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Valverde Márquez Á, Robles Lázaro C, Muñoz León JA, Vivas Vaca XC, Mories Álvarez MT. Gangliocytic paraganglioma: A case report. ENDOCRINOL DIAB NUTR 2024; 71:317-320. [PMID: 39089969 DOI: 10.1016/j.endien.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 08/04/2024]
Abstract
Paragangliomas (PGLs) are rare and encapsulated neuroendocrine tumors (NET), located in the adrenal gland or the extra-adrenal paraganglia. Extra-adrenal PGLs may develop a gangliocytic component with ganglion cells which are called gangliocytic paragangliomas (GPs). The most common location is the duodenum, and they appear with digestive symptoms or as an incidental finding. We described a 43 years old patient, with epigastric pain, nausea and vomiting. The CT-scan reveals a nodular image in the duodenum. An ultrasound-guided FNA was performed and the pathological report revealed neuroendocrine cell groups and neural tissue. Surgery was the chosen treatment. As the patient did not present lymphatic or pancreatic parenchyma invasion, radiotherapy (RT) was not administered. The management of GPs is not well established and multidisciplinary team approach is recommended to lead to therapeutic options. Surgical resection is still key in the treatment, and adjuvant RT may be considered in cases of lymph node invasion.
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Affiliation(s)
- Álvaro Valverde Márquez
- Servicio de Endocrinología y Nutrición, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
| | - Cristina Robles Lázaro
- Servicio de Endocrinología y Nutrición, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - José Antonio Muñoz León
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ximena Carolina Vivas Vaca
- Servicio de Endocrinología y Nutrición, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Naso JR, Wang D, Romero AO, Leclair T, Smit P, Boland JM, Folpe AL, Bois MC. Pulmonary gangliocytic paraganglioma: An under-recognized mimic of carcinoid tumor. Hum Pathol 2024; 146:23-27. [PMID: 38442781 DOI: 10.1016/j.humpath.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
Gangliocytic paragangliomas are rare neoplasms occurring almost exclusively in the ampullary region of the gastrointestinal tract. Although these tumors are not typically considered in the differential diagnosis of primary pulmonary neoplasia, 5 cases of primary pulmonary gangliocytic paragangliomas have been previously reported. Herein we report our experience with 3 additional examples, all referred to our Anatomic Pathology Consultation service. The patients (a 32-year-old man, a 69-year-old woman and a 55-year-old man) each presented with an endobronchial (2 cases) or upper lobe lung mass, ranging from 1.5 to 2.5 cm in maximum dimension. Biopsy and endobronchial debulking specimens demonstrated the classic triphasic morphology of gangliocytic paraganglioma, with epithelial, spindled and ganglion-like cells. By immunohistochemistry, the tumors were positive for keratin, synaptophysin and chromogranin A in the epithelial component, S100 protein and glial fibrillary acidic protein (GFAP) in the Schwannian spindled cells, and synaptophysin in ganglion cells. TTF1 expression was seen in the epithelial components of 2 cases. The Ki-67 labelling index was low (<2%). Primary pulmonary gangliocytic paragangliomas should be distinguished from carcinoid tumors, given the different natural histories and risk stratification approaches for these morphologically similar tumors. Awareness that gangliocytic paraganglioma may occur in the lung and appropriate immunohistochemical studies are key to correct diagnosis.
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Affiliation(s)
- Julia R Naso
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA, 55905
| | - Diping Wang
- Intermountain Central Laboratory, Murray, UT, USA, 84107
| | - Arthur O Romero
- Department of Internal Medicine, University Medical Center, Las Vegas, NV, USA, 89102
| | - Timothy Leclair
- Department of Cardiovascular Surgery, Intermountain Medical Center, Murray, UT, USA, 84107
| | - Peter Smit
- Department of Cardiovascular Surgery, Intermountain Medical Center, Murray, UT, USA, 84107
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA, 55905
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA, 55905
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA, 55905; Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN, USA, 55905.
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Lin YS, Cao C, Cooper WA, Cheung VKY. Primary gangliocytic paraganglioma of the lung. Pathology 2024; 56:423-426. [PMID: 37863709 DOI: 10.1016/j.pathol.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/19/2023] [Accepted: 07/09/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Yee Sing Lin
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; School of Medical Science, University of New South Wales, Kensington, NSW, Australia.
| | - Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Veronica Ka-Yan Cheung
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Liao X, Zhang D. Groove pancreatitis due to periampullary gangliocytic paraganglioma with lymph node metastasis. Pathology 2023; 55:429-432. [PMID: 36328810 DOI: 10.1016/j.pathol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 03/08/2023]
Affiliation(s)
- Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA.
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Duodenal ganglion cell paraganglioma: A case report. Asian J Surg 2023; 46:1244-1245. [PMID: 36028405 DOI: 10.1016/j.asjsur.2022.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
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Lugo-Fagundo E, Weisberg EM, Fishman EK. Distinct cases of gangliocytic paraganglioma in the duodenum: Two case reports. Radiol Case Rep 2022; 17:2855-2858. [PMID: 35711738 PMCID: PMC9194760 DOI: 10.1016/j.radcr.2022.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
Gangliocytic paraganglioma (GP) is a rare, benign neuroendocrine tumor that commonly arises in the second portion of the duodenum. Despite its favorable prognosis, there have been instances of lymph node and liver metastasis as well as 1 reported fatal case. The immunohistochemical and morphological resemblance between GP and neuroendocrine tumor G1 makes it critical to properly recognize and differentiate between the 2. In this article, we present 2 distinct cases of GP: a 70-year-old male with a GP tumor in the ampulla, and a 46-year-old male with a GP near the ampulla whose tumor was excised using a robotic Whipple procedure. We focus on optimizing diagnosis and management through the application of radiological modalities and pathological analysis.
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Dai B, He J, Zhu X, Xie Z, Zhang C, Zhou X, Yang Z, Wang J. An Analysis of Computed Tomography Imaging Features and Predictive Factors for Postoperative Recurrence and Metastasis of Abdominal Paragangliomas. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8638588. [PMID: 35280711 PMCID: PMC8885278 DOI: 10.1155/2022/8638588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022]
Abstract
Methods We studied 51 abdominal PGL patients at the First Affiliated Hospital of Bengbu Medical College, Tongde Hospital, and Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China, from June 2009 to May 2019. Thereafter, the clinical research data, tumor biomarkers, and CT features were compared between the aggressive PGLs and the nonaggressive PGLs using independent-samples t-tests and chi-square tests. Results Of the 51 cases, 43 were benign and 8 had malignant tendencies. Postoperative recurrence and metastasis were more likely to occur when the tumor diameter was >8 cm or/and the enhancement degree was not obvious. Clinical symptoms, tumor markers, sex, age, and CT image characteristics including morphology, presence of cystic degeneration, "pointed peach" sign, calcification, hemorrhage, enlarged lymph nodes, and peritumor and intratumor blood vessels were not significantly different between the two groups (p > 0.05). Conclusion Our findings suggest that CT features, including size >8 cm and enhancement degree, could provide important evidence to assess risk factors for aggressive PGLs.
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Affiliation(s)
- Bailing Dai
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jie He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiandi Zhu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zongyu Xie
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Cui Zhang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiaoli Zhou
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhao Yang
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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Lucas Guerrero V, González Costa A, Romaguera Monzonis A, Bejarano González N, García Borobia F. Surgical management strategy in ampullary tumors with low malignant potential: Presentation of a patient with a gangliocytic paraganglioma. Cir Esp 2021; 99:621-623. [PMID: 34334341 DOI: 10.1016/j.cireng.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/05/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Victoria Lucas Guerrero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Anna González Costa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Andreu Romaguera Monzonis
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Natalia Bejarano González
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Francisco García Borobia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain.
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Lucas Guerrero V, González Costa A, Romaguera Monzonis A, Bejarano González N, García Borobia F. Surgical management strategy in ampullary tumors with low malignant potential: Presentation of a patient with a gangliocytic paraganglioma. Cir Esp 2020; 99:S0009-739X(20)30258-X. [PMID: 32921417 DOI: 10.1016/j.ciresp.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/19/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Victoria Lucas Guerrero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Anna González Costa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Andreu Romaguera Monzonis
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Natalia Bejarano González
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Francisco García Borobia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España.
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Benign and non-neoplastic tumours of the duodenum. GASTROENTEROLOGY REVIEW 2019; 14:233-241. [PMID: 31988669 PMCID: PMC6983766 DOI: 10.5114/pg.2019.90250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/03/2019] [Indexed: 12/18/2022]
Abstract
This review study describes the problem of duodenal tumours, which are rare but important in gastrological practice. The most common location of small intestinal tumours is the duodenum, and this observation is probably partly due to the greater diagnostic availability for most proximal segments of the small intestine. Among tumours the following should be mentioned – benign: adenomas, lipomas, haemangiomas, and leiomyomas; and malignant: malignant tumours of epithelial origin, primary gastrointestinal stromal tumours, neuroendocrine tumours and carcinoids, lymphomas, sarcomas, teratomas, and secondary metastases. Early duodenal tumour recognition, especially with histological assessment, plays a crucial diagnostic role with future therapeutic implications. In recent years the prevalence of benign duodenal tumours has been rising due to a higher level of clinicians’ doubts and the convenience of gastrointestinal endoscopy; hence, knowledge of this problem is important in routine clinical practice. The method of duodenal tumour treatment should be selected on an individual basis.
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