S3231 Unmasking the Silent Giant: Ganglioneuroma of the Pancreatic Head

Introduction: Ganglioneuromas are benign tumors derived from mature ganglion cells, often involving sympathetic or parasympathetic nerve fibers. They are typically found in the retroperitoneum, adrenal glands, or along sympathetic nerve trunks. Pancreatic involvement is extremely rare with very few cases reported in medical literature. This case report describes a 21-year-old man presenting with abdominal pain and found to have a pancreatic mass. Case Description/Methods: A 21-year-old man with no significant past medical history presented with a 12-hour history of periumbilical abdominal pain with radiation to the right upper quadrant. The pain was described as dull with no clear relation to oral intake or body position. The patient reported occasional nausea and early satiety with physical examination only remarkable for mild tenderness in the upper mid-abdomen. Blood work including complete blood count, liver function tests, and pancreatic enzymes were all within normal limits. Initial abdominal ultrasound was inconclusive, prompting further imaging studies. A contrast-enhanced computed tomography scan of the abdomen revealed a well-defined mass in the pancreatic head without evidence of biliary obstruction or pancreatic duct dilation. Magnetic resonance cholangiopancreatography was performed confirming presence of a well-defined heterogeneous mass measuring 5.1 cm × 2.8 cm × 6 cm along the superior margin of the pancreatic head. An endoscopic ultrasound for fine needle aspiration of the mass was done with cytology consistent with ganglioneuroma. The patient was discharged with plans for outpatient hepato-biliary surgery follow up, as well as genetic testing to rule out associated syndromes. Discussion: Pancreatic ganglioneuroma is exceedingly rare, with only a few cases reported in the literature. The clinical presentation is often nonspecific and usually asymptomatic until it reaches a size large enough to cause symptoms related to mass effect like abdominal pain, nausea, vomiting, and jaundice. Imaging studies, including computed tomography and magnetic resonance imaging, are helpful in diagnosis, as ganglioneuromas often present as well-defined, non-calcified masses with a characteristic imaging profile. Surgical resection is the gold standard treatment and prognosis is excellent with no recurrence in a vast majority of cases. Further studies should be performed to check for genetic syndromes including Neurofibromatosis 1 (NF1), Multiple Endocrine Neoplasia Type 2B (MEN2B) and Von Hippel Lindau (VHL).