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Bahmad HF, Trinh S, Qian L, Terp K, Alloush F, Elajami MK, Kilinc E, Poppiti R. Colonic Ganglioneuroma: A Combined Single-Institution Experience and Review of the Literature of Forty-Three Patients. Diseases 2023; 11:diseases11020069. [PMID: 37218882 DOI: 10.3390/diseases11020069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Ganglioneuromas (GNs) are rare, benign tumors composed of ganglion cells, nerve fibers, and glial cells. Three types of colonic GN lesions exist: polypoid GNs, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. Less than 100 cases of GN are documented in the literature. A 10-year retrospective search of the pathology database at our institution identified eight cases of colonic GNs. All cases were incidental. Seven of the eight cases presented with colonoscopy findings of small sessile polyps (ranging between 0.1 and 0.7 cm) treated with polypectomy, whereas one case showed a 4 cm partially circumferential and partially obstructing mass in the ascending colon, treated with right hemicolectomy. Almost two-thirds of the cases (5/8) demonstrated associated diverticulosis. All cases were positive for S100 protein and Synaptophysin via immunohistochemistry (IHC). No syndromic association was identified in any of the cases. We also conducted a comprehensive review using PubMed to identify cases of colonic GN reported in the literature. In total, 173 studies were retrieved, among which 36 articles met our inclusion criteria (35 patients and 3 cases on animals). We conclude that while most GNs are incidental and solitary small sessile lesions, many can be diffuse and associated with syndromes. In these cases, the tumor can result in bowel obstruction simulating adenocarcinoma.
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Affiliation(s)
- Hisham F Bahmad
- Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Sally Trinh
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Linda Qian
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Kristy Terp
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Ferial Alloush
- Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Mohamad K Elajami
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Ekim Kilinc
- Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Robert Poppiti
- Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Pathology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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2
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Eldredge JA, Manton N, Abu-Assi R. Pediatric Hematochezia Caused by Intestinal Ganglioneuromatous Polyposis. J Pediatr Gastroenterol Nutr 2022; 75:e87. [PMID: 35696713 DOI: 10.1097/mpg.0000000000003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jessica A Eldredge
- From the Department of Gastroenterology, Women's & Children's Hospital, North Adelaide, South Australia
| | - Nicholas Manton
- the Department of Surgical Pathology, SA Pathology (at Women's and Children's Hospital), North Adelaide, South Australia
| | - Rammy Abu-Assi
- the Department of Gastroenterology, Women's & Children's Hospital, South Australia School of Paediatrics, University of Adelaide, North Adelaide, South Australia
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3
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Yan J, Shen Q, Peng C, Pang W, Chen Y. Colocolic Intussusception in Children: A Case Series and Review of the Literature. Front Surg 2022; 9:873624. [PMID: 35465438 PMCID: PMC9018986 DOI: 10.3389/fsurg.2022.873624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundColocolic intussusception is a rare subtype of intussusception mostly caused by juvenile polyps. The treatment of colocolic intussusception caused by other pathologic lead points in children remains poorly understood.MethodA systematic literature review was performed between January 2000 and June 2021 to characterize the comprehensive treatment of colocolic intussusception in children. This report also included patients admitted to our center between January 2010 and June 2021 who were not previously reported in the literature.ResultsWe identified 27 patients in 20 studies in addition to 17 patients from our center for a total of 44 patients (median age, 4.4 years; 52.3% male). The lead point was identified in 40 patients (40/44, 90.9%). The most common lead point was juvenile polyps (19/44, 43.2%). A therapeutic enema was performed in 15 patients with colocolic intussusception caused by juvenile polyps and was successful in 9 patients (9/15, 60.0%). Colonoscopic polypectomy was subsequently performed in 8 patients and was successful in 7 patients (7/8, 87.5%). The other patient had undergone laparoscopic exploration, and no abnormality was found. Subsequently, the patient underwent open surgery. The patients with colocolic intussusception caused by other pathologic lead points almost underwent surgical treatment (15/21, 71.4%), including 13 open surgeries and 2 laparoscopic surgeries.ConclusionA therapeutic enema followed by colonoscopic polypectomy is feasible to treat colocolic intussusception caused by juvenile polyps unless the patient has bowel perforation; however, surgery is sometimes needed. For patients with colocolic intussusception caused by other pathologic lead points, open surgery remains the primary treatment.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qiulong Shen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Chunhui Peng
