2019 Volume 34 Issue 5 Pages 214-221
A 74-year-old female presented for evaluation of a mass around the gallbladder. Plain abdominal CT scan revealed a round tumor anterior to the pancreatic head. The tumor showed strong enhancement in the arterial phase and washed-out on the delayed phase on abdominal dynamic CT scan. From the enhanced pattern, we suspected this to be a lymph node metastasis from a pancreaticoduodenal NET. EUS-FNA was performed and the cytological diagnosis was NET. Somatostatin receptor scintigraphy showed increased radioactive tracer suggestive of NET. Serum pancreatic hormone levels such as insulin, gastrin and glucagon were normal. All studies supported the diagnosis of a lymph node metastasis from a pancreaticoduodenal NET although no pancreaticoduodenal NET was detected. The tumor was resected and histological diagnosis showed paraganglioma. Paraganglioma usually arises from the extra-adrenal paraganglionic system. Tumor location and various imaging studies complicated establishing the diagnosis. We report a rare case of paraganglioma anterior to the pancreatic head.
