49 year-old woman with hematemesis (vomiting blood) and anemia. Endoscopy revealed a 2 cm smooth polypoid mass in the descending duodenum, best seen with a side-viewing duodenoscope. The lesion was soft and completely obscured the ampulla, which could not be located endoscopically.


The lesion was ulcerated, with intermittent bleeding (see below). Endoscopic biopsies, taken from both the ulcer and surrounding tissue, were nondiagnostic.


Bleeding from the ulcerated focus, which occurred prior to biopsy. At surgery, the lesion could be seen to arise adjacent to the ampulla, which appeared normal. The lesion did not extend beyond the duodenum. Microscopic exam of the resected specimen provided the diagnosis of paraganglioma.