Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2021; 27(37): 6322-6331
Published online Oct 7, 2021. doi: 10.3748/wjg.v27.i37.6322
Pancreatic paraganglioma diagnosed by endoscopic ultrasound-guided fine needle aspiration: A case report and review of literature
Gandhi Lanke, John M Stewart, Jeffrey H Lee
Gandhi Lanke, Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Lubbock, TX 79407, United States
John M Stewart, Pathology-lab Medicine Division, MD Anderson Cancer Center, Houston, TX 77030, United States
Jeffrey H Lee, Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Lanke G composed and drafted the paper; Stewart JM provided path images, revised, and edited the draft; Lee JH conceptualized, designed, revised, and edited the draft.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any potential conflicts (financial, professional, or personal) that are relevant to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeffrey H Lee, AGAF, FACG, FASGE, MD, Director, Professor, Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX 77030, United States. jefflee@mdanderson.org
Received: April 6, 2021
Peer-review started: April 6, 2021
First decision: June 17, 2021
Revised: June 28, 2021
Accepted: September 3, 2021
Article in press: September 3, 2021
Published online: October 7, 2021
Abstract
BACKGROUND

Pancreatic paragangliomas (PPGL) are rare benign neuroendocrine neoplasms but malignancy can occur. PPGL are often misdiagnosed as pancreatic neuroendocrine tumor or pancreatic adenocarcinoma.

CASE SUMMARY

We reviewed 47 case reports of PPGL published in PubMed to date. Fifteen patients (15/47) with PPGL underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Only six (6/15) were correctly diagnosed as PPGL. All patients with PPGL underwent surgical resection except three (one patient surgery was aborted because of hypertensive crisis, two patients had metastasis or involvement of major vessels). Our patient remained on close surveillance as she was asymptomatic.

CONCLUSION

Accurate preoperative diagnosis of PPGL can be safely achieved by EUS-FNA with immunohistochemistry. Multidisciplinary team approach should be considered to bring the optimal results in the management of PPGL.

Keywords: Pancreatic paraganglioma, Endoscopic ultrasound-guided fine needle aspiration, Meta-iodobenzylguanidine scan, Metanephrines, GATA-3, Immunohistochemistry, Case report

Core Tip: The morphologic overlap between pancreatic paraganglioma and neuroendocrine tumor is significant. An accurate diagnosis by endoscopic ultrasound-guided fine needle aspiration requires firstly that the possibility of paraganglioma is considered and secondly that a cell block is available for immunohistochemical stains. A patient-centered approach supported by a multidisciplinary team of radiologists, advanced endoscopists, endocrinologists, pathologists, oncologists, and surgeons is paramount in the management of pancreatic paraganglioma.