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Park E, Lee YS, Yi JS, Choi E. Cervical ganglioneuroma as a rare cause of cervicogenic headache: A case report and literature review. J Back Musculoskelet Rehabil 2024:BMR230330. [PMID: 38848167 DOI: 10.3233/bmr-230330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Cervicogenic headache is characterized by chronic posterior neck pain radiating to one side of the head, resulting from cervical spine bone or soft tissue diseases. Cervical ganglioneuroma (GN), a rare benign neuroblastic tumor, especially in the cervical spine, may cause cervicogenic headache-like symptoms. OBJECTIVE We report a case of GN which was surgically removed successfully to relieve the symptom. CASE REPORT A 68-year-old male presented with right posterior neck pain with referred pain to the ipsilateral occipital area in May 2020. Despite administration of medications, physical therapy, and spine interventions, the symptoms intermittently recurred over one year. In July 2021, the patient complained of painful limitation of neck motion, especially on right-sided bending; no motor or sensory deficits, except for subjective numbness of the finger tips, were detected. Plain radiography of the cervical spine showed moderate degenerative changes in the mid-cervical spine. Cervical MRI revealed a cystic mass (1.5 cm × 0.5 cm × 1 cm-in size) around the right C2 dorsal root ganglion adjacent to the C1-C2 facet joint. His symptoms significantly improved after complete tumor excision. CONCLUSION GN of the upper cervical spine should be considered when persistent cervicogenic headache is refractory to conservative management. In such a case, advanced imaging studies such as MRI should be performed for early diagnosis and appropriate treatment.
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Affiliation(s)
- Eunjin Park
- Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Yeon Soo Lee
- Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Eunseok Choi
- Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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Li W, Ou Z, Wu Z, Li L, Ye F, Wen X, Ye D. Development and validation of a prognostic nomogram for patients with ganglioneuroblastoma: A SEER-based study. Heliyon 2024; 10:e30891. [PMID: 38774105 PMCID: PMC11107237 DOI: 10.1016/j.heliyon.2024.e30891] [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: 09/16/2023] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Background The objective of this study was to construct a prognostic nomogram for ganglioneuroblastoma (GNB), as the prognosis of GNB is difficult to accurately predict before therapy. Methods The data were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The patients included in this study were randomly divided into a development group and a validation group at a ratio of 7:3. Univariate and multivariate Cox regression analyses were used to filter the variables. Receiver operating characteristic (ROC) curves and calibration curves were used to assess the nomogram. All patients were redivided into two groups based on their nomogram total points, and overall survival was compared. Results A total of 1194 GNB patients were retrospectively included, with 835 and 359 patients in the development and validation groups, respectively. Five independent prognostic factors, including age, primary tumor site, SEER stage, surgery and chemotherapy, were screened out and included in the nomogram. The consistency index (C-index) of the Cox regression model was 0.862 and 0.827 in the development group and the validation group, respectively. The areas under the receiver operating characteristic (ROC) curve (AUC) showed that the nomogram had good accuracy in predicting 3-, 5- and 10-year overall survival for GNB patients. The calibration curves of the nomogram showed good agreement between the predicted outcomes and the actual observations. The Kaplan-Meier (KM) survival curves revealed that patients with nomogram scores below the median had a better prognosis. Conclusions Age, primary tumor site, SEER stage, surgery and chemotherapy may be independent prognostic factors for GNB. We constructed a nomogram based on the SEER database to predict the prognosis of GNB, but further optimization by adding more risk factors is needed for clinical application.
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Affiliation(s)
- Weiyu Li
- Department of Oncology, Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
- Collaborative Innovation Center for Civil Affairs of Guangzhou, Guangzhou, China
| | - Zhaoxing Ou
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Zhanghai Wu
- Department of Oncology, Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
- Collaborative Innovation Center for Civil Affairs of Guangzhou, Guangzhou, China
| | - Liujun Li
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Feile Ye
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Xin Wen
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Dalin Ye
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
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Bourouail O, Kada A, Bahou K, Sekkat H, Zouaidia F, Derquaoui S, Youness B, Mouna AM, Sabbah F, Hrora A, Raiss M. Large retroperitoneal ganglioneuroma revealed by a left ovarian endometrioma: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241252744. [PMID: 38756330 PMCID: PMC11097720 DOI: 10.1177/2050313x241252744] [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: 11/30/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Uncommon in nature, retroperitoneal ganglioneuroma represents a neuroblastic benign tumor, predominantly manifesting in young adults, with a notable predilection for females. Often asymptomatic, the condition is frequently diagnosed incidentally due to delayed growth. Clinical manifestations arise primarily from the compression exerted on neighboring organs and vessels. The exclusive curative recourse lies in surgical intervention, underscoring the challenging task of achieving complete tumor excision, particularly when the ganglioneuroma attains considerable development and encapsulates significant retroperitoneal vessels. In this instance, we elucidate a case involving a 33-year-old woman, who had previously undergone a triple valve replacement due to rheumatic valvular disease, presenting persistent pelvic pain, unearthing a substantial asymptomatic retroperitoneal ganglioneuroma concomitant with an ovarian endometrioma. A laparotomy procedure was conducted, and to achieve a comprehensive excision of the mass, a meticulous intratumoral circular dissection of the prominent vessels, notably the superior mesenteric artery and celiac trunk, was undertaken. No local recurrence has been reported, 6 months after surgery. The significance of an experienced and well-trained surgical staff is underscored in addressing the complexities associated with this condition.
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Affiliation(s)
- Othmane Bourouail
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Ali Kada
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Khawla Bahou
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Hamza Sekkat
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Fouad Zouaidia
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Sabrine Derquaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Bakali Youness
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Alaoui Mhamdi Mouna
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Farid Sabbah
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Anatomopathology Department, Ibn Sina University Hospital, Rabat, Morocco
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Jiang X, Wu J, Su F, Huang H, Ding Y, Zhu X. Gastric Ganglioneuroblastoma in an Elderly man: A Case Report and Literature Review. Int J Surg Pathol 2024; 32:401-407. [PMID: 37331966 DOI: 10.1177/10668969231177703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background. Ganglioneuroblastoma is a borderline tumor of sympathetic origin that is considered a childhood disease, with the majority of patients occurring in children less than five years old and few patients occurring in adults. There are no treatment guidelines for adult ganglioneuroblastoma. Here, we report a rare patient of adult gastric ganglioneuroblastoma that was completely resected by a laparoscopic approach. Case presentation. A 73-year-old man presented with dull pain in the upper abdomen along with abdominal distension for one month. Gastroscopy examination revealed chronic gastritis and submucosal tumors of the gastric antrum. Endoscopic ultrasonography showed a hypoechoic mass in the gastric antrum arising from the muscularis propria. An abdominal computed tomography scan revealed an irregular soft tissue mass in the gastric antrum with heterogeneous enhancement in the arterial phase. The mass was completely resected by laparoscopic surgery. Postoperative histopathology revealed that the mass contained differentiated neuroblasts, mature ganglion cells and ganglioneuroma components. The pathological diagnosis was ganglioneuroblastoma intermixed, and the patient was determined to be in stage I. The patient received no adjuvant chemotherapy or radiotherapy. At his two-year follow-up, the patient was doing well and showed no signs of recurrence. Conclusion. Despite the rarity of gastric ganglioneuroblastoma as a primary site of origin, it should be considered in the differential diagnosis of gastric masses in adults. Radical surgery is sufficient for the treatment of ganglioneuroblastoma intermixed, and long-term follow-up should be performed.
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Affiliation(s)
- Xuetong Jiang
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Jianqiang Wu
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Feng Su
- Department of Digestion, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Hailong Huang
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Yang Ding
- Department of Pathology, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Xinqiang Zhu
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
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Aydin Goker ET, Yalçın B, Karnak İ, Orhan D, Haliloglu M, Ekinci S, Oguz B, Aydin B, Kurucu N, Varan A, Kutluk T. Ganglioneuromas in Childhood: Hacettepe Experience With 70 Cases. J Pediatr Surg 2024; 59:483-487. [PMID: 37858397 DOI: 10.1016/j.jpedsurg.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Ganglioneuromas (GNs) are rare benign peripheral neuroblastic tumors (PNTs). We shared our institutional experience with childhood GNs. METHODS Records of the children with PNTs between January 1995 and December 2021 were reviewed, and cases with histopathological diagnoses of GN were identified. Clinical, laboratory, radiological, and histopathological findings, image-defined risk factors (IDRFs), procedures, and overall outcomes were recorded. RESULTS Of 668 cases with PNTs, 70 (10.4%) had GNs. The median age was 7.4 years (range, 2.6-15.7 years) (girls/boys, 41/29). Common presenting complaints were abdominal pain and cough; 33/70 cases (47.1%) were diagnosed incidentally. Primary tumors were in the abdomen in 41/70, the thorax in 25/70, the neck in 3 cases, and the pelvis in one. The median tumor size was 6.5 cm (range, 1.4-17). Fifty cases (71.4%) were staged as INRG-L1; 20 cases with IDRFs (15 single, five >1) were staged as INRG-L2. Complete and partial tumor resections were performed in 58/70 and 6/70 cases, while 6 had no resection. The overall complication rate was 17.1% (11/64). At a median follow-up of 9 years, five were lost to follow-up; 65 were alive. One patient with gross residue underwent total resection due to progression 13 years after the surgery, and one in the unresected group was lost to follow-up. Ten other cases without a complete resection experienced no tumor progression. CONCLUSIONS Ganglioneuromas are benign PNTs, and most are free of IDRFs. Even without complete resection, long-term outcomes are excellent. Guidelines should be devised considering the high surgical complication rates and benign course of GNs. LEVEL OF EVIDENCE Case series, IV.
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Affiliation(s)
| | - Bilgehan Yalçın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric and Perinatal Pathology Research, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burca Aydin
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Kurucu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Varan
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Tocan V, Nakamura-Utsunomiya A, Sonoda Y, Matsuoka W, Mizuguchi S, Muto Y, Hijioka T, Nogami M, Sasaoka D, Nagamatsu F, Oba U, Kawakubo N, Hamada H, Mushimoto Y, Chong PF, Kaku N, Koga Y, Sakai Y, Oda Y, Tajiri T, Ohga S. High-Titer Anti-ZSCAN1 Antibodies in a Toddler Clinically Diagnosed with Apparent Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation Syndrome. Int J Mol Sci 2024; 25:2820. [PMID: 38474067 DOI: 10.3390/ijms25052820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Severe obesity in young children prompts for a differential diagnosis that includes syndromic conditions. Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) syndrome is a potentially fatal disorder characterized by rapid-onset obesity associated with hypoventilation, neural crest tumors, and endocrine and behavioral abnormalities. The etiology of ROHHAD syndrome remains to be established, but recent research has been focusing on autoimmunity. We report on a 2-year-old girl with rapid-onset obesity during the first year of life who progressed to hypoventilation and encephalitis in less than four months since the start of accelerated weight gain. The patient had a high titer of anti-ZSCAN1 antibodies (348; reference range < 40), and the increased values did not decline after acute phase treatment. Other encephalitis-related antibodies, such as the anti-NDMA antibody, were not detected. The rapid progression from obesity onset to central hypoventilation with encephalitis warns about the severe consequences of early-onset ROHHAD syndrome. These data indicate that serial measurements of anti-ZSCAN1 antibodies might be useful for the diagnosis and estimation of disease severity. Further research is needed to determine whether it can predict the clinical course of ROHHAD syndrome and whether there is any difference in antibody production between patients with and without tumors.
