Voluminous juxtapapillary gangliocytic paraganglioma.

A 56-year-old woman was referred because of anemia with recurrent melena. The duodenoscopy revealed a voluminous pedunculated submucosal tumor adjacent to the major papilla (A). Standard forceps biopsy specimens were negative for malignancy. Abdominal CTshowed a mass located within the duodenum that appeared solid with central hypodensity (B). There was no evidence of a pancreatic or retroperitoneal mass or lymphadenopathy. Despite the large volume, the tumor was resected endoscopically by electrosurgical snare polypectomy. Arterial bleeding occurred immediately, which was controlled with placement of 3 clips (C). The excised tumor measured 4 2 3 cm (D). The opening of the major papilla was not touched, despite its close location. The outcome