title: Duodenal gangliocytic paraganglioma as a radiological moving defect.
abstract: BACKGROUND
  Gangliocytic paraganglioma of the duodenum is a peculiar neuroendocrine tumor, often revealed as an incidental radiographic finding or as a result of gastrointestinal hemorrhage, due to frequent ulceration of the overlying mucosa. Most lesions are pedunculated and submucosal with distinctive histology, consisting of endocrine, ganglion and spindle-shaped Schwann cells.
  
  
  METHODS
  A case of a duodenal gangliocytic paraganglioma is reported in a 50-year-old woman presenting with episodes of melena. Enteroclysis revealed a pedunculated tumor observed either in the second or third portion of the duodenum. Upper gastrointestinal endoscopy revealed a pedunculated ulcerated tumor which was subsequently confirmed by computed tomography. The tumor was simply excised through a duodenotomy.
  
  
  RESULTS
  The size of the tumor was 4.5 x 3 x 1.5 cm. Immunohistochemical and ultrastructural features of the tumor classified it as a typical duodenal gangliocytic paraganglioma with positive cellular reaction for neuron-specific enolase, chromogranin, somatostatin, gastrin and S100.
  
  
  CONCLUSIONS
  Forty-six months after surgery, the patient is well with no evidence of recurrence. The majority of the reported duodenal gangliocytic paragangliomas were of benign nature. However, the fact that in 4 isolated cases there was lymph node involvement indicates that thorough investigation for lymph node metastases is needed, as well as thorough postoperative follow-up.
authors.affiliation: 2nd Department of Surgery, Aretaeion Hospital, Medical School, University of Athens, Greece. kotsisth@otenet.gr
authors.forename: T
authors.initials: T
authors.lastname: Kotsis
authors.forename: D
authors.initials: D
authors.lastname: Voros
authors.forename: A
authors.initials: A
authors.lastname: Paphiti
authors.forename: M
authors.initials: M
authors.lastname: Frangou
authors.forename: E
authors.initials: E
authors.lastname: Mallas
mesh_terms: D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D010235:Paraganglioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D011859:Radiography