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Affiliation(s)
- Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Akari Nakamura-Utsunomiya
- Department of Genetic Medicine/Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8511, Japan
- Department of Pediatrics, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan
- Division of Neonatal Screening, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Wakato Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Soichi Mizuguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yuichiro Muto
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Takaaki Hijioka
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Masao Nogami
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Daiki Sasaoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Fusa Nagamatsu
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Utako Oba
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroshi Hamada
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yuichi Mushimoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Perez Pachon ME, Horton R, Rumer KK. Appendiceal ganglioneuroma incidentally found during resection of recurrent rectal cancer: case report and review of the literature. J Surg Case Rep 2024; 2024:rjae019. [PMID: 38370592 PMCID: PMC10873856 DOI: 10.1093/jscr/rjae019] [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: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024] Open
Abstract
Ganglioneuromas (GN) are benign neuroblastic tumors that arise from neural crest cells. Since they present with nonspecific symptoms, diagnosis is often incidental. We are reporting a case of an adult appendiceal GN incidentally found during rectal cancer surgery. A 42-year-old male was diagnosed with recurrent rectal cancer after experiencing urinary difficulties and buttock pain. A multiple-stage pelvic exenteration was carried out after neoadjuvant chemotherapy and chemoradiation. Prophylactic appendectomy was done during the course of surgery, and pathology reported an appendix with GN at the distal tip. GN are often found incidentally and rarely cause appendicitis. Depending on their location and size, they might become symptomatic. While there is some controversy on whether surgery is the treatment of choice for all GN, diagnosis is rarely apparent preoperatively, and all appendiceal masses should be resected.
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Affiliation(s)
- Mauricio E Perez Pachon
- Department of Surgery, Division of Colorectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Rachel Horton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Kristen K Rumer
- Department of Surgery, Division of Colorectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
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8
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den Bakker MA, Weissferdt A. Neurogenic tumours of the posterior mediastinum and differential diagnosis considerations. Histopathology 2024; 84:238-252. [PMID: 37771117 DOI: 10.1111/his.15045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The mediastinal compartment harbours vital organs and structures, including the heart, great vessels, major airways, and thymus. These structures are embedded in and associated with soft-tissue elements consisting of adipose and fibro-collagenous tissue in which soft-tissue tumours may develop. A detailed inventory of soft-tissue tumours that may be encountered in the mediastinum based on the WHO 2013 classification was published in 2015. In addition, several comprehensive reviews on mediastinal soft-tissue pathology are available, including reviews focusing specifically on a single tumour type. This review will focus on primary neurogenic and spindle cell tumours of the somatic soft tissue of the posterior mediastinum and provide a discussion of the pertinent differential diagnoses.
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Affiliation(s)
- Michael A den Bakker
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Pathology, Erasmus MC, Rotterdam, the Netherlands
| | - Annikka Weissferdt
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Chauhan D, Bonasso P, Udassi JP, Mascio CE. En Bloc Resection of a Giant Ganglioneuroma of the Chest Through Clamshell Thoracotomy. World J Pediatr Congenit Heart Surg 2024; 15:116-118. [PMID: 37661824 DOI: 10.1177/21501351231183967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Ganglioneuroma is a benign tumor requiring subtotal resection as a primary mode of treatment. There are several surgical approaches. A giant ganglioneuroma of the chest cavity may be approached via a clamshell thoracotomy. This manuscript presents a case of giant ganglioneuroma resected en bloc via clamshell thoracotomy in a seven-year-old child.
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Affiliation(s)
- Dhaval Chauhan
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University Medicine Children's Hospital, Morgantown, WV, USA
| | - Patrick Bonasso
- Division of Pediatric General Surgery, Department of General Surgery, West Virginia University Medicine Children's Hospital, Morgantown, WV, USA
| | - Jai P Udassi
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University Medicine Children's Hospital, Morgantown, WV, USA
| | - Christopher E Mascio
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University Medicine Children's Hospital, Morgantown, WV, USA
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10
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Yousefi O, Saghebdoust S, Abdollahifard S, Motlagh MA, Farrokhi MR, Motiei-Langroudi R, Mousavi SR. Spinal Ganglioneuroma: A Systematic Review of the Literature. World Neurosurg 2023; 180:163-168.e7. [PMID: 37659751 DOI: 10.1016/j.wneu.2023.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Spinal ganglioneuromas (GNs) are rare benign tumors that often manifest as symptoms related to the compression of neural elements. The preferred treatment for affected patients is surgical resection, which typically improves symptoms and accompanies a low likelihood of tumor recurrence. We conducted a systematic review of reports of GNs involving the spinal cord and nerve roots, examining their clinical presentation, surgical management, and outcomes. METHODS Using the keywords "ganglioneuroma" and "spinal," we conducted a systematic database review of MEDLINE (PubMed), Scopus, and Embase, querying studies reporting cases of spinal GNs. Patients' demographics, location of the tumors, clinical features, and surgical outcomes were extracted from eligible articles. RESULTS A total of 93 spinal GN cases in 52 case reports/series met our criteria. Data analysis revealed a general male predominance, though thoracic spinal GNs were seen more in females. The mean age of patients with cervical, thoracic, thoracolumbar, and lumbar spinal GNs were 41.28, 27.65, 15.61, and 38.73 years, respectively. Multiple-level GNs were mostly seen in male patients or individuals with neurofibromatosis type 1. In all but 1 case, recurrence and reoperation were not reported in the short-term (months) and long-term (2-10 years) follow-up. CONCLUSIONS We found unique epidemiologic characteristics for patients with GNs of different spinal regions. The treatment of choice is achieving gross total resection, but given the eloquency of the lesions, achieving decompression via subtotal resection can also be associated with improved outcomes. To date, no global postoperative surveillance protocol exists, considering the low recurrence rate and relevant cost-benefit ratios.
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Affiliation(s)
- Omid Yousefi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Saeed Abdollahifard
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Majid Reza Farrokhi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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11
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Lecompte JF, Sarnacki S, Irtan S, Piolat C, Scalabre A, Talon I, Rod J, Panait N, Rodesch G, Luis Huertas AL, Abbo O, Demarche M, Habonimana E, Ballouhey Q, Valteau-Couanet D, Guérin F. Thoracoscopy for Pediatric Thoracic Neurogenic Tumors-A European Multi-Center Study. Cancers (Basel) 2023; 15:5467. [PMID: 38001727 PMCID: PMC10670815 DOI: 10.3390/cancers15225467] [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: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. METHODS We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. RESULTS We identified 119 patients with a median age of 4 years old (3 months-17 years). The diameter was 5.7 cm (1.1-15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9-T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7-24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0-46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner's syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4-195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9-T12 only) and the need for preoperative chemotherapy (p = 0.04 and 0.020). CONCLUSION Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology.
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Affiliation(s)
| | - Sabine Sarnacki
- Necker Enfants Malade Hospital, Université Paris-Cité, GHU Centre Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Sabine Irtan
- Trousseau Hospital, Université Paris-Sorbonne, GHU-Paris Sorbonne Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France;
| | | | - Aurélien Scalabre
- Saint-Etienne University Hospital, 42270 Saint-Priest-en-Jarez, France;
| | - Isabelle Talon
- Hopital Hautepierre, CHRU Strasbourg, 67200 Strasbourg, France
| | | | - Nicoleta Panait
- La Timone Hospital, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - Gregory Rodesch
- Hôpital Universitaire des Enfants Reine Fabiola, 1020 Bruxelles, Belgium
| | | | - Olivier Abbo
- Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France;
| | | | | | - Quentin Ballouhey
- Hôpital de la mère et de l’enfant, Centre Hospitalier Universitaire de Limoges, 87000 Limoges, France
| | | | - Florent Guérin
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), 94270 Le Kremlin Bicêtre, France
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12
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Radhakrishnan S, Rao R, Lashkari HP, Kini H, Kini JR, Kudurugundi VB, Ashok V, Gowthuvalli CV. A needle in the haystack: An unusual case presentation of ganglioneuroblastoma at a tertiary care center in Coastal Karnataka. Clin Case Rep 2023; 11:e8149. [PMID: 38028045 PMCID: PMC10665580 DOI: 10.1002/ccr3.8149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case report highlights the importance of recognizing and accurately diagnosing ganglioneuroblastoma, an uncommon variant of neuroblastic tumors in children. Ganglioneuroblastomas have diverse clinical and morphological presentations, and histopathological examination is paramount in guiding treatment decisions, especially in cases with ambiguous symptoms. Early detection is crucial, as the prognosis varies significantly based on the subtype and the presence of metastatic disease. Clinicians should maintain a high index of suspicion and utilize radiological examinations to promptly identify and treat these tumors. Abstract Children are frequently affected by neuroblastic tumors, which grow from the sympathoadrenal lineage of the neural crest during its development. However, intermixed ganglioneuroblastomas are far less common within the same tumor spectrum, the diagnosis of which could become challenging amidst an unusual presentation. In our case report, we present a 4-year-old boy who had complaints of fever and difficulty in walking, with a supra-renal mass on ultrasound, which was diagnosed as ganglioneuroblastoma-intermixed type on histopathological examination. This report aims to contribute to the understanding of the diverse clinical and morphological spectrum of ganglioneuroblastomas and the importance of multidisciplinary collaboration and histopathological examination to enhance decision-making in such ambiguous scenarios.
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Affiliation(s)
- Shalini Radhakrishnan
- Department of PathologyKasturba Medical College Mangalore, Manipal Academy of Higher EducationManipalIndia
| | - Ranjitha Rao
- Department of PathologyKasturba Medical College Mangalore, Manipal Academy of Higher EducationManipalIndia
| | - Harsha Prasada Lashkari
- Department of Paediatric Haematology and OncologyKasturba Medical College Mangalore, Manipal Academy of Higher EducationManipalIndia
| | - Hema Kini
- Department of PathologyKasturba Medical College Mangalore, Manipal Academy of Higher EducationManipalIndia
| | - Jyoti Ramnath Kini
- Department of PathologyKasturba Medical College Mangalore, Manipal Academy of Higher EducationManipalIndia
| | | | - Vanishree Ashok
- Kasturba Medical College Mangalore, Jyothi CircleMangaloreIndia
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13
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Belei O, Basaca DG, Heredea ER, Iacob ER, Olariu L, Folescu R, Motoc AGM, Nanu AM, Mărginean O. Chronic Diarrhea Caused by Vasoactive Intestinal Peptide-Secreting Tumor. Life (Basel) 2023; 13:1974. [PMID: 37895355 PMCID: PMC10608053 DOI: 10.3390/life13101974] [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: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
VIPomas are a type of neuroendocrine tumor that independently produces vasoactive intestinal peptide (VIP). VIPomas causing watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome are not frequently observed in adult patients without pancreatic ailments. However, in children, the occurrence of a VIPoma originating in the pancreas is exceedingly uncommon. Instead, WDHA syndrome is more commonly associated with neurogenic tumors that secrete VIP, often located in the retroperitoneum or mediastinum. Among infants, chronic diarrhea is a prevalent issue that often necessitates the attention of pediatric gastroenterologists. The underlying causes are diverse, and delays in arriving at a definitive diagnosis can give rise to complications affecting the overall well-being of the child. The authors present the case of an infant with chronic watery diarrhea, subocclusion manifestations, mild hypokalemia, and metabolic hyperchloremic acidosis secondary to a VIPoma in the retroperitoneum that was diagnosed via abdominal ultrasound and tomography. The laboratory results revealed lowered potassium levels and an excessive secretion of VIP. Following the surgical removal of the tumor, the diarrhea resolved, and both electrolyte levels and the imbalanced hormone levels returned to normal. Immunohistochemical examination confirmed the diagnosis of ganglioneuroblastoma, with N-MYC negative on molecular biology tests. We present the clinical and histo-genetic aspects of this rare clinical entity, with a literature review.
