Gastric paraganglioma: case report and review of the literature

Abstract

Very few cases of gastric paragangliomas have been reported in the literature to date. We report a rare case of parietal gastric paraganglioma fortuitously detected during intraoperative exploration. A 82-years-old woman presented to our emergency room for abdominal pain. On physical examination abdomen was painful on palpation and Blumberg's sign was present. The laboratory exams showed a neutrophilia in absence of leukocytosis. Acute appendicitis was suspected and a laparoscopy was performed. At exploration, the vermiform appendix was normal while a lumpy, hard-fibrous and white-pinkish extraluminal lesion of the anterior wall of the gastric body near the greater curvature of about 2 cm in diameter was present. Laparoscopic resection of the gastric lesion was performed. The patient was discharged in good condition in the fourth postoperative day. Pathologic examination revealed a gangliocitic paraganglioma. The patient is alive and well without evidence of relapse 6 months after surgery. Gastric paraganglioma is a very rare tumor and its diagnosis is very difficult. Surgical excision is the treatment of choice which can be performed successfully with laparoscopy.

Figure 1

Low magnification shows a well circumscribed lesion.

Figure 2

The lesion is composed of epithelioid cells, ganglion cells or ganglion-like cells, and spindle-shaped cells; the components are unevenly distributed.

Figure 3

The same lesion at higher magnification.

Figure 4

The epithelioid cells, the ganglion cells and the spindle-shaped cells are stained by neuron-specific enolase (NSE).

Figure 5

Strong immunohistochemical expression of S-100 protein.