Paraganglioma of the duodenum: a case report with radiological findings and literature review

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Abstract
Paraganglioma of the gastrointestinal tract is an uncommon, usually benign neoplasm. It usually occurs in the second section of the duodenum. A review of the literature reveals 73 reported cases. We studied a case of paraganglioma by hypotonic duodenography (HDG), computed tomography (CT), angiography and histological examination. The rare occurrence of this neoplasm and the first comparative study using HDG, CT and angiography justify this case report. A 65-year-old Japanese woman had been in excellent health until she presented to her physician with tarry stool. The bleeding site was not determined. Seven months later, she visited another physician because of general fatigue, and was found to be anaemic and bleeding from the gastrointestinal tract. She was referred to the Kawasaki Medical School Hospital for further evaluation. On admission, she was moderately anaemic but not jaundiced. The abdomen was flat and soft without rebound tenderness. A slightly rough-surfaced, gooseegg sized mass was palpable in the right upper quadrant of the abdomen which moved with respiration but was not tender. Routine laboratory examination showed no abnormalities except anaemia. A hypotonic duodenogram showed a relatively smoothedged filling defect with a deep and irregular niche on the lateral wall of the second portion of the duodenum (Fig. 1). Contrast-enhanced CT revealed an inhomogeneous mass of soft-tissue density along the lateral aspect of the duodenum. This study was carried out with Gastrografin so that the mass could be easily demonstrated (Fig. 2).