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Affiliation(s)
- Oana Belei
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
| | - Diana-Georgiana Basaca
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
| | - Elena Rodica Heredea
- Department of Pathology, “Louis Ţurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania;
- Department of Clinical Practical Skills, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Laura Olariu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
- First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Roxana Folescu
- Department of Balneology, Medical Recovery, and Rheumatology, Family Medicine Discipline, Center for Preventive Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Andrei Gheorghe Marius Motoc
- Department of Anatomy and Embryology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Anda-Maria Nanu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
| | - Otilia Mărginean
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
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14
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Lipiński Ł, Lipińska J, Kowalczuk M, Kopeć I, Woźniak MM, Mitek-Palusińska J, Mitura-Lesiuk M. Nonspecific Gastrointestinal Symptoms as the First Sign of Ganglioneuroblastoma Intermixed-Case Report and Literature Review. J Clin Med 2023; 12:6092. [PMID: 37763032 PMCID: PMC10531539 DOI: 10.3390/jcm12186092] [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: 07/20/2023] [Revised: 08/19/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Nonspecific gastrointestinal symptoms remain a problem for pediatricians because, out of a thousand trivial cases, there are rare diseases that require in-depth diagnostics and extensive knowledge to identify them. These complaints may be caused by a neoplastic process. We present the case of a 5-year-old boy whose diagnostic pathway lasted about 3 months. He was admitted to hospital due to severe abdominal pain. Physical examination revealed a bloated, hard, and painful abdomen. In the standing X-ray, the features of intestinal obstruction were visualized. An ultrasound examination showed a possible malignant lesion in the location of the left adrenal gland. After the surgical removal of the pathological mass and histopathological examination, the diagnosis of ganglioneuroblastoma intermixed was made. This tumor, along with neuroblastoma, ganglioneuroma, and ganglioneuroblastoma nodular, belongs to neuroblastic tumors (NTs), which originate from primitive cells of the sympathetic nervous system. NTs are quite rare, but they are still the majority of extracranial solid tumors in children, and their symptoms often appear relatively late when the neoplastic process is already advanced. The purpose of this review is to present current information about ganglioneuroblastoma, with a special emphasis on nonspecific gastrointestinal symptoms as first sign of this tumor and its diagnostics.
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Affiliation(s)
- Łukasz Lipiński
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-093 Lublin, Poland; (Ł.L.); (J.L.); (M.K.); (I.K.)
| | - Justyna Lipińska
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-093 Lublin, Poland; (Ł.L.); (J.L.); (M.K.); (I.K.)
| | - Maria Kowalczuk
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-093 Lublin, Poland; (Ł.L.); (J.L.); (M.K.); (I.K.)
| | - Izabela Kopeć
- Students’ Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-093 Lublin, Poland; (Ł.L.); (J.L.); (M.K.); (I.K.)
| | | | | | - Małgorzata Mitura-Lesiuk
- Department of Pediatric Hematology, Oncology and Transplantation, Medical University of Lublin, 20-093 Lublin, Poland;
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15
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Chakraborty U, Chakrabarti A, Bandyopadhyay M. Ganglioneuroma presenting as subpulmonic effusion-a differential to consider? Indian J Thorac Cardiovasc Surg 2023; 39:526-530. [PMID: 37609606 PMCID: PMC10441855 DOI: 10.1007/s12055-023-01522-7] [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: 01/12/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 08/24/2023] Open
Abstract
Ganglioneuroma is a benign, slow-growing neurogenic tumor arising from neural crest cells. It is extremely rare (1/1,000,000) and is located most commonly in the posterior mediastinum (41.5%), retroperitoneum (37.5%), and adrenal glands (21%). We present a case of a 62-year-old lady who had complaints of shortness of breath on exertion and dyspnea for the past 3 months. She had no other significant history. Computerised tomography (CT) scan of the thorax suggested left-sided loculated subpulmonic pleural effusion, 14 × 12 cm in dimension. She underwent assisted video-assisted thoracoscopic surgery (VATS) exploration of the thorax with debridement and drainage of subpulmonic collection that was abutting the diaphragm, along with release of trapped lung. Histopathological examination showed multiple ruptured cystic masses with nodules; microscopical evidences of Schwann cells, ganglion cells, and spindle cells-all these along with immunohistochemistry-revealed features consistent with ganglioneuroma. Postoperative recovery was uneventful, and the patient did not have any complaints or other limitations to daily life activities at 6 months' follow-up. Ganglioneuroma is essentially benign in nature, asymptomatic, and rare. A systematic review of the literature has shown that giant-sized ganglioneuromas (size more than 10 cm) have rarely been reported. Surgical excision and clearance is the treatment modality of choice. In our case, due to large size and difficulty in access and mobilisation of the mass adherent to the diaphragm, assisted VATS had to be performed. We increased the size of the utility port from 5 to 10 cm and used a rib retractor for better surgical negotiation. This could have been more challenging, as there have been incidences where ganglioneuromas have extended both into the thoracic and abdominal cavities and even involved vital organs and vessels. Regular follow-up is essential, as late recurrence and slow progression potential is a known complication.
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Affiliation(s)
- Unmesh Chakraborty
- Department of Cardiothoracic and Vascular Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Amitabha Chakrabarti
- Department of Thoracic and Vascular Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
- Department of CTVS, KPC Medical College, Kolkata, India
| | - Manujesh Bandyopadhyay
- Department of Thoracic and Vascular Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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16
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Noh S, Nessim C, Keung EZ, Roland CL, Strauss D, Sivarajah G, Fiore M, Biasoni D, Cioffi SPB, Mehtsun W, Cananzi FCM, Sicoli F, Quagliuolo V, Chen J, Luo C, Gladdy RA, Swallow C, Johnston W, Ford SJ, Evenden C, Tirotta F, Almond M, Nguyen L, Rutkowski P, Krotewicz M, Pennacchioli E, Cardona K, Gamboa A, Hompes D, Renard M, Kollár A, Ryser CO, Vassos N, Raut CP, Fairweather M, Krakorova DA, Quildrian S, Perhavec A, Nizri E, Farma JM, Greco SH, Vincenzi B, Lopez JAG, Solerdecoll MS, Iwata S, Fukushima S, Kim T, Tolomeo F, Snow H, Howlett-Jansen Y, Tzanis D, Nikulin M, Gronchi A, Sicklick JK. Retrospective Analysis of Retroperitoneal-Abdominal-Pelvic Ganglioneuromas: An International Study by the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg 2023; 278:267-273. [PMID: 35866666 PMCID: PMC10191524 DOI: 10.1097/sla.0000000000005625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The Transatlantic Australasian Retroperitoneal Sarcoma Working Group conducted a retrospective study on the disease course and clinical management of ganglioneuromas. BACKGROUND Ganglioneuromas are rare tumors derived from neural crest cells. Data on these tumors remain limited to case reports and single-institution case series. METHODS Patients of all ages with pathologically confirmed primary retroperitoneal, intra-abdominal, and pelvic ganglioneuromas between January 1, 2000, and January 1, 2020, were included. We examined demographic, clinicopathologic, and radiologic characteristics, as well as clinical management. RESULTS Overall, 328 patients from 29 institutions were included. The median age at diagnosis was 37 years with 59.1% of patients being female. Symptomatic presentation comprised 40.9% of cases, and tumors were often located in the extra-adrenal retroperitoneum (67.1%). At baseline, the median maximum tumor diameter was 7.2 cm. One hundred sixteen (35.4%) patients underwent active surveillance, whereas 212 (64.6%) patients underwent resection with 74.5% of operative cases achieving an R0/R1 resection. Serial tumor evaluations showed that malignant transformation to neuroblastoma was rare (0.9%, N=3). Tumors undergoing surveillance had a median follow-up of 1.9 years, with 92.2% of ganglioneuromas stable in size. With a median follow-up of 3.0 years for resected tumors, 84.4% of patients were disease free after resections, whereas recurrences were observed in 4 (1.9%) patients. CONCLUSIONS Most ganglioneuromas have indolent disease courses and rarely transform to neuroblastoma. Thus, active surveillance may be appropriate for benign and asymptomatic tumors particularly when the risks of surgery outweigh the benefits. For symptomatic or growing tumors, resection may be curative.
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Affiliation(s)
- Sangkyu Noh
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, CA 92093-0987, USA
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA
| | - Carolyn Nessim
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Surgery, Ottawa, Ontario, Canada
| | - Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L. Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dirk Strauss
- Department of Surgical Oncology, Royal Marsden Hospital, London, UK
| | | | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Winta Mehtsun
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, CA 92093-0987, USA
| | - Ferdinando Carlo Maria Cananzi
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Federico Sicoli
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Jun Chen
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, China, 102206
| | - Chenghua Luo
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, China, 102206
| | - Rebecca A. Gladdy
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Carol Swallow
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wendy Johnston
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Samuel J. Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Caroline Evenden
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Fabio Tirotta
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Laura Nguyen
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Surgery, Ottawa, Ontario, Canada
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcoma and Rare Tumors, IRCCS, European Institute of Oncology, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Adriana Gamboa
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - Marleen Renard
- Department of Paediatric Oncology, University Hospitals, Leuven, Belgium
| | - Attila Kollár
- Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph O. Ryser
- Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikolaos Vassos
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Chandrajit P. Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Sergio Quildrian
- Sarcoma and Melanoma Unit, General Surgery Department, Buenos Aires British Hospital, Buenos Aires, Argentina
- Sarcoma and Melanoma Unit, Angel H Roffo Institute of Oncology, University of Buenos Aires, Buenos Aires, Argentina
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1105, Ljubljana, Slovenia
| | - Eran Nizri
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeffrey M. Farma
- Fox Chase Cancer Center, Department of Surgical Oncology, 333 Cottman Ave, Philadelphia, PA 19111, USA
| | - Stephanie H. Greco
- Fox Chase Cancer Center, Department of Surgical Oncology, 333 Cottman Ave, Philadelphia, PA 19111, USA
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - José Antonio González Lopez
- Unidad de Mama y Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Mireia Solans Solerdecoll
- Unidad de Mama y Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Shintaro Iwata
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukushima
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Teresa Kim
- Department of Surgery, University of Washington, Seattle
| | - Francesco Tolomeo
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Hayden Snow
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ynez Howlett-Jansen
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Maxim Nikulin
- N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia, Moscow, Russia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jason K. Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, CA 92093-0987, USA
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17
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Nezami BG, Modak S, Cardenas FI, Sarungbam J, Sirintrapun SJ, Gopalan A, Chen Y, Al-Ahmadie H, Fine SW, Reuter VE, Tickoo SK. Ganglioneuroblastoma intermixed: Clinicopathological implications of diagnosis at presentation and genomic correlations. Pediatr Blood Cancer 2023; 70:e30434. [PMID: 37243318 PMCID: PMC10810239 DOI: 10.1002/pbc.30434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Ganglioneuroblastoma intermixed (GNBI) is classified as "favorable" histology by International Neuroblastoma Pathology Classification system. However, the International Neuroblastoma Risk Group (INRG) stratifies patients using wider clinicopathological and cytogenetic/molecular parameters. While the diagnosis of GNBI is typically made on resected tumor, it may sometimes be rendered on initial biopsy. We studied GNBI noted at diagnosis to evaluate its correlation with INRG staging and other clinicopathological and molecular features. METHODS In this retrospective study, clinical, radiological, pathological, cytogenetic, and molecular information from patients with GNBI at diagnosis seen between 1995 and 2021 was analyzed. INRG staging was performed. RESULTS Of the 15,827 neuroblastoma specimens, GNBI was noted in 237 patients. Of these, 53 had the initial pathological diagnosis of GNBI; median follow-up 3.5 (range: 0.2-14) years. Disease was locoregional in 41 (77%, 16 stage L1 and 25 L2); none relapsed. Twelve (23%) had metastatic disease at presentation; six (50%) relapsed, and two died of disease. MYCN was amplified in two metastatic tumors. Six of 31 (19%) tumors tested had recurrent cytogenetic abnormalities and nonrecurrent somatic gene mutations in 10/23 (43%). The presence of any adverse molecular/cytogenetic findings was associated with metastatic disease (p < .05). For patients with localized GNBI undergoing both biopsy and resection, GNBI was diagnosed in both in 17/19 (90%). CONCLUSIONS Localized GNBI at diagnosis has excellent long-term clinical outcome even without cytotoxic therapy. For localized GNBI, a biopsy sample is adequate to make the diagnosis. When associated with metastasis at diagnosis, prognosis is poorer, possibly due to associated adverse biological features.
