was responsible for table preparation and data analysis; Wang DN and Ren YT provided processed image data and interpretation; Li K checked the manuscript and provided suggestions for revision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kang Li, MD, Chief Doctor, Professor, Department of Radiology, Chongqing General Hospital, No. 118 Xingguang Avenue, Liangjiang New Area, Chongqing 401147, China. lkrmyydoctor@126.com
Received: July 21, 2022 Peer-review started: July 21, 2022 First decision: August 19, 2022 Revised: August 29, 2022 Accepted: October 9, 2022 Article in press: October 9, 2022 Published online: November 6, 2022 Processing time: 97 Days and 15.9 Hours
Abstract
BACKGROUND
Primary pancreatic paraganglioma is exceedingly rare. Most patients with pancreatic paraganglioma lack a typical clinical presentation, and the tumor is difficult to accurately differentiate from other pancreatic neuroendocrine tumors, making the misdiagnosis rate extremely high. Surgical excision is the primary treatment modality but is considered high risk. Because of its rich vascularity, the tumor easily bleeds during surgery, especially malignant paragangliomas invading large blood vessels. Thus, a thorough preoperative evaluation of the tumor is necessary. Here, we report a primary malignant pancreatic paraganglioma, the second such case in a young patient that was successfully resected surgically.
CASE SUMMARY
A 26-year-old female patient was admitted to the hospital with unexplained abdominal pain. Dual-layer spectral-detector computed tomography (DLCT) revealed a mixed density mass in the pancreatic body and tail. The patient was transferred to our hospital after previous failed surgical resection at other hospitals. The patient and her family strongly desired surgery. After a thorough preoperative evaluation and adequate preparation, a large mass with the greatest dimension of 8.0 cm was successfully resected. The final pathological diagnosis was malignant paraganglioma. The patient was discharged in good condition 2 wk postoperatively.
CONCLUSION
The rare malignant pancreatic paraganglioma reported here was difficult to diagnose preoperatively. Early filling of the draining vein may be a crucial diagnostic imaging feature. DLCT can provide more precise information for surgical resection through dual-energy imaging.
Core Tip: Primary pancreatic paraganglioma is an exceedingly rare, generally benign tumor, with only four cases of malignancy reported. They are often misdiagnosed as pancreatic neuroendocrine tumors (pNETs). Early filling of the draining veins may be a crucial imaging feature to differentiate pancreatic paraganglioma from pNETs and may be observed more frequently in malignant cases. Surgical resection is the primary treatment modality. However, the rich vascularity and potential functionality of the tumor pose a significant risk for invasive surgery. Thorough preoperative evaluation and preparation are necessary. Definitive diagnosis relies primarily on histopathological examination.