- Department of General Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yajun Chen
- Department of General Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yajun Chen
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Essa M. Neonatal intestinal diffuse ganglioneuromatosis with plexiform neurofibromas; Diagnostic and management pitfalls-A case report. Clin Case Rep 2022; 10:e05173. [PMID: 35198200 PMCID: PMC8841024 DOI: 10.1002/ccr3.5173] [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: 03/29/2021] [Revised: 09/28/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022] Open
Abstract
Neonatal intestinal ganglioneuroma and neurofibromatosis are rare in neonates. It is a challenging pathology to diagnose and treat. A 3-week-old full-term newborn with a birth weight of 3.5 kg of Arabic ethnicity presented to the emergency department with a recurrent refractory intestinal obstruction. The patient has been diagnosed initially with intestinal obstruction secondary to malrotation and then operated again because of adhesion and internal herniation. Finally, after the third laparotomy, the patient was diagnosed with intestinal ganglioneuromatosis and neurofibromatosis. We reviewed the literature on the diagnosis and management of this rare pathology among neonates and to increase the awareness of it. Intestinal ganglioneuromatosis is a rare neonatal pathology. The clinical presentation of intestinal ganglioneuromatosis is similar to that of intestinal obstructions caused by many other diseases. Ganglioneuromatosis is differentiated from other differential diagnoses based on histopathology. Early diagnosis is vital to ensure appropriate management.
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Affiliation(s)
- Madani Essa
- Departments Pediatric SurgeryJazan Faculty of MedicineJazan UniversityJazanSaudi Arabia
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5
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Successful colonoscopic decompression of colocolic intussusception with polypectomy in a five-year-old. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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6
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The diagnosis and treatment of retrograde intussusception: a single-centre experience. BMC Surg 2021; 21:398. [PMID: 34774032 PMCID: PMC8590751 DOI: 10.1186/s12893-021-01391-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background/Purpose To investigate the clinical manifestations, treatments of retrograde intussusception and summarize the experience. Methods Children with retrograde intussusception treated in our hospital from January 2011 to January 2021 were retrospectively analysed. Demographics, clinical manifestations, preoperative colour Doppler ultrasound (CDU) findings, findings during surgery and follow-up results were collected. Results A total of 4719 cases of intussusception were treated in our department, including 12 cases of retrograde intussusception (0.25%). There were 8 males and 4 females.The age ranged from 4.1 to 14.3 months, with an average of (8.3 ± 2.8) months.; The weight ranged from 5.5 to 12.6 kg, with an average of (9.4 ± 2.3) kg; The onset time ranged from 6 to 15 h, with an average of (10.0 ± 2.4) h. All the children received CDU examination before surgery, and in one case, the possibility of 2 intussusception masses was considered. Emergency surgical exploration was performed after the failure of air enema reduction. During the operation, multiple types of intussusception were found (coincidence of anterograde and retrograde intussusception). The pattern of anterograde intussusception was all ileo-ileo-colic variety and the retrograde intussusception was proximal sigmoid colon into descending colon. All the children were successfully reduced by manual reduction without intestinal necrosis or intestinal malformation. All children were discharged 6–7 days after surgery, and had no recurrence after 3–6 months of follow-up. Conclusions Retrograde intussusception is easily misdiagnosed before surgery. During air enema, if the intussusception mass was fixed and did not move with increasing pressure, we should be aware of the possibility of retrograde intussusception, and the enema pressure should not be too large to avoid intestinal perforation. If the intraoperative position of the intussusception mass was not consistent with that of the preoperative enema, it was recommended to use bimanual examination to explore whether there was still a mass in the abdominal cavity to avoid misdiagnosis.