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Affiliation(s)
- Behtash G. Nezami
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Judy Sarungbam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yingbei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samson W. Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satish K. Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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Shah D, Chaudhary SR, Khan S, Mallik S. Overreliance on Radiological Findings Leading to Misdiagnosed Giant Retroperitoneal Ganglioneuroma: A Case Report and Literature Review. Cureus 2023; 15:e43914. [PMID: 37746449 PMCID: PMC10512760 DOI: 10.7759/cureus.43914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Ganglioneuroma is a rare, benign, well-differentiated neurogenic tumor most commonly located in the posterior mediastinum or retroperitoneum. Giant ganglioneuromas are even less common; this is only the 19th reported case in literature to date. We present a case of a giant retroperitoneal ganglioneuroma in a five-year-old child, which on imaging mimicked a mesenteric cyst and posed various challenges in its management. Histopathology later confirmed our misdiagnosis and revealed the tumor to be a ganglioneuroma. This unique case serves as a lesson for clinicians to not operate before receiving histopathological confirmation of their diagnosis.
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Affiliation(s)
| | | | - Shahin Khan
- General Surgery, Medical College Baroda, Vadodara, IND
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19
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Aldirawi M, Yavuz L, Ghoweba Y, Mohamedali S, Chencheri N, Thalange N. Rapid-Onset Obesity With Hypothalamic Dysfunction, Hypoventilation, Autonomic Dysregulation, and Neuroendocrine Tumor (ROHHADNET) Syndrome: A Case Report. Cureus 2023; 15:e41413. [PMID: 37546061 PMCID: PMC10403153 DOI: 10.7759/cureus.41413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Here, we report the case of a rare and complex disorder, rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neuroendocrine tumor (ROHHADNET) syndrome, in a three-year-old girl with no significant medical history. This is the first such case reported from the UAE. ROHHADNET is a rare disorder of respiratory control and autonomic nervous system regulation with endocrine abnormalities. It typically presents in children older than 18 months with rapid weight gain. This is a challenging diagnosis as there is no clear diagnostic test, and treatment is essentially supportive. This report describes a case of ROHHADNET syndrome in a previously well child who presented with rapid weight gain followed by ophthalmoplegia, dysphagia, electrolyte disturbance, and other comorbidities. The paper outlines in detail the clinical course, investigations, and management of ROHHADNET syndrome. Cerebrospinal fluid analysis revealed oligoclonal bands, which have been reported in only two other cases of ROHHADNET syndrome. Our goal in reporting this case is to increase awareness of this condition among clinicians to facilitate early diagnosis and timely management.
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Affiliation(s)
| | - Lemis Yavuz
- Pediatrics, Al Jalila Children's Specialty Hospital, Dubai, ARE
| | - Yousra Ghoweba
- Pediatrics, Al Jalila Children's Specialty Hospital, Dubai, ARE
| | | | - Nidheesh Chencheri
- Pediatric Neurology, Al Jalila Children's Specialty Hospital, Dubai, ARE
| | - Nandu Thalange
- Medicine, Mohammed Bin Rashid University, Dubai, ARE
- Endocrinology, Al Jalila Children's Specialty Hospital, Dubai, ARE
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20
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Zhuang H, Ruan Z, Xu C. A giant lobular thoracic ganglioneuroma cause skeletal erosion: A case report and literature review. Medicine (Baltimore) 2023; 102:e33891. [PMID: 37335670 DOI: 10.1097/md.0000000000033891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
RATIONALE Ganglioneuroma (GN) is a rare tumor that originates from neural crest cells and can manifest in any location along the sympathetic chain. It typically exhibits a circular or oval shape and does not invade the surrounding tissue destructively and the enormous lobular appearance and erosion of adjacent skeletal tissues are extremely infrequent among GN. PATIENT CONCERNS A 15-year-old girl presented to our thoracic surgery clinic with a large intrathoracic mass that was incidentally discovered on a chest X-ray. Further imaging with computed tomography and magnetic resonance imaging revealed a lobular profile and an aggressive growth pattern of the tumor, which destroyed the vertebral and rib bones. A tissue sample obtained by needle biopsy was subjected to histopathological analysis, which confirmed the diagnosis of a GN. DIAGNOSIS Thoracic (posterior mediastinal) GN and Hashimoto's thyroiditis. INTERVENTIONS After thoracoscopic exploration, a thoracotomy was performed to excise the mass. OUTCOMES The patient recovered well after surgery, had no major complications, and was discharged without any issues. Further follow-up is necessary to clarify the medium to long-term outcome. LESSONS Based on existing reports, thoracic GN rarely erodes adjacent bone tissue. By examining previously reported cases, we speculate that the lobular morphology of the tumor may be linked to the more aggressive biological behavior of GN. We also discovered that female patients may be more susceptible to bone erosion. However, further research and additional cases are required to confirm these potential associations.
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Affiliation(s)
- Haoxiang Zhuang
- Department of Thoracic Surgery, Ganzhou People's Hospital, Nanchang University, Ganzhou, China
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21
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Tirotta F, Napolitano A, Noh S, Schmitz E, Nessim C, Patel D, Sicklick JK, Smith M, Thway K, van der Hage J, Ford SJ, Tseng WW. Current management of benign retroperitoneal tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1081-1090. [PMID: 35879135 DOI: 10.1016/j.ejso.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
Benign retroperitoneal tumors (BRT) represent a rare group of heterogeneous diseases. The literature lacks high-quality evidence about the optimal management of BRT, and most of the information available takes the form of case reports or case series. The aim of this review is to provide an overview of current management strategies for adult patients with BRT. A literature search using PubMed indexed articles was conducted and BRT were classified into five different biological subgroups: 1) lipomatous tumors, 2) smooth muscle tumors, 3) peripheral nerve sheath tumors, 4) myofibroblastic tumors, and 5) others. Tumors that are primarily pelvic in origin were excluded. Despite the significant heterogeneity of the disease, several generic considerations have emerged and can be applied to the management of BRT. Specifically, the risk of misdiagnosing a BRT with another pathology such as retroperitoneal sarcoma is notable. When encountered, suspected BRT should therefore be referred to a specialized sarcoma center. Multidisciplinary tumor boards, present at these centers, have a pivotal role in managing BRT. The decision of whether to offer surgery, nonsurgical treatment or a "watch-and-wait" approach should be made after multidisciplinary discussion, depending on tumor histology. Moving forward, collaborative research efforts dedicated to BRT remain crucial in gathering evidence and knowledge to further optimize patient care.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Sangkyu Noh
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, San Dieg, CA, 92093-0987, USA; College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, 91766-1854, USA
| | - Erika Schmitz
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dakshesh Patel
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, San Dieg, CA, 92093-0987, USA
| | - Myles Smith
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Department of Pathology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Jos van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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22
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Xiu WL, Liu J, Zhang JL, Su N, Wang FJ, Hao XW, Wang FF, Dong Q. Computer-assisted rescue of the inferior mesenteric artery in a child with a giant ganglioneuroblastoma: A case report. World J Gastrointest Surg 2023; 15:984-991. [PMID: 37342847 PMCID: PMC10277949 DOI: 10.4240/wjgs.v15.i5.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/22/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Ganglioneuroblastoma (GNB) is a peripheral neuroblastoma (NB) with malignant degree between highly malignant NB and benign ganglioma (GN). Pathology is the gold standard of diagnosis. Although GNB is not uncommon in children, biopsy alone may lead to an inaccurate diagnosis, especially for giant tumors. However, surgical resection may be associated with significant complications. Here, we report a case of computer-assisted surgical resection of a giant GNB in a child and successful rescue of the inferior mesenteric artery.
CASE SUMMARY A 4-year-old girl was admitted to our department for a giant retroperitoneal lesion, which was considered to be an NB by her local hospital. The symptoms of the girl disappeared spontaneously without treatment. On physical examination, a mass of about 10 cm × 7 cm could be palpated in her abdomen. Ultrasonography and contrast-enhanced computed tomography performed in our hospital also showed an NB, and there was a very thick blood vessel inside the tumor. However, aspiration biopsy revealed GN. Surgical resection is the best treatment option for this giant benign tumor. For precise preoperative evaluation, three-dimensional reconstruction was performed. It was clear that the tumor was close to the abdominal aorta. The superior mesenteric vein was pushed forward, and the inferior mesenteric artery passed through the tumor. Because GN generally does not invade blood vessels, we split the tumor with a CUSA knife during the operation and found that there was indeed a straight and intact vascular sheath. Arterial pulsation was observed in the completely exposed inferior mesenteric artery. The pathologists interpreting the tissue finally diagnosed it as a mixed GNB (GNBi), which is more malignant than GN. However, both GN and GNBi usually have a good prognosis.
CONCLUSION This was a case of successful surgical resection of a giant GNB, and aspiration biopsy underestimated the pathological staging of the tumor. Preoperative three-dimensional reconstruction assisted with the radical resection of the tumor and rescue of the inferior mesenteric artery.
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Affiliation(s)
- Wen-Li Xiu
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
| | - Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Jing-Li Zhang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Nan Su
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Feng-Jiao Wang
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xi-Wei Hao
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Fei-Fei Wang
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
| | - Qian Dong
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
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23
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Nayab A, Malik MH, Madhavan AA, Glockner J, Collins DA, Wenger DE. Incidental diagnosis of presacral ganglioneuroma in a patient with hematuria. Radiol Case Rep 2023; 18:1324-1328. [PMID: 36704366 PMCID: PMC9870923 DOI: 10.1016/j.radcr.2022.11.084] [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: 08/09/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 01/20/2023] Open
Abstract
Ganglioneuromas are benign neuroblastic tumors seen most in pediatric population. The most common locations are mediastinal, retroperitoneal and adrenal regions. Ganglioneuromas rarely occur in presacral space. We present one such case of an incidentally diagnosed presacral ganglioneuroma in an asymptomatic 71-year-old male who initially presented with hematuria.
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Affiliation(s)
- Asra Nayab
- Corresponding author at: Mayo Clinic, Department of Radiology, 200 1st St SW Rochester MN 55905.
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24
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Torimaki S, Sasaki N, Ohara J, Ueda S, Hoshimaru M. Cervical ganglioneuroma arising from the dorsal root ganglion: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22456. [PMID: 36647254 PMCID: PMC9844522 DOI: 10.3171/case22456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ganglioneuroma is a benign and well-differentiated tumor derived from neural crest cells, which occurs infrequently, with most patients being female and adolescents. While predilection sites are the posterior mediastinum and retroperitoneal cavity, ganglioneuroma originating from the dorsal root ganglion is very rare. Here the authors report a case with C2 dorsal root ganglion-derived ganglioneuroma with some literature review. OBSERVATIONS A 45-year-old male patient complained of persistent right-side throbbing occipital headache for more than a year. Magnetic resonance imaging (MRI) of the cervical spine revealed a dumbbell-shaped intradural extramedullary tumor from the C2 posterior surface of the odontoid to right C1-2 intervertebral foramen with high T2- and low T1-weighted signal intensities. The tumor displayed homogeneous contrast enhancement by MRI. The authors suspected schwannoma and performed a tumorectomy for both diagnosis and treatment purposes. Intraoperative findings showed that the tumor originated from the dorsal root ganglion, and pathological examination revealed ganglioneuroma. Immediately after the tumorectomy, the throbbing occipital headache disappeared and the patient was discharged from the hospital without major complications. LESSONS Although ganglioneuroma derived from the dorsal root ganglion is very rare, a differential diagnosis of the ganglioneuroma should be made, when schwannoma is suspected.
