Duodenal gangliocytic paraganglioma treated with endoscopic hemostasis and resection.

Gangliocytic paragangliomas are exceedingly rare tumors that arise in close proximity to the papilla of Vater. There are few reports of the endoscopic resection of duodenal gangliocytic paraganglioma. A 61-year-old woman was admitted with a complaint of melena. Endoscopic examination revealed a pedunculated submucosal tumor with erosion in the third portion of the duodenum. Hemostasis, using a gold probe, was performed. Nine days later, we successfully resected the tumor, using endoscopic polypectomy. To determine the depth of tumor invasion, endoscopic ultrasonography was used. The size of the tumor was 3.0 x 2.5 x 1.0 cm. A total of 25 cases of duodenal gangliocytic paraganglioma have been reported in Japan. Generally, this tumor is considered benign. However, resection was performed in many patients because preoperative diagnosis was impossible. In Japan, no previous studies have reported using endoscopic hemostasis, to our knowledge. Our patient is the fourth in Japan to be treated by endoscopic resection. We report on our patient, with a review of the literature.

Spontaneous esophageal submucosal hematoma in which the course could be observed endoscopically.

A 66-year-old man was hospitalized after vomiting blood after inducing vomiting using his fingers due to laryngeal discomfort. Upper digestive tract endoscopy revealed a large, dark red mass that connected from the upper esophagus to the lower esophagus. Esophageal submucosal hematoma was diagnosed using endoscopy, X-ray images, a small-diameter ultrasonic probe, and chest CT scanning. Pain from the epigastrium to the larynx disappeared after 3 days. Melena occurred on Day 3. Endoscopic examination revealed that the hematoma had collapsed over a wide area. Endoscopic examination after one week showed that the mucous membrane covering the hematoma had peeled away revealing an extensive shallow ulcer in the esophagus. Endoscopic examination after one month confirmed the ulcer had scarred and healed.

Ileal schwannoma in which blood loss scintigraphy was useful for diagnosis.

An 85-year-old woman was hospitalized with severe melena of unknown origin. Upper gastrointestinal (GI) endoscopy and lower GI endoscopy did not detect the origin and we could not establish any diagnosis. To explore the bleeding site, 99mTc-HSA blood loss scintigraphy was performed and a tumor of the small intestine was suspected. Fluoroscopic examination of the small intestine and abdominal CT scan confirmed an ileal tumor measuring 4x3 cm. The mass was a well-demarcated tumor about 80 cm proximal to Bauhin's valve. Partial resection of the ileum was carried out and the tumor was histologically diagnosed as schwannoma. Thereafter, there has been no recurrence of melena nor metastasis of the tumor. It is thought that blood loss scintigraphy is a useful method for unexplained exacerbation of melena.