PMC9871575_01
MRI, CT, 18F-FDG-PET, and MIBG imaging results. (A-C) MRI of the head revealed an approximately 3-cm mass at the right transvenous foramen. (D, E) Enhanced abdominal CT revealed two tumors in the retroperitoneum: a nodal tumor measuring 30 mm (arrow) on the anterior left renal vein and (G, H) a tumor measuring 13 mm (arrow) near the ligament of Treitz. (F, I, J) 18F-FDG-PET showed accumulation in both tumors [(1) the tumor measuring 30 mm (wide arrow) and (2) the tumor measuring 13 mm (narrow arrow)]. (K) MIBG scintigraphy showed accumulation in an area consistent with a mass (arrow). (L, M) Esophagogastroduodenoscopy and enteroscopy did not identify the smaller tumor. (N, O) MRI, magnetic resonance imaging; CT, computed tomography; FDG-PET, fluorodeoxyglucose-positron emission tomography; MIBG, 123I-metaiodobenzylguanidine.
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Treitz ( Figures 1G-I ). There were no abnormally enlarged retroperitoneal lymph nodes, and no obvious abnormalities were observed in the liver, gallbladder, spleen, kidney, and gastrointestinal tract. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed FDG accumulation in these tumors ( Figure 1J ). 123I-metaiodobenzylguanidine (MIBG) scintigraphy also showed an accumulation in an area consistent with a mass, but because of the close proximity of the two tumors, the hormone production of the smaller tumor could not be identified ( Figure 1K ). Although he underwent esophagogastroduodenoscopy, endoscopic ultrasonography, and enteroscopy, the tumor still could not be identified ( Figures 1L-O ).
PMC9871575_02
MRI, CT, 18F-FDG-PET, and MIBG imaging results. (A-C) MRI of the head revealed an approximately 3-cm mass at the right transvenous foramen. (D, E) Enhanced abdominal CT revealed two tumors in the retroperitoneum: a nodal tumor measuring 30 mm (arrow) on the anterior left renal vein and (G, H) a tumor measuring 13 mm (arrow) near the ligament of Treitz. (F, I, J) 18F-FDG-PET showed accumulation in both tumors [(1) the tumor measuring 30 mm (wide arrow) and (2) the tumor measuring 13 mm (narrow arrow)]. (K) MIBG scintigraphy showed accumulation in an area consistent with a mass (arrow). (L, M) Esophagogastroduodenoscopy and enteroscopy did not identify the smaller tumor. (N, O) MRI, magnetic resonance imaging; CT, computed tomography; FDG-PET, fluorodeoxyglucose-positron emission tomography; MIBG, 123I-metaiodobenzylguanidine.
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Treitz ( Figures 1G-I ). There were no abnormally enlarged retroperitoneal lymph nodes, and no obvious abnormalities were observed in the liver, gallbladder, spleen, kidney, and gastrointestinal tract. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed FDG accumulation in these tumors ( Figure 1J ). 123I-metaiodobenzylguanidine (MIBG) scintigraphy also showed an accumulation in an area consistent with a mass, but because of the close proximity of the two tumors, the hormone production of the smaller tumor could not be identified ( Figure 1K ). Although he underwent esophagogastroduodenoscopy, endoscopic ultrasonography, and enteroscopy, the tumor still could not be identified ( Figures 1L-O ).
Pathological findings of the paraganglioma of the duodenum. (A, B) Gross findings of the duodenal tumor. (C) Hematoxylin and eosin staining, high-power field. The tumor was positive for chromogranin A (D) and tyrosine hydroxylase (E) but negative for SDHB (F) and ChAT (G). SDHB, succinate dehydrogenase complex iron sulfur subunit B; ChAT, choline acetyltransferase.
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In addition, the fact that his twin brother had died owing to a hypertensive crisis when he was 23 years old came to light ( Figure S2 ). Histologically, the tumor was mainly located in the submucosal to subserosal layer ( Figure 2 ).