Polypoidal Ampullary Gangliocytic Paraganglioma: A Rare Case of Biliary Obstruction
Juinn Huar Kam, Alexander Yaw Fui Chung, Hock Foong Lui and Rafay Azhar
World Journal of Medical and Surgical Case Reports 2015, 4:4
Gangliocytic paraganglioma is a distinctively rare tumor that is mainly found in the second part of duodenum. It is a benign tumor which rarely recur or metastasize to regional lymph nodes. It can be sessile or pedunculated. It is usually in close proximity with the ampulla of vater, invasion of which may present with obstructive jaundice. Most of the gangliocytic paragangliomas are found incidentally during endoscopy or during investigation for gastrointestinal bleeding. Our patient is a 46 year old female and a hepatitis B carrier. Noted to have raised alkaline phosphatase on routine blood test. MRCP revealed dilated CBD with no ductal stone, pancreatic head mass or liver mass. ERCP showed a 4cm ampullary polyp with elongated mucosal stalk. Transduodenal ampullectomy with sphinteroplasty was performed. Histology and immunohistochemical staining confirmed tumor consistent with gangliocytic paraganglioma arises from the wall of ampulla, the tumor was excised completely with clear margin.