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Affiliation(s)
- Shinya Torimaki
- Shin-Aikai Spine Center, Katano Hospital, Katano City, Osaka, Japan
| | - Nobuhiro Sasaki
- Shin-Aikai Spine Center, Katano Hospital, Katano City, Osaka, Japan
| | - Jiro Ohara
- Shin-Aikai Spine Center, Katano Hospital, Katano City, Osaka, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano City, Osaka, Japan
| | - Minoru Hoshimaru
- Shin-Aikai Spine Center, Katano Hospital, Katano City, Osaka, Japan
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25
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Ganglioneuroblastoma in a Child With Neurofibromatosis Type 1: A Case Report and Literature Review. J Pediatr Hematol Oncol 2023; 45:e131-e134. [PMID: 35398860 DOI: 10.1097/mph.0000000000002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic condition commonly associated with a predisposition to tumor development. Affected individuals have an increased risk of benign and malignant tumors of the central and peripheral nervous system. Though pediatric patients with NF1 have an increased risk of tumors such as optic gliomas and neurofibromas during childhood, neuroblastic tumors are less often observed in this population. We report a rare case of a 5-year-old female with ganglioneuroblastoma intermixed and known history of NF1 and review the existing literature on the occurrence of ganglioneuroblastoma in pediatric patients with NF1.
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26
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Montante C, Fabozzi F, Villani MF, D’Andrea ML, Stracuzzi A, Natali GL, Del Baldo G, Del Bufalo F, Garganese MC, Serra A, Tomà P, Alaggio R, Vennarini S, Colafati GS, Mastronuzzi A, De Ioris MA. The Pitfall of Ganglioneuroblastoma-Nodular Diagnosis: Clinical and Imaging Considerations over a Rare Bifocal Sporadic Case. Diagnostics (Basel) 2022; 12:diagnostics12123221. [PMID: 36553228 PMCID: PMC9777706 DOI: 10.3390/diagnostics12123221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neuroblastic tumors (NTs) represent the most common extracranial neoplasm occurring in childhood. Although ganglioneuroblastoma intermixed (GNBI) and ganglioneuroma (GN) are classified as very low-risk tumors, neuroblastoma (NB) and ganglioneuroblastoma-nodular (GNBN) may represent a serious risk to survival. Unfortunately, areas of GNBI and GNBN can coexist in the same mass, leading to incorrect risk staging when only biopsy is performed. Herein, we describe a case of multifocal NT (thoracic and abdominal localization) occurring in a 4-year-old male. Different histological subtypes, namely GNBI and GNBN, were revealed in the two lesions. We focus on the difficulties of proper diagnosis and risk stratification, underlining the usefulness of several diagnostic tools for appropriate management and therapeutic choices.
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Affiliation(s)
- Claudio Montante
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Francesco Fabozzi
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | | | - Maria Luisa D’Andrea
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandra Stracuzzi
- Department of Pathology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gian Luigi Natali
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giada Del Baldo
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Francesca Del Bufalo
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | | | - Annalisa Serra
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Rita Alaggio
- Department of Pathology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
| | | | - Angela Mastronuzzi
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Correspondence:
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27
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Liu Q, Wang S, Chu P, Sun J, Jin Y, Guo Y, Ma X, He L, Su Y, Zhang J, Peng Y, Li Y, Zhang X, Sun N, Liu Z, Ni X. Clinical and surgical outcome differences on the basis of pathology category in cervical neuroblastic tumors. J Pediatr Surg 2022; 57:926-933. [PMID: 35961818 DOI: 10.1016/j.jpedsurg.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cervical neuroblastic tumors (NTs) are rare but less aggressive cancer with an above-average survival rate. Little has been published regarding the management and surgical outcomes of patients with cervical NTs based on pathology category. This study compared and identified the preoperative characteristics of cervical NTs in different pathology categories and evaluated the outcomes of patients undergoing surgical resection. MATERIALS AND METHODS Upon the institutional review board's approval, a retrospective chart review was performed at Beijing Children's Hospital from April 2013 to August 2020. Demographics of patients, imaging data, lab test results, operation details and outcomes were recorded and analyzed. RESULTS Of 32 cervical NTs, 24(80%) were classified as neuroblastoma (NB) /ganglioneuroblastoma-nodular (GNBn) and 8(20%) as ganglioneuroblastoma-intermixed (GNBi)/ ganglioneuroma (GN). Patients with GNBi/GN were older than those with NB/GNBn (44.5 months (IQR 16-81) vs 9 months (IQR 1-47); P = 0.001). GNBi/GN patients presented more frequently with stage 1 disease compared with NB/GNBn patients (100% vs. 29.2%, P = 0.001), less frequently with tumor-related symptoms (0% vs. 70.8%, P = 0.001), artery encased tumor (0% vs. 41.7%, P = 0.035), and surgical complications (25% vs. 70.8%, P = 0.038). GNBi/GN patients were also less likely to show elevated neuron specific enolase (NSE) (12.5% vs. 79.2%, P = 0.002). CONCLUSIONS Cervical NB/GNBn and GNBi/GN patients had distinct characteristic clinical presentations and surgical outcomes. For children with features suggestive of benign disease (older age, asymptomatic, normal serum tumor markers) and no artery image-defined risk factors (IDRFs), upfront resection can be considered.
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Affiliation(s)
- Qiaoyin Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ping Chu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jihang Sun
- Imaging center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yaqiong Jin
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoli Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Su
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yun Peng
- Imaging center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanzhen Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuexi Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Nian Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiyong Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Montero-Vilchez T, Navarro-Pelayo I, Sanchez-Díaz M, Ortega-Acosta MJ, Arias-Santiago S, Tercedor-Sanchez J. Blueberry muffin baby secondary to ganglioneuroblastoma. Pediatr Dermatol 2022; 40:537-539. [PMID: 36394113 DOI: 10.1111/pde.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
We report the case of a neonate presenting with the clinical features of blueberry muffin syndrome caused by ganglioneuroblastoma, a rare variant of neuroblastoma. This syndrome may be the only visible manifestation of a neonatal tumor and highlights the importance of early recognition and initiation of therapy to reduce mortality.
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Affiliation(s)
| | - Isabel Navarro-Pelayo
- Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Manuel Sanchez-Díaz
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
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29
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Ling K, Xiaoping C, Xiaolu Y. A case of ganglioneuroma of the ureter and review of the literature. J Int Med Res 2022; 50:3000605221123671. [PMID: 36412222 PMCID: PMC9706062 DOI: 10.1177/03000605221123671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/16/2022] [Indexed: 10/28/2023] Open
Abstract
Ganglioneuroma is a rare tumor originating from neural crest tissue of the sympathetic nervous system. We report on an approximately 55-year-old woman who was admitted to hospital with abdominal pain. Surgery revealed a tumor in her right ureter, which was pathologically confirmed as a ganglioneuroma. The patient underwent transabdominal total hysterectomy, bilateral adnexal resection, release of pelvic and intestinal adhesions, right ureteroscopy, right ureter retrograde intubation, right ureteral lesion excision, and ureteral anastomosis. A literature review indicated that most ganglioneuromas are benign tumors. Clinicians may consider total or subtotal tumor resection, depending on the tumor location and patient's condition. The patient's clinical condition may improve after surgery combined with periodic long-term follow-up.
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Affiliation(s)
- Ke Ling
- Department of Gynecology, Maoming
People’s Hospital, Maoming, China
| | - Chen Xiaoping
- Department of Pathology, Maoming
People’s Hospital, Maoming, China
| | - Yuan Xiaolu
- Department of Pathology, Maoming
People’s Hospital, Maoming, China
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30
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Edo H, Hyoue E, Hamamoto K, Tsuda M, Morimura F, Okano K, Okazaki M, Kawamura K, Ito K, Sato K, Edo N, Shinmoto H. Composite pheochromocytoma–ganglioneuroma: a case with two distinct components radiographically. BJR Case Rep 2022; 8:20220079. [PMID: 36211605 PMCID: PMC9518729 DOI: 10.1259/bjrcr.20220079] [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: 05/29/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Composite pheochromocytoma is an extremely rare tumor that comprises a pheochromocytoma and an embryologically related neurogenic tumor, such as ganglioneuroma, ganglioneuroblastoma, neuroblastoma, or peripheral nerve sheath tumor. A 46-year-old male with hypertension, elevated plasma catecholamine levels, and suspected pheochromocytoma presented to the National Defense Medical College Hospital. CT and MRI showed two adjacent masses in the left adrenal gland; one was a 6 cm cephalic lesion and the other was a 1.5 cm caudal lesion. Only the 1.5 cm caudal mass showed uptake on 123I-metaiodobenzylguanisine single photon emission CT/CT. Pheochromocytoma was suspected and a left adrenalectomy was performed. Pathology confirmed that the 6 cm mass was a ganglioneuroma and the 1.5 cm mass a pheochromocytoma, with cellular intermingling at their border. The two masses were diagnosed as a composite pheochromocytoma–ganglioneuroma. This is the first report in which the two components of a composite pheochromocytoma can be clearly distinguished in the pre-operative images. If a patient with clinically suspected pheochromocytoma has different components from a typical pheochromocytoma, composite pheochromocytoma should be considered.
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Affiliation(s)
- Hiromi Edo
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Eiko Hyoue
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Kohei Hamamoto
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Masaki Tsuda
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Fumio Morimura
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Kousuke Okano
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Michiko Okazaki
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Kazuki Kawamura
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Kimiya Sato
- Department of Basic Pathology, National Defense Medical College, Saitama, Japan
| | - Naoki Edo
- Division of Behavioral Science, National Defense Medical College Research Institute, Saitama, Japan
- Department of Clinical Research Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Saitama, Japan
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31
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Impellizzeri P, Peri FM, Arena S, Trimarchi R, Romeo C, Dionigi G. Retroperitoneal approach in a child with ganglioneuroma: points of technique and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background data
Ganglioneuroma is rare in children and often incidentally discovered. The transperitoneal laparoscopic approach is the surgical choice for most of the surgeons because of the familiar anatomy and the wider working spaces. However, a posterior retroperitoneal approach started to be used in pediatric population demonstrating to be safe and effective.
Case presentation
We present a case of a child with radiological finding of a right adrenal mass. Due to the increased risk of having a malignant transformation, a surgical resection was decided using a retroperitoneal approach. The adrenal mass was recognized and completely enucleated. The histopathological examination revealed a GN. Clinical course was uneventful with hospital discharge after 3 days. The outcome was evaluated by ultrasound examination performed 3–6 to 12–24 months and then annually. After 24 months, the patient is completely asymptomatic, and no adrenal masses in both sides have been detected.
Conclusions
The posterior retroperitoneoscopy permits a more direct exposure of the adrenal gland, without violating the peritoneum, and a close vision to the main vessels. We believe that this technique is a valid option for pediatric patients with small adrenal lesions.
