WORLD JOURNAL OF SURGICAL ONCOLOGY Kwon et al. World Journal of Surgical Oncology 2010, 8:42 http://www.wjso.com/content/8/1/42 Open Access CASE REPORT © 2010 Kwon et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case report A case of gangliocytic paraganglioma in the ampulla of Vater Junsik Kwon, Seung Eun Lee, Mee Joo Kang, Jin-Young Jang* and Sun-Whe Kim Abstract Background: Duodenal gangliocytic paraganglioma is an extremely rare tumor and few cases have been reported to date. Case presentation: The authors report a case of gangliocytic paraganglioma verified by post-op pathology after pancreaticoduodenectomy for a tumor in the ampulla of Vater. The 56-year-old male patient concerned visited our emergency room with melena that started one week prior to hospitalization. The patient was diagnosed to have a tumor in the ampulla of Vater with bleeding on its surface. However post-op, he was diagnosed as having gangliocytic paraganglioma by immunohistochemistry. Conclusion: This tumor has precise clinical implications, and if continuous follow up is conducted after careful diagnosis and surgical treatment, invasive major operations, such as, radical pancreaticoduodenectomy can be avoided. Background Gangliocytic paragangliomas are rare tumors which are usually encountered in the second portion of the duode- num. They can be diagnosed histologically by the pres- ence of epithelioid, spindle, and ganglion cells, which is similar to that observed for paraganglioma [1]. Although gancliocytic paragangliomas have no specific accompany- ing symptoms, they are sometimes found due to bleeding caused by mucosal ulceration, and rarely because of huge mass effect, such as, abdominal pain or obstruction. However, they are usually detected incidentally during radiologic imaging conducted for different purposes [2]. Here, we report a gangliocytic paraganglioma in the sec- ond portion of the duodenum in a patient hospitalized for melena, which was removed by pancreaticoduodenec- tomy. We also include a review of the literature. Case presentation A 56-year-old male patient visited our emergency room due to melena of duration one week. History taking revealed no particular issues other than antihypertensive medication after a diagnosis of hypertension five years previously. He did no smoke, but consumed a small amount of alcohol regularly. No specific features arose from his family or social history. He did not experience nausea or vomiting at the time of hospitalization, and only complained of mild indigestion. Furthermore, he showed no epigastric soreness, abdominal pain, or weight loss, and his vital signs at hospitalization were stable. His physical examination was uneventful. His hemoglobin was 10.4 g/dL, and renal and liver function, as deter- mined by blood tests, were also normal. No lesions were found in the esophagus or stomach by esophagogastrodu- odenoscopy. However, an exophytic tumor with a bleed- ing surface ulcer was observed luminally in the ampulla of Vater in the second portion of the duodenum (Figure 1). An endoscopic biopsy was performed on the tumor and bleeding from the ulcer was controlled endoscopi- cally. And abdominal computer tomography (CT) and magnetic resonance imaging (MRI) revealed a hypoatten- uating mass of diameter 1.6 cm in the second portion of the duodenum. The pathological result later revealed atypical chronic inflammation and regenerative atypia. Although no malignant cells were observed, surgery was performed based on the judgment that gross findings indicated that the possibility of malignancy was high. During surgery, a papillary 2.5 × 2.0 × 0.7 cm sized mass was found in the ampulla of Vater. Distant metastasis or * Correspondence: jangjy4@snu.ac.kr 1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Full list of author information is available at the end of the article