Duodenal gangliocytic paraganglioma with lymph node metastases: A case report and comparative review of 31 cases

Figure 1 Preoperative computed tomography imaging. Coronal section demonstrating a 2.1 cm × 1.4 cm periampullary duodenal mass (blue arrows). Red arrow: Common bile duct; yellow arrow: Pancreatic duct.

Figure 2 Fine needle aspiration biopsy and endoscopic tunneled biopsy of duodenal mass. A: Cellular specimen with predominantly bland epithelioid cells with round to oval nuclei, Diff-Quick stain, × 20; B: Rare large ganglion-like cells with eccentric nuclei and prominent nucleoli, Diff-Quick stain, × 40; C: Epithelioid tumor cells within the duodenal lamina propria/submucosa, endoscopic tunnel biopsy, H&E stain, × 20; D: Tumor cells with positive reactivity for synaptophysin, endoscopic tunnel biopsy, × 20.

Figure 3 The tumor protruded into the duodenal lumen, 2. 0 cm proximal to the ampulla (A, probed). The mass was restricted to the duodenal submucosa, and did not invade into the adjacent pancreas (B).

Figure 4 Primary tumor. A: Tumor with overlying mucosa, H&E × 100; B: Tumor with epithelioid (left) and gangliocytic (right) components, H&E × 200; C: Ki-67 immunostaining proliferative index, × 100; D: CD-117 immunostaining for mast cells, × 200.

Figure 5 Lymph node metastasis, × 200. Inset, positive immunostaining for synaptophysin, × 100.