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Whitlock RS, Mehl SC, Larson SK, Foster JH, Hicks J, Nuchtern JG, Sher AC, Vasudevan SA, Naik-Mathuria B. Characteristics of benign neuroblastic tumors: Is surgery always necessary? J Pediatr Surg 2022; 57:1538-1543. [PMID: 34281709 DOI: 10.1016/j.jpedsurg.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/16/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Ganglioneuroma (GN) and ganglioneuroblastoma-intermixed (GNB-I) represent benign variants of neuroblastic tumors in children; however, differentiating from more aggressive histological variants of GNB including the nodular subtype (GNB-N) prior to resection can be challenging, even with biopsy. Currently, no standard treatment guidelines exist. The purpose of this study was to identify pre-operative characteristics of benign neuroblastic tumors and evaluate outcomes for patients who underwent surgical resection or observation. METHODS Retrospective chart review of children treated at a single institution between 2009 and 2019 for non-metastatic tumor with a tissue diagnosis of GN, GNB-N or GNB-I. Demographics, imaging, labs, operative details and outcomes were recorded and analyzed. RESULTS Of 53 patients, 45% were male. The most common tumor location was abdomen (49%), followed by thorax (34%). Forty-five percent had at least one image defined risk factor. Biopsy was performed in 32% (17/53) and upfront surgery in 68% (36/53). Three patients (3/53, 5.6%) with biopsy demonstrating GN tumors were observed due to high surgical risk. Pathology of resected specimens demonstrated GN in 52% (26/50) and GNB-I or GNB-N in 48% (24/50). The majority of GNB tumors (75% (18/24) were GNB-I and 25% (6/24) were GNB-N. Therefore, 88% of the resected tumors were benign spectrum neuroblastic tumors (GN & GNB-I). Seven (7/50, 14%) patients experienced perioperative complication (temporary paralysis, Horner's syndrome, chylothorax, vocal cord paralysis). Recurrence was noted in 1 patient with GN (1/50, 2%) and 3 with GNB-N (3/50, 6%). There were no tumor-related deaths. Patients with GN were older than those with GNB (8.8 years (IQR 6-11.25) vs 5.6 years for GN (IQR 3-7); p = 0.01). GNB tumors were also more likely to have calcifications on imaging (63% vs. 38%, p = .01) and more commonly had MIBG avidity (88% vs 66%, p = .04). There were no significant differences in tumor size or symptoms at presentation. CONCLUSIONS In children with neuroblastic tumors, older age, CT without tumor calcifications, lack of MIBG avidity, and/or normal urine catecholamines may indicate benign GN. Close observation could be considered for asymptomatic patients meeting these criteria with biopsy-proven GN, with resection reserved for progressive growth or symptom development. However, larger, multicenter studies are needed for further validation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Richard S Whitlock
- Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 185, One Baylor Plaza, Houston, TX 77030, USA; Department of Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Steven C Mehl
- Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 185, One Baylor Plaza, Houston, TX 77030, USA; Department of Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sara K Larson
- Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 185, One Baylor Plaza, Houston, TX 77030, USA; Department of Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer H Foster
- Texas Children's Cancer and Hematology Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - John Hicks
- Departmant of Pathology, Texas Children's Hospital, Baylor College of Medicine Houston, TX, USA
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 185, One Baylor Plaza, Houston, TX 77030, USA; Department of Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew C Sher
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 185, One Baylor Plaza, Houston, TX 77030, USA; Department of Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 185, One Baylor Plaza, Houston, TX 77030, USA; Department of Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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33
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Gulati V, Swarup MS, Kumar J. Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach. Indian J Radiol Imaging 2022; 32:235-252. [PMID: 35924125 PMCID: PMC9340194 DOI: 10.1055/s-0042-1744142] [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] [Indexed: 11/17/2022] Open
Abstract
Mass lesions in the retroperitoneal space may be primary or secondary. Primary retroperitoneal mass lesions are relatively uncommon as compared to pathology that arises secondarily from retroperitoneal organs. These may be solid or cystic lesions. The overlapping imaging features of various solid primary retroperitoneal tumors make the diagnosis difficult, and hence, histopathology remains the mainstay of diagnosis. This paper provides a brief review of the anatomy of the retroperitoneal space and provides an algorithmic approach based on cross-sectional imaging techniques to narrow down the differential diagnosis of solid primary retroperitoneal masses encountered in the adult population.
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Affiliation(s)
- Vaibhav Gulati
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - M. Sarthak Swarup
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Jyoti Kumar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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34
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Zhang S, Xiao B, Zhang Y, Zhou Z, Fu X, Zuo S. Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature. Oncol Lett 2022; 24:208. [PMID: 35720481 PMCID: PMC9178696 DOI: 10.3892/ol.2022.13329] [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: 01/29/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Ganglioneuroblastoma (GNB) is a condition belonging to the neuroblastoma family. It is a transitional tumor consisting of a mixture of mature ganglioneuromas and malignant neuroblastomas. Its biological behavior is intermediate between benign and malignant, with a risk of recurrence and metastasis. It usually occurs in pediatric patients aged <10 years, particularly between the ages of 1 and 2 years, but may also occur in adolescents or adults. The present study reported on the clinical management of a case of postoperative stress ulcer with perforation in a 17-year-old female patient with retroperitoneal GNB and provided a review of the literature on retroperitoneal GNB in adolescents and adults.
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Affiliation(s)
- Shilong Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Benli Xiao
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Yewei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Zihan Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Xiangyu Fu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Shi Zuo
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
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35
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Schmidt M, Decarolis B, Franzius C, Hero B, Pfluger T, Rogasch JMM, Simon T. Durchführung und Befundung der 123I-mIBG-Szintigraphie bei Kindern und Jugendlichen mit Neuroblastom (Version 3) – DGN-Handlungsempfehlung (S1-Leitlinie), Stand: 2/2020 – AWMF-Registernummer: 031-040. Nuklearmedizin 2022; 61:96-110. [PMID: 35421899 DOI: 10.1055/a-1778-3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfasssungDie aktualisierte 3. Fassung der 123I-mIBG-Szintigrafie bei Kindern und Jugendlichen berücksichtigt folgende aktuelle Entwicklungen: Die Leitlinie fokussiert auf die diagnostische Anwendung von 123I-mIBG beim Neuroblastom. 131I-mIBG kommt bei der Radionuklidtherapie zum Einsatz. An wenigen Stellen wird auf Besonderheiten des 131I-mIBG bei der Befundung von Posttherapie-Szintigrammen eingegangen. Es werden aktuelle Entwicklungen in der Patientenvorbereitung bei den Medikamenteninterferenzen und Empfehlungen zur Schilddrüsenblockade berücksichtigt. Neue Empfehlungen der zu applizierenden Aktivität werden genannt und die damit assoziierten Probleme diskutiert. Die Bildakquisition unter Berücksichtigung von SPECT bzw. SPECT/CT des Körperstammes inkl. des Kopfes wird berücksichtigt. Die Befundung unter Verwendung des SIOPEN-Scores wird neu aufgenommen. Auf PET bzw. PET/CT mit 18F-DOPA bzw. 68Ga-DotaTATE wird verwiesen.
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Affiliation(s)
- Matthias Schmidt
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Köln (Cologne), Germany
| | - Boris Decarolis
- Klinik und Poliklinik für Kinderheilkunde, Abteilung Kinderonkologie und -Hämatologie, Universitätsklinikum Köln, Köln (Cologne), Germany
| | - Christiane Franzius
- Zentrum für moderne Diagnostik (ZeMoDi), MR- und MR/PET, Schwachhauser Heerstraße 63 A, 28211 Bremen, ZeMoDi, Bremen, Germany
| | - Barbara Hero
- Klinik und Poliklinik für Kinderheilkunde, Abteilung Kinderonkologie und -Hämatologie, Universitätsklinikum Köln, Köln (Cologne), Germany
| | - Thomas Pfluger
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | | | - Thorsten Simon
- Klinik und Poliklinik für Kinderheilkunde, Abteilung Kinderonkologie und -Hämatologie, Universitätsklinikum Köln, Köln (Cologne), Germany
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36
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Tas ML, Molenaar JJ, Peek AM, Lequin MH, Verdijk RM, de Krijger RR, Tytgat GA, van Noesel MM. Refractory Stage M Ganglioneuroblastoma With Bone Metastases and a Favorable, Chronic Course of Disease: Description of a Patient Cohort. J Pediatr Hematol Oncol 2022; 44:e5-e13. [PMID: 33885033 PMCID: PMC8728760 DOI: 10.1097/mph.0000000000002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
Refractory stage M neuroblastoma (NB) is associated with a poor prognosis and a progressive course of disease. Here, we describe a unique group of patients with a discrepant clinical course. Seven histologically confirmed ganglioneuroblastoma (GNB) (n=6) and differentiating NB (n=1) patients were identified who were diagnosed with stage M disease based on iodine-123-metaiodobenzylguanidine avid bone metastases. Six patients started on high-risk treatment, without tumor response (stable disease). Treatment was discontinued before the start of consolidation treatment because of refractory response in all patients. Unexpectedly, after cessation of treatment no progression of disease occurred. In 2 patients, the primary tumors expanded (>25%) very slowly during 1.5 and 3 years, and remained stable thereafter. Metabolically, a slow decrease of urinary homovanillic acid and vanillylmandelic acid levels and iodine-123-metaiodobenzylguanidine avidity was observed. All patients are alive with presence of metastatic disease after a median follow-up of 17 years (range: 6.7 to 27 y). Interestingly, at diagnosis, 6 patients were asymptomatic, 6 patients had GNB morphology, and 5 patients had meningeal metastases. These are all features seen in only a small minority of stage M patients. This GNB entity illustrates the clinical heterogeneity of neuroblastic tumors and can be used to further study the developmental origin of different NB subtypes.
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Affiliation(s)
| | | | - Annemarie M.L. Peek
- Departments of Solid Tumors
- Department of Pediatric Oncology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen
| | - Maarten H. Lequin
- Departments of Solid Tumors
- Departments of Radiology and Nuclear Medicine
| | - Rob M. Verdijk
- Department of Pathology, Section Neuropathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ronald R. de Krijger
- Diagnostics and Pathology, Princess Máxima Center for Pediatric Oncology
- Pathology, University Medical Center Utrecht, Utrecht
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37
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Lebby E, Kwan D, Bui TL, O’Connell R, Seetharaman M, Houshyar R. Retroperitoneal ganglioneuroma with nodal involvement in an adult patient with human immunodeficiency virus: a case report and review of the literature. J Med Case Rep 2021; 15:634. [PMID: 34963492 PMCID: PMC8715619 DOI: 10.1186/s13256-021-03134-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ganglioneuromas are a benign tumor originating from neural crest cells. As one of the neuroblastic tumors, ganglioneuromas are most common in children, with a mean age at presentation of 7 years. Ganglioneuromas are typically singular in nature, but rarely can present with lymph node involvement and distant metastasis. We present a rare case of a retroperitoneal ganglioneuroma found in a human immunodeficiency virus positive adult, which was complicated by lymph node involvement. This case is notable not only in regard to the age of the patient, but also because of his human immunodeficiency virus positive status and the extension of tumor to lymph nodes. Case presentation A 27-year-old Latino male with history of human immunodeficiency virus presented with a 6-month history of left upper quadrant and epigastric abdominal pain with associated nausea and vomiting. The patient had a computed tomography scan showing a retroperitoneal mass encasing the aorta, celiac axis, and superior mesenteric artery. Core needle biopsy revealed ganglioneuroma. Owing to obstructive symptoms, resection of the mass along with partial gastric resection, partial pancreatic resection, and splenectomy was performed by a multidisciplinary group of surgeons. Pathology results revealed metastatic spread of ganglioneuroma to surrounding lymph nodes. Conclusions Ganglioneuromas are most common in children and very rarely occur in adults. However, it is still important to consider this entity in the differential for patients presenting with suspicious symptoms. While rare, it is essential to consider metastasis in this generally benign disease.
