Surgical management of duodenal gangliocytic paraganglioma causing upper gastrointestinal bleeding: a case report

Introduction: Gangliocytic paraganglioma is rare duodenal tumor characterized by distinctive histological features including neuroendocrine, ganglion and Schwann-like cells. It is typically benign, though occasional regional lymph node metastasis have been reported, and most patients present with gastrointestinal bleeding or obstruction. Recurrence after resection is rare. Case presentation: We present a 46-year-old male presented with a 15-day history of melena, fatigue and dizziness. Initial hemoglobin was 10.7 g/dl, which dropped to 8.2 g/dl during admission. Upper GI endoscopy revealed a large pedunculated lesion in the second part of duodenum. Endoscopic ultrasound (EUS) demonstrated a 3-4 cm submucosal mass without lymphadenopathy and EUS-guided biopsy confirmed gangliocytic paraganglioma. CT scan showed a 2.7 × 3.5 × 2.7 cm exophytic duodenal lesion. The patient subsequently underwent duodenal mass resection. Final histopathology was consistent with gangliocytic paraganglioma. postoperative recovery was uneventful and he remained asymptomatic at 6 months follow-up. Discussion: Duodenal gangliocytic paraganglioma is a rare neoplasm that may present with variable symptoms, most commonly gastrointestinal bleeding. Radiological imaging plays an important role in localizing the lesion and excluding metastatic disease, though definitive diagnosis relies on histopathology. While endoscopic resection may be feasible for small, localized tumors. surgery is often required for definitive management in cases of significant bleeding or concern for incomplete excision. Conclusion: Duodenal gangliocytic paraganglioma should be distinguished from other neuroendocrine tumors. The possibility of malignant behavior with nodal or distant spread should be excluded prior to surgery. Careful treatment planning and long-term follow-up are essential.