title: Duodenal gangliocytic paraganglioma, successfully treated by local surgical excision-a case report.
abstract: BACKGROUND
  Duodenal gangliocytic paragangliomas are rare neoplasms often arising in proximity to the major duodenal papilla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastatic disease even more so. Resection of the tumor is the only definitive therapy.
  
  
  METHODS
  A 67year old male presented to a referring hospital with symptoms of fatigue and malaise. Evaluation with CT imaging revealed a 3.1cm intraluminal mass situated grossly at the junction of the third with the fourth portion of the duodenum. The tumor was found to be situated near the ampulla of Vater and was excised through a longitudinal duodenotomy followed by myotomy of the sphincter of Oddi.
  
  
  CONCLUSIONS
  Complete resection of duodenal gangliocytic paragangliomas by surgical or endoscopic means is the only potential cure. Endoscopic removal is the first option and is both safe and adequate. Ηowever, localized excision may be utilized instead in those cases in which endoscopic removal is not possible or cannot achieve negative margins. Recurrent disease after complete resection is unlikely.
  
  
  CONCLUSIONS
  Cases of duodenal gangliocytic paragangliomas are best managed with endoscopic resection. However, local surgical excision remains as a second-choice procedure. Adjuvant chemotherapy and radiotherapy are unnecessary after complete excision.
authors.affiliation: 3rd Department of Surgery, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Dimetrios
authors.initials: D
authors.lastname: Papaconstantinou
authors.affiliation: 2nd Department of Surgery, General Hospital "Laiko", Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Machairas
authors.affiliation: 2nd Department of Pathology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Vasileia
authors.initials: V
authors.lastname: Damaskou
authors.affiliation: Pediatric Surgery Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Greece. Electronic address: nzavras@med.uoa.gr.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zavras
authors.affiliation: Second Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Christine
authors.initials: C
authors.lastname: Kontopoulou
authors.affiliation: 3rd Department of Surgery, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
keywords: Case report; Duodenum; Gangliocytic paraganglioma; Surgical excision