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38
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Sandru F, Dumitrascu MC, Petca A, Carsote M, Petca RC, Oproiu AM, Ghemigian A. Adrenal ganglioneuroma: Prognostic factors (Review). Exp Ther Med 2021; 22:1338. [PMID: 34630692 DOI: 10.3892/etm.2021.10773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
Ganglioneuroma, a rare neural crest-derived tumor, exhibits a benign profile in contrast to other neuroblastic tumors (neuroblastoma/ganglioneuroblastoma). Ganglioneuromas can be found anywhere autonomic ganglia are located, mostly abdominal/pelvic sites followed by the adrenal glands (one-third of cases), mediastinum/thorax and cervical area. Affecting especially children more than 10 years of age, Ganglioneuroma is either asymptomatic or may cause local compressive effects; rarely inducing nonspecific abdominal complains or arterial hypertension related to oversecretion of epinephrine/norepinephrine/dopamine. Despite a good prognosis, adrenalectomy is necessary in order to rule out a malignancy. Open procedure represents the standard therapeutic option; alternatively, centers with large laparoscopic pediatric experience and good stratification protocols have reported successful procedures. High uptake of I123-MIBG is associated with a more severe outcome in cases with increased mitotic index. In neuroblastic tumors, neuron-specific enolase >33 ng/ml, age at diagnosis <49 months, and blood vessel invasion indicate a poor prognosis. Concurrent extra-adrenal/adrenal ganglioneuroma is associated with a more severe prognosis; post-surgical complications are more frequent in non-adrenal vs. adrenal ganglioneuroma. Exceptionally, immune-mediated paraneoplastic neurologic syndromes have been reported: anti-N-methyl-D-aspartate receptor encephalitis and opsoclonus-myoclonus-ataxia syndrome. ROHHAD syndrome is the underlying cause in 40-56% of cases of neuroendocrine tumors including ganglioneuroma; 70% of tumors are diagnosed within the first 24 months after hypothalamic obesity onset, associated with a severe prognosis due to hypoventilation, sleep apnea, and dysautonomia. Recently, the PKB/AKT/mTOR/S6 pathway was identified as a tumorigenic pathway in pediatric ganglioneuroma, not in neuroblastoma; mTOR inhibitors are a potential option for pre-operatory tumor shrinkage. Pediatric adrenal ganglioneuroma has a good prognosis if adequately treated; its recognition requires adrenalectomy. Further development of specific biomarkers is needed. In the present article, we aimed to introduce a review of the literature involving adrenal ganglioneuroma based on a practical, multidisciplinary perspective of prognostic factors.
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Elias' Emergency Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Elias' Emergency Hospital, 022461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 061344 Bucharest, Romania
| | - Ana Maria Oproiu
- Department of Plastic and Reconstructive Surgery, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Adina Ghemigian
- Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania
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Dhali A, Ray S, Dhali GK, Ghosh R, Sarkar A. Duodenal Ganglioneuroma: A Rare Tumor Causing Upper Gastrointestinal Bleed. Surg J (N Y) 2021; 7:e255-e258. [PMID: 34541318 PMCID: PMC8440055 DOI: 10.1055/s-0041-1735644] [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: 04/25/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Neuroblastic tumors (NTs) include neuroblastoma, ganglioneuroblastoma, and ganglioneuroma (GN). They are very rare in adults. The Surveillance, Epidemiology, and End Results identified 144 patients ≥20 years old at diagnosis (6.1%) from 1973 to 2002. GNs account for 14% of all localized NT. Since 1957, a total of four cases of GN of the duodenum have been reported. We report a novel case of GN of the periampullary region in the duodenum in a 41-year-old man presenting with chronic upper gastrointestinal bleed. Given the rarity of GNs in this age group and the nonspecificity of radiological features, this diagnosis is often missed until histopathology is done. This may negatively affect the prognosis of an otherwise well-prognosticated disease.
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Affiliation(s)
- Arkadeep Dhali
- Department of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sukanta Ray
- Department of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Gopal Krishna Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Ranajoy Ghosh
- Department of GI Pathology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Avik Sarkar
- Department of GI Radiology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Miyata K, Akaihata M, Shimomura Y, Hori T, Kaneko K, Okumura A. Harlequin syndrome associated with ganglioneuroblastoma-induced Horner syndrome. Childs Nerv Syst 2021; 37:2683-2686. [PMID: 33125512 DOI: 10.1007/s00381-020-04948-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
A 1-year-old boy presented with a 4-month history of hypertension, ptosis of the right upper eyelid, left hemifacial sweating, and flushing. He was diagnosed with Harlequin syndrome associated with Horner syndrome. Computed tomography revealed a mass lesion in the right superior mediastinum. Therefore, the patient underwent total tumor resection. Histological examination demonstrated ganglioneuroblastoma. The MYCN oncogene was not amplified, and the mitosis-karyorrhexis index was low. Accordingly, radiation and chemotherapy were not performed. No recurrence was observed within 8 months after surgery, and the patient's blood pressure was normalized. However, the ptosis, hemifacial sweating, and flushing persisted.
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Affiliation(s)
- Kenji Miyata
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Mitsuko Akaihata
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuto Shimomura
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Toshinori Hori
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastrointestinal Surgery, Aichi Medical University, School of Medicine, Nagakute, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Ma R, Wang Y, He W. Primary orbital ganglioneuroblastoma: A case report. Open Med (Wars) 2021; 16:1076-1081. [PMID: 34307890 PMCID: PMC8284332 DOI: 10.1515/med-2021-0230] [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] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background Ganglioneuroblastoma (GNB) is a neoplasm that arises from the primitive cells of the sympathetic nervous system during childhood. The current case is very unique because of the initial primary tumor manifestation in the orbit and an adrenal tumor being observed later during follow-up. Case presentation A 2-year-old girl presented to the Ophthalmology Department of our hospital complaining of swelling of the left upper eyelid for approximately one month. Orbital computed tomography (CT) revealed a left orbital mass with bone destruction. Thoracic and abdominal CT indicated no abnormalities. The mass was surgically resected, and histopathological analysis confirmed it as GNB. During follow-up, abdominal CT detected an adrenal tumor with internal calcification, a calcified nodule on the left side of the abdominal aorta, and mesenteric lymph nodes. Accordingly, primary orbital GNB and metastatic adrenal GNB were the possible considerations. We removed the adrenal tumor, and the patient underwent chemotherapy. However, the patient died 18 months after the ophthalmic surgery. Conclusion Primary orbital GNB in children is easily misdiagnosed because of its rare occurrence and atypical clinical findings. Imaging methods combined with histopathological examination contribute to the detection and diagnosis of primary and metastatic GNBs. Thus, timely surgery combined with adjuvant chemotherapy and long-term follow-up is essential for controlling the metastasis of GNB and improving the survival rate of patients.
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Affiliation(s)
- Ruixin Ma
- Department of Ophthalmology, Ophthalmic Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yujiao Wang
- Department of Ophthalmology, Ophthalmic Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Weimin He
- Department of Ophthalmology, Ophthalmic Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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Dages KN, Kohlenberg JD, Young WF, Murad MH, Prokop L, Rivera M, Dy B, Foster T, Lyden M, McKenzie T, Thompson G, Bancos I. Presentation and outcomes of adrenal ganglioneuromas: A cohort study and a systematic review of literature. Clin Endocrinol (Oxf) 2021; 95:47-57. [PMID: 33721367 PMCID: PMC8178203 DOI: 10.1111/cen.14460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/20/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the presentation and outcomes of patients with adrenal ganglioneuromas (AGNs). DESIGN Single-centre retrospective cohort study (1 January 1995 to 31 December 2019) and systematic review of literature (1 January 1980 to 19 November 2019). PATIENTS Diagnosed with histologically confirmed AGN. MEASUREMENTS Baseline clinical, imaging and biochemical characteristics, recurrence rates and mortality. Subgroup analysis was performed on tumours with histologic elements of ganglioneuroma and pheochromocytoma (ie composite tumours). RESULTS The cohort study included 45 patients with AGN, 20 (44%) of which had composite tumours. Compared to pure AGN, patients with composite tumour were older (median age, 62.5 vs. 35 years, p < .001), had smaller tumours (median size, 3.9 vs. 5.7 cm, p = .016) and were discovered incidentally less frequently (65% vs. 84%, p = .009). No recurrences or ganglioneuroma-specific mortality occurred during follow-up (range, 0-266 months). The systematic review included 14 additional studies and 421 patients. The mean age of diagnosis was 39 years, and 47% were women. AGNs were discovered incidentally in 72% of patients, were predominantly unilateral (99%) and had a mean diameter of 5.8 cm and an unenhanced computed tomography (CT) attenuation of -118 to 49 Hounsfield units (HU). On imaging, 69% of AGNs were homogenous, 41% demonstrated calcifications, and 40% were lobulated. CONCLUSIONS AGNs are rare benign tumours that present with variable imaging features including large size, unenhanced CT attenuation >20 HU, calcifications and lobulated shape. Imaging characteristics can assist in establishing a diagnosis and avoiding an unnecessary adrenalectomy. The association of pheochromocytomas with AGNs is frequent. Diagnosis should include biochemical testing.
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Affiliation(s)
- Kelley N. Dages
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob D. Kohlenberg
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - William F. Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohammad Hassan Murad
- Evidence-Based Practice Center, Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Benzon Dy
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Trenton Foster
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Melanie Lyden
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Travis McKenzie
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Geoffrey Thompson
- Division of Breast, Endocrine, Metabolic and GI Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Vassallo L, Fasciano M, Baralis I, Pellegrino L, Fortunato M, Orcioni GF, Sorrentino S. A rare case of adrenal ganglioneuroblastoma-intermixed in an adult and a review of literature. Radiol Case Rep 2021; 16:2351-2356. [PMID: 34306280 PMCID: PMC8258789 DOI: 10.1016/j.radcr.2021.06.005] [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] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/04/2022] Open
Abstract
Peripheral neuroblastic tumors are extremely rare in the adult with less just over 20 cases involving adrenal gland described in the literature. We reported herewith the case of a 22-year-old young male who presented with epigastric pain and diarrhea. Imaging studies documented a 3.5cm x 3cm x 4cm solid well-circumscribed right adrenal mass, of heterogeneous structure and with fine calcifications. The lesion turned negative at MIBG scintigraphy. A right robotic-assisted adrenalectomy was performed leading to complete excision of the lesion without complications. Histology was consistent with intermixed stroma-rich ganglioneuroblastoma. A wait-and-see strategy was considered adequate. Two years after diagnosis patient is alive disease-free. Although the definitive diagnosis of a peripheral neuroblastic tumor is obtained after histopathological analysis, CT, and MRI are helpful to further characterize masses and useful in pretreatment risk stratification. Clinicians should be aware of the possibility of GNB development in adult population and its malignant potential.
