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Voluminous juxtapapillary gangliocytic paraganglioma
At the Focal Point
Voluminous juxtapapillary gangliocytic paraganglioma
A 56-year-old woman was referred because of anemia with recurrent melena. The duodenoscopy revealed a voluminous pedunculated submucosal tumor adjacent to the major papilla (A). Standard forceps biopsy specimens were negative for malignancy. Abdominal CTshowed a mass located within the duodenum that appeared solid with central hypodensity (B). There was no evidence of a pancreatic or retroperitoneal mass or lymphadenopathy. Despite the large volume, the tumor was resected endoscopically by electrosurgical snare polypectomy. Arterial bleeding occurred immediately, which was controlled with placement of 3 clips (C). The excised tumor measured 4 2 3 cm (D). The opening of the major papilla was not touched, despite its close location. The outcome
was uneventful, without bleeding, perforation, or acute pancreatitis. Histopathologic examination revealed a benign gangliocytic paraganglioma that was composed of carcinoid-like cells, spindle-shaped Schwann’s cells, and rare differentiated ganglion-like cells. An endoscopic check-up examination 2 months later showed a cicatricial area, with one persistent clip located 1 cm below the major papilla. An endosonographic examination was carried out at this moment and was without abnormality. At the 1-year follow-up, the patient was still asymptomatic, and no residual tumor was detected by endoscopy and in biopsy specimens taken from the resection site.
www.mosby.com/gie
Volume 62, No. 3 : 2005 GASTROINTESTINAL ENDOSCOPY 445
At the Focal Point
Abdennaceur El Idrissi-Lamghari, MD, Department of Gastroenterology, Hoˆpital Pontchaillou, University of Rennes, Rennes, France, Department of Gastroenterology, Hoˆpital Avicenne, University of Rabat, Rabat, Morocco; Nathalie Rioux-Leclercq, MD, Department of Pathology; Mael
Pagenault, MD, Jean-Franc¸ois Bretagne, MD, Department of Gastroenterology, Hoˆpital Pontchaillou, University of Rennes, Rennes, France doi:10.1016/j.gie.2005.04.003
Commentary This case nicely illustrates the many potentials endoscopy has to offer: diagnosis (gangliocytic paraganglionoma); therapy (snare polypectomy); treatment of an endoscopic complication (bleeding) by clip placement; and follow-up (endoscopy and endosonography). A job well done! Lawrence J. Brandt, MD Associate Editor of Focal Points
Confined progression of cap polyposis along the anastomotic line, implicating the role of inflammatory responses in the pathogenesis
A 76-year-old Japanese woman presented with progression of anemia and hypoproteinemia associated with mucous and bloody stool. Colonoscopy revealed charac-
teristic findings of cap polyposis, showing approximately 30 reddened and eroded sessile polyps with caps of white fibrinopurulent exudate throughout the total colon (A and
446 GASTROINTESTINAL ENDOSCOPY Volume 62, No. 3 : 2005
www.mosby.com/gie
Voluminous juxtapapillary gangliocytic paraganglioma
A 56-year-old woman was referred because of anemia with recurrent melena. The duodenoscopy revealed a voluminous pedunculated submucosal tumor adjacent to the major papilla (A). Standard forceps biopsy specimens were negative for malignancy. Abdominal CTshowed a mass located within the duodenum that appeared solid with central hypodensity (B). There was no evidence of a pancreatic or retroperitoneal mass or lymphadenopathy. Despite the large volume, the tumor was resected endoscopically by electrosurgical snare polypectomy. Arterial bleeding occurred immediately, which was controlled with placement of 3 clips (C). The excised tumor measured 4 2 3 cm (D). The opening of the major papilla was not touched, despite its close location. The outcome
was uneventful, without bleeding, perforation, or acute pancreatitis. Histopathologic examination revealed a benign gangliocytic paraganglioma that was composed of carcinoid-like cells, spindle-shaped Schwann’s cells, and rare differentiated ganglion-like cells. An endoscopic check-up examination 2 months later showed a cicatricial area, with one persistent clip located 1 cm below the major papilla. An endosonographic examination was carried out at this moment and was without abnormality. At the 1-year follow-up, the patient was still asymptomatic, and no residual tumor was detected by endoscopy and in biopsy specimens taken from the resection site.
www.mosby.com/gie
Volume 62, No. 3 : 2005 GASTROINTESTINAL ENDOSCOPY 445
At the Focal Point
Abdennaceur El Idrissi-Lamghari, MD, Department of Gastroenterology, Hoˆpital Pontchaillou, University of Rennes, Rennes, France, Department of Gastroenterology, Hoˆpital Avicenne, University of Rabat, Rabat, Morocco; Nathalie Rioux-Leclercq, MD, Department of Pathology; Mael
Pagenault, MD, Jean-Franc¸ois Bretagne, MD, Department of Gastroenterology, Hoˆpital Pontchaillou, University of Rennes, Rennes, France doi:10.1016/j.gie.2005.04.003
Commentary This case nicely illustrates the many potentials endoscopy has to offer: diagnosis (gangliocytic paraganglionoma); therapy (snare polypectomy); treatment of an endoscopic complication (bleeding) by clip placement; and follow-up (endoscopy and endosonography). A job well done! Lawrence J. Brandt, MD Associate Editor of Focal Points
Confined progression of cap polyposis along the anastomotic line, implicating the role of inflammatory responses in the pathogenesis
A 76-year-old Japanese woman presented with progression of anemia and hypoproteinemia associated with mucous and bloody stool. Colonoscopy revealed charac-
teristic findings of cap polyposis, showing approximately 30 reddened and eroded sessile polyps with caps of white fibrinopurulent exudate throughout the total colon (A and
446 GASTROINTESTINAL ENDOSCOPY Volume 62, No. 3 : 2005
www.mosby.com/gie