Mesenteric paraganglioma mimicking nodal metastasis of an occult small intestinal neuroendocrine tumor.

Paragangliomas (PGLs) are rare neuroendocrine neoplasms of neural-crest origin, with primary mesenteric localization representing an exceptionally uncommon entity that is rarely considered in the preoperative differential diagnosis of mesenteric masses. We report the case of a 51-year-old woman who was referred to our institute following the incidental detection of a 12 × 9 mm hypervascular nodule within the pelvic small bowel mesentery on contrast-enhanced computed tomography (CT). Subsequent Learning points: Primary mesenteric paragangliomas should be considered in the differential diagnosis of solitary, hypervascularized mesenteric masses.A solitary SSTR-avid mesenteric nodule in an asymptomatic, biochemically silent patient does not necessarily imply nodal metastasis from an occult small intestinal neuroendocrine tumor.Considering alternative diagnoses may avoid unnecessary endoscopic, radiological, and surgical investigations for an intestinal primary lesion.Definitive diagnosis and risk stratification rely on histopathology and immunohistochemistry, including epithelial markers, GATA3, and SDHB.Awareness of mesenteric paraganglioma as a diagnostic mimic can prevent overtreatment and guide appropriate surgical management.