J Korean Soc Radiol.  2019 Nov;80(6):1258-1264. 10.3348/jksr.2019.80.6.1258.

Malignant Gastric Paraganglioma with Liver Metastasis: Imaging Findings and Literature Review

• Kim YR
• Lee YH
• Yun KJ

• KMID: 2464924
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1258

Abstract

Paraganglioma is a neuroendocrine tumor that grows in organs other than the adrenal gland and typically originates in the chromaffin cells, which are distributed along the regions of the sympathetic and parasympathetic branches of the nervous system in the entire body. Abdominal paraganglioma mainly arises in the retroperitoneum, which lines the sympathetic nerve branches; it rarely arises in other anatomical structures. In only a few cases reported in the literature, paraganglioma originated from the stomach. According to the current and previous case reports, gastric paraganglioma seems to be a hypervascular tumor growing around the stomach; it can be easily contrast-enhanced and may be accompanied by distant metastases.

MeSH Terms

Adrenal Glands
Chromaffin Cells
Liver*
Magnetic Resonance Imaging
Multidetector Computed Tomography
Neoplasm Metastasis*
Nervous System
Neuroendocrine Tumors
Paraganglioma*
Paraganglioma, Extra-Adrenal
Stomach

Figure

• 

  Fig. 1 Gastric paraganglioma in a 61-year-old man. A. Coronal portal-phase CT shows a large hypervascular mass, with heterogeneous enhancement in the right upper quadrant of the abdomen. The large mass from the gastric antrum (arrow) has a tortuous peritumoral and intratumoral vessels (arrowheads) (left image). Coronal maximal intensity projection CT reveals peritumoral and intratumoral vessels arising in the right gastric, gastroduodenal, gastroepiploic (arrowheads), and superior mesenteric arteries (right image). B. Multiplanar reformatted CT shows that the large mass arises from the gastric antrum (arrow) (left image). Axial T1-weighted in-phase MRI shows hyperintense lesions, which indicate hemorrhage (arrow) (right image). C. Coronal T2-weighted MRI reveals a large heterogeneous hyperintense mass with internal signal void vessels (arrows). Axial T1-weighted fat-suppressed contrast-enhanced MRI shows a heterogeneous enhancing mass with hypervascularity in the gastric antrum. D. Photomicrograph shows epithelioid (arrow) and mesenchymal cells (arrowhead) with some portion of nested pattern (dotted circle) (left, hematoxylin and eosin, × 100). Immunohistochemistry shows tumor cells positive for neuron-specific enolase (right, × 200). E. In the 1-year follow-up, axial portal-phase CT shows multiple enhancing liver masses, confirmed as metastases from the paraganglioma on liver biopsy. Surgical clips after mass excision from the gastric antrum are shown (arrow).

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