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Key Words
- ADC, Apparent Diffusion Coefficient
- Adrenal gland
- Adult
- CT, Computed Tomography
- Computed tomography
- GN, Ganglioneuroma
- GNB, Ganglioneuroblastoma
- Ganglioneuroblastoma
- INPC, International Neuroblastoma Pathology Classification
- INRG, International Neuroblastoma Risk Group
- INSS, International Neuroblastoma Staging System
- MRI, Magnetic Resonance Imaging
- Magnetic resonance imaging
- NB, Neuroblastoma
- Neuroblastoma
- PNT, Neuroblastic tumors
- RT, Radiotherapy
- US, Ultrasound
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Affiliation(s)
- Lorenzo Vassallo
- Unit of Radiology, S.S. Annunziata Hospital, ASLCN1, Via degli Ospedali 9, 12038, Cuneo, Italy
| | - Mirella Fasciano
- Unit of Radiology, S.S. Annunziata Hospital, ASLCN1, Via degli Ospedali 9, 12038, Cuneo, Italy
| | - Ilaria Baralis
- Department of Diagnostic and Interventional Radiology, S. Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Luca Pellegrino
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Mirella Fortunato
- Department of Pathology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | | | - Stefania Sorrentino
- Unit of Pediatric Oncology, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
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AlShammari S, Alsalouli MM, Alkabli AM, Abanumay FM, AlAli MN, Al-Sakkaf H, Bin Traiki T. Large Asymptomatic Retroperitoneal Ganglioneuroma Displacing Major Abdominal Organs and Vessels in an Adult. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931725. [PMID: 34155189 PMCID: PMC8235676 DOI: 10.12659/ajcr.931725] [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] [Indexed: 12/04/2022]
Abstract
Patient: Female, 29-year-old Final Diagnosis: Ganglioneuroma Symptoms: Asymptomatic • incidental finding Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Sulaiman AlShammari
- Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Monirah M Alsalouli
- Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - AbdulRahman M Alkabli
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Faisal M Abanumay
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed N AlAli
- Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hussein Al-Sakkaf
- Department of Radiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Thamer Bin Traiki
- Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Haitao S, Yao W, Xin J, Xiaopan C, Ting W, Yan L, Chenglong Z, Zhipeng W, Jianru X. Real-world experience with management of spinal ganglioneuroma: long-term follow-up observations of 31 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2896-2905. [PMID: 34146136 DOI: 10.1007/s00586-021-06896-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Spinal ganglioneuroma (GN) is the most benign neoplasm of neuroblastic origin. There is little knowledge about spinal GN because of sporadic cases reported. The objective of this study is to describe the clinical manifestations and long-term follow-up outcomes of spinal GN after consecutive treatment. METHODS The clinical and follow-up data of 31 patients with spinal GN receiving consecutive treatment in our institute are retrospectively analyzed. RESULTS The mean age of the 31 patients was 40.39 ± 14.8 years. They were diagnosed with spinal GN and received surgical treatment in our institution between February 2012 and August 2019. Of them, 22 (71%) patients presented preoperative neurological symptoms. The mean duration from symptom onset to surgery was 19.76 ± 49.59 months. Eighteen patients received complete surgical resection and 13 patients received subtotal excision. In addition, radicotomy was performed simultaneously after sophisticated consideration in 19 patients. The follow-up period averaged 64.13 ± 22.67 months. The preoperative neurological dysfunction was improved significantly during the follow-up period in all cases. No local recurrence or malignant transformation has occurred so far. CONCLUSION Spinal GN is a rare but benign neoplasm, and the origin of spinal GN remains controversial. With our experience, we propose that the origin of spinal GN from dorsal root ganglion should be equally considered as its counterpart of sympathetic ganglion. Complete resection is the preferred surgical strategy to avoid malignant events and recurrence. And the close postoperative follow-up observations are warranted.
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Affiliation(s)
- Sun Haitao
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Wang Yao
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Jiang Xin
- Department of Anesthesiology, Changzheng Hospital, Shanghai, China
| | - Cai Xiaopan
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Wang Ting
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Lou Yan
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Zhao Chenglong
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China.
| | - Wu Zhipeng
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China.
| | - Xiao Jianru
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, China.
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Zhang R, Fang YF, Wu DM, Lin Y, Zhang B, Liu MK, Bai JX, Chen F. Comparison of the Efficacy of Minimally Invasive and Open Surgery on Children with Neuroblastoma: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 31:829-838. [PMID: 34076504 DOI: 10.1089/lap.2020.0618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Evaluate the clinical efficacy and safety of minimally invasive surgery (MIS) and open surgery in the treatment of neuroblastoma (NB) in children by a meta-analysis. Materials and Methods: This is a meta-analysis. We searched for random or nonrandomized controlled study of MIS group and OPEN surgery group for the treatment of childhood NB included in PubMed, ClinicalTrials, EMBASE, and Cochrane library before January 31, 2020. Data extraction was performed in a standard format for the included studies, including tumor diameter, operation time, intraoperative bleeding, length of hospital stay (LOHS), complications, recurrence, and MYCN. Results: Seven retrospective studies were finally included, with a total of 571 children, including 162 in MIS group and 409 in the OPEN surgery group. Compared with the OPEN surgery group, the MIS group had reduced intraoperative bleeding (mean difference [MD] = -12.72, 95% CI: -24.84 to -0.61, P < .05), and reduced l LOHS (MD = -3.35, 95% CI: -5.55 to -1.15, P < .05) and decreased postoperative recurrence (MD = 0.20, 95% CI: 0.05-0.75, P < .05). The differences between the groups were statistically significant. There was no significant difference between groups in tumor diameter (MD = -18.84, 95% CI: -48.12 to 10.43, P > .05), operation time (MD = -21.7, 95% CI: -97.52 to 54.13, P > .05), and MYCN results (odds ratio = 2.27, 95% CI: 0.56-9.18, P > .05). Conclusions: Preliminary evidence indicates that the treatment of NB with MIS has the advantages of less intraoperative bleeding, shorter LOHS, and less postoperative recurrence compared with open surgery.
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Affiliation(s)
- Rong Zhang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Yi Fan Fang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Dian Ming Wu
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Bing Zhang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Ming Kun Liu
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Jiang Xi Bai
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Fei Chen
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
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47
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Agrawal N, Awasthi A, Mahata R, Chakraborty PP. Continuous and progressive 'wash-in' without 'wash-out' of contrast in adrenal mass: a useful feature of ganglioneuroma. BMJ Case Rep 2021; 14:14/5/e241661. [PMID: 34011673 DOI: 10.1136/bcr-2021-241661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Computed tomography (CT) scan is a useful and widely performed diagnostic modality to evaluate adrenal masses. Nature of the mass determines the degree of attenuation both in unenhanced and in different phases of contrast enhancement. Benign neurogenic tumours like ganglioneuroma mimicks pheochromocytoma and adrenocortical carcinoma in non-contrast CT scan. The 'adrenal protocol' routinely calculates the wash-out pattern at delayed venous phase (DVP) (15 min) following contrast administration to differentiate majority of benign masses from the malignant ones. Ganglioneuromas typically exhibit continuous wash-in of contrast where enhancement gradually increases to attain its peak in DVP. Such wash-in pattern is different from the wash-out pattern observed in pheochromocytomas or adrenocortical adenomas or carcinomas. Presence of this wash-in pattern provides a useful clue to the clinician for underlying ganglioneuroma in hormonally inactive adrenal masses with suspicious morphological appearances. This wash-in pattern also effectively rules out any malignant potential of ganglioneuroma, and thus helps in preoperative decision-making.
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Affiliation(s)
- Neeti Agrawal
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Avivar Awasthi
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Rahin Mahata
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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48
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Kora C, Oulad Amar A, El Arabi S, Rockson O, Nasri S, Skiker I. Retroperitoneal ganglioneuroma presenting as an obstructive pyelonephritis: a case report. J Surg Case Rep 2021; 2021:rjab104. [PMID: 33927851 PMCID: PMC8068418 DOI: 10.1093/jscr/rjab104] [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: 01/04/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Ganglioneuroma is a nerve tumor arising from the sympathetic neural crest. It is a rare benign tumor. Retroperitoneum is its second location after the posterior mediastinum. Usually asymptomatic, it is discovered incidentally on imaging. Surgical resection is the sole treatment. The prognosis is good if the diagnosis is made early with quality R0 surgical excision. We report a case in a 14-year-old female admitted to the emergency department for obstructive pyelonephritis. Imaging features found a retroperitoneal mass with characteristics suggestive of a retroperitoneal ganglioneuroma, which was confirmed by histological study. Ganglioneuroma should be a part of differential diagnoses for any retroperitoneal mass in children and young adults.
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Affiliation(s)
- Christine Kora
- Department of Radiology, Mohammed VI University Hospital Oujda, Oujda, Morocco
| | - Asmae Oulad Amar
- Department of Radiology, Mohammed VI University Hospital Oujda, Oujda, Morocco
| | - Soumia El Arabi
- Department of Radiology, Mohammed VI University Hospital Oujda, Oujda, Morocco
| | - Obed Rockson
- Department of Surgical Oncology, Mohammed VI University Hospital Oujda, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital Oujda, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital Oujda, Oujda, Morocco
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49
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McGann EK, Goldberg AM, Lelegren MJ, Pickle JC, Bak MJ, Mark JR. Primary cervical ganglioneuroblastoma, nodular subtype. Auris Nasus Larynx 2021; 49:889-892. [PMID: 33867181 DOI: 10.1016/j.anl.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Primary cervical ganglioneuroblastoma is rare and reports of its subtypes are limited. This case series describes two pediatric patients with the nodular subtype of primary cervical ganglioneuroblastoma with lymphatic spread. Clinical course, diagnosis, and management of this rare tumor are discussed with emphasis on the importance of including neuroblastic tumors in the differential diagnosis of pediatric neck masses. We also report the use of nerve monitoring of the recurrent laryngeal nerve as a surrogate for the vagus nerve during a pediatric neck dissection.
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Affiliation(s)
- Ethan K McGann
- Eastern Virginia Medical School, 825 Fairfax Ave., Norfolk VA 23507, United States.
| | - Allison M Goldberg
- Eastern Virginia Medical School, 825 Fairfax Ave., Norfolk VA 23507, United States.
| | - Matthew J Lelegren
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk VA 23507, United States.
| | - Jerrah C Pickle
- Eastern Virginia Medical School, 825 Fairfax Ave., Norfolk VA 23507, United States.
| | - Matthew J Bak
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk VA 23507, United States.
| | - Jonathan R Mark
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk VA 23507, United States.
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50
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Samim A, Tytgat GA, Bleeker G, Wenker ST, Chatalic KL, Poot AJ, Tolboom N, van Noesel MM, Lam MG, de Keizer B. Nuclear Medicine Imaging in Neuroblastoma: Current Status and New Developments. J Pers Med 2021; 11:jpm11040270. [PMID: 33916640 PMCID: PMC8066332 DOI: 10.3390/jpm11040270] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
Neuroblastoma is the most common extracranial solid malignancy in children. At diagnosis, approximately 50% of patients present with metastatic disease. These patients are at high risk for refractory or recurrent disease, which conveys a very poor prognosis. During the past decades, nuclear medicine has been essential for the staging and response assessment of neuroblastoma. Currently, the standard nuclear imaging technique is meta-[123I]iodobenzylguanidine ([123I]mIBG) whole-body scintigraphy, usually combined with single-photon emission computed tomography with computed tomography (SPECT-CT). Nevertheless, 10% of neuroblastomas are mIBG non-avid and [123I]mIBG imaging has relatively low spatial resolution, resulting in limited sensitivity for smaller lesions. More accurate methods to assess full disease extent are needed in order to optimize treatment strategies. Advances in nuclear medicine have led to the introduction of radiotracers compatible for positron emission tomography (PET) imaging in neuroblastoma, such as [124I]mIBG, [18F]mFBG, [18F]FDG, [68Ga]Ga-DOTA peptides, [18F]F-DOPA, and [11C]mHED. PET has multiple advantages over SPECT, including a superior resolution and whole-body tomographic range. This article reviews the use, characteristics, diagnostic accuracy, advantages, and limitations of current and new tracers for nuclear medicine imaging in neuroblastoma.
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Affiliation(s)
- Atia Samim
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Godelieve A.M. Tytgat
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
| | - Gitta Bleeker
- Department of Radiology and Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands;
| | - Sylvia T.M. Wenker
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Kristell L.S. Chatalic
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Alex J. Poot
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Nelleke Tolboom
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Max M. van Noesel
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
| | - Marnix G.E.H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Bart de Keizer
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (A.S.); (G.A.M.T.); (S.T.M.W.); (K.L.S.C.); (A.J.P.); (N.T.); (M.M.v.N.)
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-887-571-794
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