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Ncheye MS, Mrimba PM, Dekker M, Massawe H, Mwanga D, Rabiel H. Spinal ganglioneuroma with extension to the brachial plexus. The challenges for total surgical excision, a case report. Int J Surg Case Rep 2024; 119:109756. [PMID: 38754158 PMCID: PMC11109351 DOI: 10.1016/j.ijscr.2024.109756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Ganglioneuromas are benign neurogenic tumors that arise from the sympathetic ganglia. They are less aggressive compared to the more immature neuroblastomas and ganglioneuroblastomas but can grow to exert mass effect on surrounding tissues. PRESENTATION OF CASE A 7 years old girl who presented with progressive quadriplegia for 4 months. On examination, she had a right supra-clavicular mass with reduced power in the right hand than the left. Power in the lower limbs was also reduced with hyper-reflexia, clonus and Babinski positive. Laboratory investigations were unremarkable and Chest X-Ray showed a widened mediastinum. Magnetic Resonance Imaging (MRI) scan revealed an extra-medullary spinal tumor at C6/C7 extending laterally on the right through the C6/7 neuro-foramen to the para-spinal tissue and brachial plexus. A C6/7 laminectomy with Spinal cord decompression by partial resection of the tumor was done. Histology of the resected tissue showed ganglioneuroma. DISCUSSION The presentation of Ganglioneuromas is usually asymptomatic until they are huge enough to exert mass effect on surrounding tissue. Most are located in the posterior mediastinum, retro-peritoneum and neck. Due to this, it may be very challenging to achieve total resection especially when they surround major vessels or nerves. A multi-disciplinary approach is needed for the best surgical outcomes but this is not always realized in our setting. CONCLUSION In resource limited settings, more collaboration and training is needed to realize appropriate management of complex surgical conditions. Although complications are not uncommon, total surgical excision is necessary to prevent recurrence and progression of Ganglioneuromas.
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Affiliation(s)
- Mathias S Ncheye
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania.
| | - Peter Magembe Mrimba
- Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Marieke Dekker
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Honest Massawe
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Daniel Mwanga
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Happiness Rabiel
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Neurosurgery, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
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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 F, Feng H, Liao J, Bao Y, Xu S, Qin G. Parapharyngeal Space Ganglioneuroma: Clinical Experience and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2023; 102:765-771. [PMID: 36450599 DOI: 10.1177/01455613221142658] [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: 11/17/2023] Open
Abstract
Ganglioneuroma is a rare benign tumor originating in the sympathetic ganglia, composed of differentiated ganglion cells, nerve sheath cells, and nerve fibers, which tend to occur in the posterior mediastinum, adrenal gland, retroperitoneal, and other locations, occurring in the head and neck is relatively rare, and parapharyngeal space involvement is extremely rare. In our report, we present 2 adult male patients whose preoperative imaging and fine needle cytology did not confirm the diagnosis of a parapharyngeal space mass and who completely resected the tumor through a combined cervical and oral approach. Finally, pathology confirmed ganglioneuroma; we also reviewed the English articles on parapharyngeal ganglioneuroma over the past 40 years, and summarized the diagnostic and treatment characteristics of parapharyngeal ganglioneuroma in combination with our cases to improve understanding of the disease.
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Affiliation(s)
- Fei Li
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Huajun Feng
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiangxue Liao
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yilin Bao
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shengen Xu
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gang Qin
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Sarnat HB, Chan ES, Ng D, Yu W. Maturation of metastases in peripheral neuroblastic tumors (neuroblastoma) of children. J Neuropathol Exp Neurol 2023; 82:853-864. [PMID: 37682248 DOI: 10.1093/jnen/nlad068] [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: 09/09/2023] Open
Abstract
Peripheral neuroblastic tumors of childhood exhibit 3 principal neural crest lineages: primitive neuroblastoma, ganglioneuroblastoma, and ganglioneuroma. They are unique in undergoing maturation of neurons (ganglion cells) and Schwann cells, thereby recapitulating normal fetal neuronal development in the brain. Precision in estimating neurogenesis is enhanced by immunoreactivities of markers of neuronal maturation. Whether organ tissue factors in different sites of metastases influence rates of maturation and whether metastases are similar to their primary neuroblastic tumor are incompletely documented. Four young children, 1 with a mixed primary adrenal tumor and 3 with metastases were studied at surgery or autopsy. Immunocytochemical reactivities included microtubule-associated protein-2, synaptophysin, chromogranin-A, somatostatin, keratan sulfate, vimentin, S-100β protein, and PHOX2B. Primary tumors were non-uniform with regions of either poor or enhanced maturation. Both neuronal and Schwannian lineages were represented in each tumor type but differed in proportions. Bi- or multi-nucleated ganglion cells matured equal to mononuclear forms. Ganglion cell maturation was similar in metastases regardless of the target organ. Metastases resembled primary tumors. Immunocytochemical markers of neuronal and of Schwann cell maturation provide greater diagnostic precision to supplement histological criteria. Interval between diagnosis of primary tumor and metastases, metastatic target tissues, and chemotherapy over an interval of time do not appear to influence neuroblastic or Schwann cell differentiation.
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Affiliation(s)
- Harvey B Sarnat
- Department of Paediatrics, University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute (Owerko Centre), Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine (Neuropathology), University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute (Owerko Centre), Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute (Owerko Centre), Calgary, Alberta, Canada
| | - Elaine S Chan
- Department of Pathology and Laboratory Medicine (Paediatric Anatomical Pathology), University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute (Owerko Centre), Calgary, Alberta, Canada
| | - Denise Ng
- Department of Pathology and Laboratory Medicine (Neuropathology), University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute (Owerko Centre), Calgary, Alberta, Canada
| | - Weiming Yu
- