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Open Access Case Report

Duodenal gangliocytic paraganglioma showing lymph node metastasis: A rare case report

Yoichiro Okubo1, Tomoyuki Yokose2, Masaru Tuchiya3, Aki Mituda1, Megumi Wakayama1, Chikako Hasegawa2, Daisuke Sasai1, Tetsuo Nemoto4 and Kazutoshi Shibuya1*

Author affiliations

1 Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan

2 Department of Pathology, Kanagawa Cancer Center, 1-1-2, Nakao, Asahi-Ku, Yokohama-city, Kanagawa, 245-0815, Japan

3 Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan

4 Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 18-22, Honkomagome 3 chome, Bunkyo-Ku, Tokyo, 113-8677, Japan

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Citation and License

Diagnostic Pathology 2010, 5:27  doi:10.1186/1746-1596-5-27

Published: 6 May 2010

Abstract

We describe a case of duodenal gangliocytic paraganglioma showing lymph node metastasis. A 61-year-old Japanese man underwent pylorus preserving pancreaticoduodenectomy to remove a tumor at the papilla of Vater. The section of the tumor extending from the mucosa to submucosa of the duodenum was sharply demarcated, solid, and white-yellowish. Neither necrosis nor hemorrhage was present. Histological examination confirmed the immunohistochemical identification of three components comprising epithelioid cells, spindle-shaped cells, and ganglion-like cells. Epithelioid cells showed positive reactivity for synaptophysin, somatostatin, and CD56. In contrast, spindle-shaped cells showed positive reactivity for S-100 protein, but not for synaptophysin, somatostatin or CD56. Furthermore, we found lymph node metastasis despite lack of bcl-2 and p53 expression. In addition to the rarity of the tumor, we are describing here the present case suggests the malignant potency of the tumor despite lack of acceptable prognostic indicators for neuroendocrine tumor.