Gastric Neoplasm – A Diagnostic Puzzle

Abstract

Introduction: Paragangliomas are non-epithelial neuroendocrine tumors originating from neural crest derived paraganglion cells situated in the region of the autonomic nervous system ganglia and accompanying nerves. Very few cases of primary gastric paraganglioma have been reported in the literature till date. We report a rare case of primary gastric paraganglioma.

Case Report: A 38 year old woman presented with history of melena and dyspepsia. Physical examination revealed mild tenderness in the right hypochondrium, and she was diagnosed to have gall stone disease. However, upper gastrointestinal endoscopy and contrast enhanced computed tomography whole abdomen revealed presence of a small elevated intraluminal lesion at the body of stomach along greater curvature and clinically diagnosed as gastrointestinal stromal tumor(GIST). Endoscopic biopsy report revealed a diagnosis of submucosal Brunner’s gland hamartoma. Laparoscopic cholecystectomy and laparoscopy assisted wedge resection of the stomach mass was done and the specimens were sent for histopathological examination. The stomach mass was diagnosed as paraganglioma which was confirmed by immunohistochemistry.

Conclusion: Primary gastric paraganglioma is a very rare tumor. They are more difficult to diagnose if they are non-functional. Complete surgical excision is the first line treatment that can be performed with open surgical resection or laparoscopic technique.