Paraganglioma of the Stomach

While numerous references to benign tumors of the stomach are to be found in the literature, a fairly careful search has revealed only one report of a gastric paraganglioma, that of Jones and McKee, in 1949. We present here the clinical history and operative findings in an additional case. Like Jones and McKee, we define paraganglioma as a chromaffin tumor occurring outside the adrenal as contrasted to a similar growth within the gland.

Case Report

E. E., a white male executive, 50 years of age, was admitted to the Evanston Hospital on June 26, 1951, complaining of hematemesis and melena. For many years he had experienced intermittent episodes of dull pain in the left upper abdominal quadrant, lasting for approximately a week. The pain was not related to meals but was relieved by a bland diet. Ingestion of coarse foods produced epigastric distress frequently followed by the passage of a tarry stool. Two days before admission there had been an attack of gastric discomfort, relieved by an antacid, but accompanied by a tarry stool. Severe hematemesis had occurred the following day, and again a tarry stool was passed.

Pertinent laboratory findings included a hemoglobin level of 11.5 gm. per 100 c.c. and a red cell count of 3,600,000.

X-ray examination of the stomach showed a filling defect in the antrum, just proximal to the pylorus, measuring 4.0 cm. in diameter and smooth in outline (Fig. 1). This was believed to represent a tumor, while a second small defect near its base suggested an ulcer in the tumor. On fluoroscopic examination, the stomach appeared freely movable, with peristaltic waves passing over the tumor. A benign lesion, as a leiomyoma, aberrant pancreas, adenoma, or lipoma, was suspected.

On July 9, 1951, the abdomen was opened through an upper mid-line incision. On the anterior antral wall of the stomach were four masses of tissue, red to gray in color, 0.25 cm. in greatest diameter, growing through the gastric wall from the rounded intragastric lesion. There was no adherence of this portion of the stomach to any surrounding tissue. Pieces of these tissues were sent to the laboratory for immediate frozen section and examination. Gastrotomy was done, and the gastric mucous membrane covering the rounded lesion in the gastric wall was divided, exposing a fairly firm, smooth, round granular tumor beneath. At one point there was an ulceration of the gastric mucous membrane, no doubt the source of the previous hemorrhage. Biopsy of this mass was done, and a tentative report of undifferentiated carcinoma was made. Consequently a gastrectomy with resection of the omentum and surrounding lymph nodes was performed. Recovery was uneventful.

The surgical specimen (Fig. 2) consisted of a segment of stomach measuring 11 × 6 × 3 cm., with attached tissue of the greater and lesser omentum. In the greater curvature, 4.0 cm. from the distal line of resection, was a nodular tumor measuring 3.0 cm. in diameter.