Multimodality imaging of multiple duodenal gangliocytic paragangliomas with post-surgical recurrence

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A 68-year-old man consulted for abdominal pain. CT exam showed 3 clustered complex cystic lesions arising from or abutting the duodenum measuring 1.5, 2.5 and 8 cm (Fig. 1). An esophagogastroduodenoscopy was performed with the biopsy showing evidence of gangliocytic paraganglioma (GP). A subsequent F-18 FDG PET/CT scan showed hypermetabolic septations and mural nodules of the CT-depicted lesions (Fig. 1). The patient underwent excision of all the masses with the surgical pathology confirming GP.