Papaetis GS, Georgiadis CP, Tsitskari MA, Constantinou PG, Antoniou AP. Retroperitoneal ganglioneuroma causing chronic lower back and leg pain in an 80-year-old man: A case report.
Ann Med Surg (Lond) 2020;
61:101-103. [PMID:
33437470 PMCID:
PMC7785993 DOI:
10.1016/j.amsu.2020.12.027]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction
and importance: Retroperitoneal ganglioneuromas that cause lower back and leg pain are extremely rare and are often misdiagnosed. Surgical resection has excellent prognosis in long-term survival.
Case presentation
We present an 80-year-old man with two-year worsening left lower back and leg pain. He was treated as presumed lumbar spine spondylosis with several courses of physical therapy together with medical treatment. An abdomen CT scan disclosed a tumour in the left retrorenal space. The tumour was resected and the histopathologic examination suggested a completely excised retroperitoneal ganglioneuroma. During one-year follow-up the patient is free of pain without any local recurrence.
Clinical discussion
Retroperitoneal ganglioneuromas are rare benign tumors that originate from neural crest-derived cells of the paravertebral sympathetic plexus and sometimes from the adrenal medulla. They are usually asymptomatic and discovered on routine clinical examination or on autopsy. Occasionally they may show symptoms due to local pressure effect or rarely they are hormonally active and present with adrenergic symptoms. Complete resection of the tumor is important in order establish the final diagnosis and alleviate symptoms from pressure effects.
Conclusion
This case highlights the need for great vigilance among physicians in order to consider any possible retroperitoneal pathology when indicated in the differential diagnosis of lower back and leg pain, before establishing other more common diagnosis, especially in the older population.
Retroperitoneal ganglioneuromas that cause lower back and leg pain are extremely rare.
They are composed by Schwann cells on nerve fibres and mature sympathetic ganglion cells.
Complete resection of retroperitoneal ganglioneuromas has an excellent prognosis.
High suspicion is required to rule out any retroperitoneal pathology in this clinical setting.
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