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7
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Baiomi A, Abbas H, Niazi M, Remotti H, Daniel M, Balar B. Colonic Ganglioneuroma: A Rare Lesion With Extremely Different Presentations and Outcomes in Two Patients. Gastroenterology Res 2021; 14:194-198. [PMID: 34267836 PMCID: PMC8256904 DOI: 10.14740/gr1379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/16/2021] [Indexed: 01/17/2023] Open
Abstract
Ganglioneuroma (GN) of the gastrointestinal tract is an extremely rare neuroectodermal tumor. Patients with ganglioneuromas have different presentations depending on the location, extent and size of the lesion. We present two cases of ganglioneuromas that had different clinical presentations and outcomes.
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Affiliation(s)
- Ahmed Baiomi
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Hafsa Abbas
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Masooma Niazi
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Pathology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Helen Remotti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | - Myrta Daniel
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
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8
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Mauro A, Zenzeri L, Esposito F, Gaglione G, Strisciuglio C, Pilozzi E, Corleto VD, Ziparo C, Di Nardo G. Isolated intestinal Ganglioneuromatosis: case report and literature review. Ital J Pediatr 2021; 47:80. [PMID: 33785023 PMCID: PMC8008650 DOI: 10.1186/s13052-021-01024-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intestinal Ganglioneuromatosis (IG) is a rare disorder of the enteric nervous system. In pediatric age it is often associated with genetic syndromes such as Neurofibromatosis 1 (NF1), multiple endocrine neoplasia type 2B (MEN2B) and Cowden syndrome (PTEN mutation), and ganglioneuromas (GNs) may be sometimes the first sign of the disease. Isolated GNs are rare and sporadic. Clinical symptom vary and depend on the size and on the location of the GNs. This disorder affects intestinal motility and it, consequently, causes changes in bowel habits, abdominal pain, occlusive symptoms and rarely lower gastrointestinal bleeding secondary to ulceration of the intestinal mucosa. On the other hand, patients can remain asymptomatic for many years. CASE PRESENTATION We describe a 9-year-old boy referred to our emergency department for right lower quadrant abdominal pain. No familial history for gastrointestinal disorders. No history of fever or weight loss. At physical examination, he had diffused abdominal pain. Abdominal ultrasonography showed a hypoechoic formation measuring 41.8 mm by 35 mm in the right lower quadrant of the abdomen. Routine blood tests were normal, but fecal occult blood test was positive. Abdominal TC confirmed the hypodense formation, of about 5 cm in transverse diameter, in the right hypochondrium that apparently invaginated in the caecum-last ileal loop. Colonoscopy showed in the cecum an invaginated polypoid lesion of the terminal ileal loop. Laparoscopic resection of the polypoid lesion was performed. Histological diagnosis of the large neoplasm observed in the terminal ileum was diffuse ganglioneuromatosis. NF1, RET and PTEN gene tests resulted negative for specific mutations. At the 1 year follow-up, the patient presented good general condition and blood tests, fecal occult blood test, esophagogastroduodenoscopy, colonoscopy and MR-enterography were negative. CONCLUSIONS Only few cases are reported in literature of IG in pediatric age. Although rare, the present case suggests that this disorder must be taken in consideration in every patient with GI symptoms such as abdominal pain, constipation, lower intestinal bleeding, in order to avoid a delayed diagnosis.
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Affiliation(s)
- Angela Mauro
- Pediatric Emergency Unit, AORN Santobono-Pausilipon, Naples, Italy
| | - Letizia Zenzeri
- Pediatric Emergency Unit, AORN Santobono-Pausilipon, Naples, Italy
| | - Francesco Esposito
- Department of Emergency Radiology, AORN Santobono-Pausilipon, Naples, Italy
| | | | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuela Pilozzi
- Department of Clinical and Molecular Medicine, UOC Anatomia Patologica, Sant' Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Vito Domenico Corleto
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Chiara Ziparo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
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Occurrence of paratesticular ganglioneuroma 18 years after concurrent adrenal ganglioneuroma and papillary thyroid carcinoma - a case report. BMC Cancer 2019; 19:1265. [PMID: 31888521 PMCID: PMC6937970 DOI: 10.1186/s12885-019-6440-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/08/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Ganglioneuromas (GNs) are composed of mature ganglion cells and Schwann cells with a fibrous stroma; GNs are most often observed in children and young adults. The majority of non-cranial GNs are located in the retroperitoneum and posterior mediastinum. Other reported rare sites include the adrenal gland, small intestine, colon and urinary bladder. However, para-testicular GNs are even more rare. CASE PRESENTATION Herein, we report the case of a patient with concurrent adrenal GN and thyroid papillary carcinoma who developed paratesticular GN eighteen years later. CONCLUSIONS We conclude that there is an association among papillary thyroid carcinoma, GN and MEN2 syndromes. This case report may provide important information for the proposed association. However, further studies are required.
