A Case of Paraganglioma as an Unusual Tenant of Gallbladder

Abstract

Gallbladder paraganglioma is an exceptionally uncommon tumour. Paragangliomas are a subset of Neuroendocrine Neoplasms (NENs) called neurogenic NENs that arise from neural crest cells of the neuroectoderm. They present diagnostic challenges due to their uncommon occurrence and non specific clinical manifestations. The paraganglion system consists of two cell types, called chief and sustentacular cells. The most common location of a paraganglioma is the adrenal medulla, defined as pheochromocytoma. Pheochromocytomas, found in the adrenal medulla, are known for their high Catecholamine (CA) production, leading to significant clinical manifestations like hypertension and metabolic disturbances. A 36-year-old female, otherwise asymptomatic, underwent cholecystectomy due to persistent abdominal discomfort in the right hypochondrium for two months. Preoperative imaging demonstrated a gallstone. Laparoscopic cholecystectomy was performed. The pathological analysis following surgery documented the presence of gallbladder paraganglioma and chronic cholecystitis. Immunohistochemically, chief cells displayed widespread positivity for chromogranin, synaptophysin, and sustentacular cells displayed S100 positivity. There are no definitive guidelines for the management of gallbladder paragangliomas due to their rarity. Reporting instances of paraganglioma in the gallbladder is critical to raising clinical awareness, enhancing diagnostic criteria, optimising treatment protocols, and unravelling the underlying molecular mechanisms. All of these efforts are critical for improving patient care and outcomes in treating this uncommon and enigmatic tumour entity.

Keywords

• cholecystectomy
• histopathology
• neuroendocrine tumour
• paraganglia