PMC3004405_01
Axial noncontrast CT abdomen demonstrates a retroperitoneal soft tissue lesion (arrowheads) with lobulated margins and a central calcification. Prominent vessels are noted around the lesion. The second duodenal portion contacts the mass (arrow).
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fig1
In light of this, a computed tomography (CT) scan of the abdomen and pelvis was performed in early 2006 demonstrating a hypervascular retroperitoneal mass intimately related to the pancreas (Figures 1, 2, and 3).
Axial contrast enhanced CT abdomen shows a hypervascular retroperitoneal mass (arrowheads) with enlarged surrounding vessels (large arrow). No cleavage plane is noted between the duodenum and the mass (short arrow). Also the mass contacts the inferior vena cava (IVC).
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fig2
In light of this, a computed tomography (CT) scan of the abdomen and pelvis was performed in early 2006 demonstrating a hypervascular retroperitoneal mass intimately related to the pancreas (Figures 1, 2, and 3).
Contrast enhanced CT abdomen. Curved multiplanar reconstruction demonstrates an intimal relation of the retroperitoneal paraganglioma, and the proximal pancreas, duodenum (d), and IVC. Pancreatic body and tail show parenchymal atrophy and pancreatic ductal dilatation (arrows). SMA: superior mesenteric artery.
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fig3
In light of this, a computed tomography (CT) scan of the abdomen and pelvis was performed in early 2006 demonstrating a hypervascular retroperitoneal mass intimately related to the pancreas (Figures 1, 2, and 3).
Paraganglioma composed of dual cell population arranged in characteristic nested pattern "zellballen" (20x).
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fig4
These cell nests, referred to as "zellballen", are characteristic of paragangliomas (Figure 4).
Synaptophysin (brown immunohistochemical stain) confirms neuroendocrine origin, supporting the diagnosis of paraganglioma (20x).
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fig5
Immunohistochemical stains on the permanent section specimen, including chromogranin, synaptophysin, and S100, confirmed the neuroendocrine origin of this neoplasm (Figure 5).
Axial contrast enhanced CT abdomen. Two years imaging follow-up shows interval decrease in size of the paraganglioma. Perilesional fat stranding is related to prior surgical procedure and radiation therapy (arrowhead).
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fig6
Surveillance CT imaging on 9/2009 demonstrated a mildly smaller retroperitoneal paraganglioma without evidence of recurrence or spread of either primary (Figure 6).