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10
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Morgan KM, Erwin PA, Rochester SN, Williams CF, Gates RL. Pediatric gastric ganglioneuroma presenting as anemia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Abdelfatah M, Sangah G, Harvin G. What Do We Need to Know About Colonic Polypoid Ganglioneuroma? A Case Report and A Comprehensive Review. J Gastrointest Cancer 2016; 49:327-332. [PMID: 27888390 DOI: 10.1007/s12029-016-9892-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mohamed Abdelfatah
- Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Brody School of Medicine at East Carolina University, Suite 338, Mail Stop 734, Greenville, NC, USA.
| | - George Sangah
- Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Brody School of Medicine at East Carolina University, Suite 338, Mail Stop 734, Greenville, NC, USA
| | - Glenn Harvin
- Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Brody School of Medicine at East Carolina University, Suite 338, Mail Stop 734, Greenville, NC, USA
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Sherman JL, Darbinyan A, Magid MS, Ong P, Weissman B, Benkov K, Lipskar AM. Pediatric colonic inflammatory myofibroblastic tumor presenting as colo-colonic intussusception: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Kee HM, Park JY, Yi DY, Lim IS. A Case of Intussusception with Acute Appendicitis. Pediatr Gastroenterol Hepatol Nutr 2015; 18:134-7. [PMID: 26157700 PMCID: PMC4493247 DOI: 10.5223/pghn.2015.18.2.134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/08/2014] [Accepted: 12/13/2014] [Indexed: 11/14/2022] Open
Abstract
In children presenting to hospital with gastrointestinal symptoms, diseases such as intussusception and acute appendicitis require particular attention and careful examination. Early diagnosis and proper treatment are important because of possible severe complications such as peritonitis and death. Intussusception and appendicitis share similar clinical manifestations. More importantly, the presence of acute appendicitis together with intussusception in children is very rare. We describe an interesting case of a 38-month-old boy who presented with abdominal pain in the right lower quadrant. His vital signs were stable and laboratory test findings showed no specific alterations. We detected tenderness in the right lower quadrant. A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception. The patient underwent an appendectomy and manual reduction.
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Affiliation(s)
- Hyung Min Kee
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
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14
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Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review. J Endocrinol Invest 2015; 38:547-54. [PMID: 25501841 DOI: 10.1007/s40618-014-0226-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Ganglioneuromas are benign tumors which originate from the neural crest. This tumor affects mainly young patients rather than adult ones, and its most frequent localizations are mediastinum, retroperitoneum, adrenal glands and cervical region. Usually, ganglioneuromas are discovered as incidentalomas since they are often asymptomatic, even if they could present sympathetic or mass-related symptoms. To obtain a definitive diagnosis, histological exam is necessary since CT scan and MRI are not capable of distinguishing ganglioneuromas from other tumors, such as neuroblastomas or pheocromocytomas. The surgical excision is the chosen treatment and it offers an excellent prognosis. METHODS We conducted a retrospective analysis of our cases of ganglioneuroma from 2004 to 2014; this study aims to compare our experience with literature review (2000-2014). Data about patients' features, tumor localization, symptoms, treatment and follow-up were analyzed and reported in detailed tables. RESULTS Between 2004 and 2014 we treated 14 patients affected by ganglioneuroma. For all of them the diagnosis was incidental; 9 out of 12 (64.3 %) patients presented an adrenal mass; in 2 patients (14.3 %) the tumor was localized in cervical region; in other 2 patients (14.3 %) the tumor was in the retroperitoneum and one patient (7.1 %) presented a ganglioneuroma in the costo-vertebral space. All our patients underwent surgical removal and none of them present surgery-related complications or recurrences to date. CONCLUSIONS Our data widen the knowledge about ganglioneuroma and confirm that the surgical approach has an excellent prognosis with very low incidence of surgery-related complications and recurrences.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A Barbetta
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - C Ugolini
- Department of Laboratory Medicine and Integrated Diagnostics, Section of Experimental Pathology, University of Pisa, Pisa, Italy.
