title: Duodenal gangliocytic paraganglioma: A case report and literature review.
abstract: BACKGROUND
  Gangliocytic paraganglioma is a rare tumor that is most commonly located in the duodenum. At presentation, it may be confused with a gastrointestinal stromal tumor (GIST), but distinguishing between these tumors is critical because the natural history and treatment of these two tumors differs markedly. Duodenal gangliocytic paraganglioma typically exhibits benign behavior with occasional regional lymph node metastasis and no reports of tumor associated deaths. Recurrence after resection is rare.
  
  
  METHODS
  A 50 year-old male presented with melena and hemoglobin concentration of 4.6g/dl. Esophagogastroduodenoscopy demonstrated a submucosal mass in the third portion of the duodenum with no active bleeding. CT scan identified no regional lymphadenopathy or distant metastasis. The tumor was resected through a longitudinal duodenotomy with negative margins.
  
  
  CONCLUSIONS
  Endoscopic resection of duodenal gangliocytic paraganglioma appears to be safe and effective when tumor may be removed in its entirety by this method. If the tumor is not suspended by a stalk or there is suspicion for regional lymph node disease then surgical management is preferred. Radiation oncologists at high volume centers have endorsed utilization of adjuvant radiotherapy to the postsurgical bed in cases involving lymph node metastasis. Utilization of chemotherapy for management of this disease has not been reported.
  
  
  CONCLUSIONS
  Localized duodenal gangliocytic paragangliomas are best managed by resection with negative margins. In cases in which the tumor is resected with negative margins, it appears to be safe to embark on a course of surveillance and forego adjuvant therapy.
authors.affiliation: Department of Surgery, the University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Loftus
authors.affiliation: Department of Pathology, the University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Kresak
authors.affiliation: Department of Pathology, the University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Gonzalo
authors.affiliation: Department of Surgery, the University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Sarosi
authors.affiliation: Department of Surgery, the University of Florida College of Medicine, Gainesville, FL 32610, USA. Electronic address: kevin.behrns@surgery.ufl.edu.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Behrns
keywords: Duodenum; Gangliocytic paraganglioma; Gastrointestinal stroma tumor