case_images: PMC3004405_01
case_images: 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).
case_images: HPB2010-645728.001.jpg
case_images: PMC3004405_01_HPB2010-645728.001.jpg
case_images: fig1
case_images: 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).
case_images: 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).
case_images: HPB2010-645728.002.jpg
case_images: PMC3004405_01_HPB2010-645728.002.jpg
case_images: fig2
case_images: 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).
case_images: 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.
case_images: HPB2010-645728.003.jpg
case_images: PMC3004405_01_HPB2010-645728.003.jpg
case_images: fig3
case_images: 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).
case_images: Paraganglioma composed of dual cell population arranged in characteristic nested pattern "zellballen" (20x).
case_images: HPB2010-645728.004.jpg
case_images: PMC3004405_01_HPB2010-645728.004.jpg
case_images: fig4
case_images: These cell nests, referred to as "zellballen", are characteristic of paragangliomas (Figure 4).
case_images: Synaptophysin (brown immunohistochemical stain) confirms neuroendocrine origin, supporting the diagnosis of paraganglioma (20x).
case_images: HPB2010-645728.005.jpg
case_images: PMC3004405_01_HPB2010-645728.005.jpg
case_images: fig5
case_images: Immunohistochemical stains on the permanent section specimen, including chromogranin, synaptophysin, and S100, confirmed the neuroendocrine origin of this neoplasm (Figure 5).
case_images: 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).
case_images: HPB2010-645728.006.jpg
case_images: PMC3004405_01_HPB2010-645728.006.jpg
case_images: fig6
case_images: Surveillance CT imaging on 9/2009 demonstrated a mildly smaller retroperitoneal paraganglioma without evidence of recurrence or spread of either primary (Figure 6).