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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15
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Lu C, Qiu Y, Lu X, Li G, Bu H. Synchronous diffuse ganglioneuromatosis and multiple schwannomas of the colon: A case report and literature review. Exp Ther Med 2015; 9:733-736. [PMID: 25667620 PMCID: PMC4316863 DOI: 10.3892/etm.2015.2212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/07/2015] [Indexed: 02/05/2023] Open
Abstract
Diffuse ganglioneuromatosis (DG) of the gastrointestinal tract is a rare condition that is closely associated with neurofibromatosis type 1 and multiple endocrine neoplasia type 2B. The occurrence of DG with multiple schwannomas, which, of the GI tract, usually affect the stomach, is considerably more rare. The present study describes the case of a 54-year-old male with indolent DG, principally involving the small intestine and colon, associated with multiple schwannomas in the subserosa. The patient was treated with surgery. A brief overview of intestinal ganglioneuromatous lesions and the associated conditions is additionally presented.
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Affiliation(s)
- Changli Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan Qiu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xufeng Lu
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Gandi Li
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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16
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Matthews MA, Adler BH, Arnold MA, Kumar S, Carvalho R, Besner GE. Diffuse intestinal ganglioneuromatosis in a child. J Pediatr Surg 2013; 48:1129-33. [PMID: 23701793 PMCID: PMC4076949 DOI: 10.1016/j.jpedsurg.2013.03.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/14/2013] [Accepted: 03/17/2013] [Indexed: 12/26/2022]
Abstract
A 7 year old male with a history of congenital neutropenia and growth hormone deficiency presented with abdominal pain, fevers, and diarrhea. Imaging and endoscopy revealed significant inflammation of the ascending colon with stenosis at the level of the hepatic flexure. A right hemicolectomy was performed, and pathologic findings were consistent with diffuse intestinal ganglioneuromatosis. Due to recurrent mass effect at the intestinal anastomotic site detected radiologically, a second intestinal resection was performed 7 months later. Genetic testing was negative for mutations in the RET protooncogene, NF1 and PTEN tumor suppressor genes. We report a case of diffuse intestinal ganglioneuromatosis in a child with congenital neutropenia.
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Affiliation(s)
- Mika A.B. Matthews
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Brent H. Adler
- Department of Radiology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Michael A. Arnold
- Department of Pathology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Soma Kumar
- Department of Gastroenterology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Ryan Carvalho
- Department of Gastroenterology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Gail E. Besner
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA,Corresponding author. Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, ED321, Columbus, OH 43205. Tel.: +1 614 722 3900; fax: +1 614 722 3903. (G.E. Besner)
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Colocolic intussusception in an older child: a rare case report and a literature review. Case Rep Surg 2013; 2013:106831. [PMID: 23533908 PMCID: PMC3600280 DOI: 10.1155/2013/106831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/04/2013] [Indexed: 11/18/2022] Open
Abstract
Intussusception is a common cause of intestinal obstruction and colicky abdominal pain in the children, particularly infants, the commonest being the ileocolic variety with colocolic variety being a very rare entity. We present a case of colocolic intussusception in a 13-year-old boy which is otherwise seen in adults, precipitated by colonic malignancies. The patient presented with acute abdominal pain and bleeding perrectum with obstipation for 7 days. Preoperative USG abdomen was normal, and abdominal X-rays showed multiple air fluid levels. Intraoperative findings included a polypoidal growth in the descending colon as the leading point with the formation of a colo-colic intussusception. Following reduction and segmental resection, histopathology reported mucinous adenocarcinoma of colon which is also a rarity in pediatric age group. This case has been compared with previous cases reported in the literature.
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18
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AHmad Z, Khan R, Barakzai A, Ahmed A, Qureshi A. Diffuse ganglioneuromatosis of intestine in a 15-year-old girl. BMJ Case Rep 2011; 2011:bcr.04.2011.4151. [PMID: 22692783 DOI: 10.1136/bcr.04.2011.4151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present the case of a 15-year-old girl with diffuse ganglioneuromatosis, principally involving the caecum. This is a rare condition and usually associated with multiple endocrine neoplasm IIb and neurofibromatosis type I. In our case, the myentric nerve plexus was exclusively involved. The patient presented with episodes of vomiting and weight loss. So far, to our knowledge no other manifestations of the above mentioned genetic conditions have become apparent in this patient.
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Affiliation(s)
- Zubair AHmad
- Department of Pathology, Aga Khan University, Karachi, Pakistan
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Loukas M, Pellerin M, Kimball Z, de la Garza-Jordan J, Tubbs RS, Jordan R. Intussusception: An anatomical perspective with review of the literature. Clin Anat 2011; 24:552-61. [DOI: 10.1002/ca.21099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 08/10/2010] [Accepted: 10/25/2010] [Indexed: 12/24/2022]
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20
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Suksamanapun N, Uiprasertkul M, Ruangtrakool R, Akaraviputh T. Endoscopic treatment of a large colonic polyp as a cause of colocolonic intussusception in a child. World J Gastrointest Endosc 2010; 2:268-70. [PMID: 21160618 PMCID: PMC2999144 DOI: 10.4253/wjge.v2.i7.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/26/2010] [Accepted: 07/03/2010] [Indexed: 02/05/2023] Open
Abstract
Colocolonic intussusception is an uncommon cause of intestinal obstruction in children. The most common type is idiopathic ileocolic intussusception. However, pathologic lead points occur approximately in 5% of cases. In pediatric patients, Meckel’s diverticulum is the most common lead point, followed by polyps and duplication. We present a case of recurrent colocolonic intussusception which caused colonic obstruction in a 10-year-old boy. A barium enema revealed a large polypoid mass at the transverse colon. Colonoscopy showed a colonic polyp, 3.5 centimeters in diameter, which was successfully removed by endoscopic polypectomy.
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Affiliation(s)
- Nutnicha Suksamanapun
- Nutnicha Suksamanapun, Ravit Ruangtrakool, Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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21
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Puig I, Champeval D, De Santa Barbara P, Jaubert F, Lyonnet S, Larue L. Deletion of Pten in the mouse enteric nervous system induces ganglioneuromatosis and mimics intestinal pseudoobstruction. J Clin Invest 2009; 119:3586-96. [PMID: 19884655 DOI: 10.1172/jci39929] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/09/2009] [Indexed: 01/21/2023] Open
Abstract
Intestinal ganglioneuromatosis is a benign proliferation of nerve ganglion cells, nerve fibers, and supporting cells of the enteric nervous system (ENS) that can result in abnormally large enteric neuronal cells (ENCs) in the myenteric plexus and chronic intestinal pseudoobstruction (CIPO). As phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a phosphatase that is critical for controlling cell growth, proliferation, and death, we investigated the role of PTEN in the ENS by generating mice with an embryonic, ENC-selective deletion within the Pten locus. Mutant mice died 2 to 3 weeks after birth, with clinical signs of CIPO and hyperplasia and hypertrophy of ENCs resulting from increased activity of the PI3K/PTEN-AKT-S6K signaling pathway. Further analysis revealed that PTEN was only expressed in developing mouse embryonic ENCs from E15.5 and that the rate of ENC proliferation decreased once PTEN was expressed. Specific deletion of the Pten gene in ENCs therefore induced hyperplasia and hypertrophy in the later stages of embryogenesis. This phenotype was reversed by administration of a pharmacological inhibitor of AKT. In some human ganglioneuromatosis forms of CIPO, PTEN expression was found to be abnormally low and S6 phosphorylation increased. Our study thus reveals that loss of PTEN disrupts development of the ENS and identifies the PI3K/PTEN-AKT-S6K signaling pathway as a potential therapeutic target for ganglioneuromatosis forms of CIPO.
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Affiliation(s)
- Isabel Puig
- Institut Curie, Centre de Recherche, Developmental Genetics of Melanocytes, Orsay, France
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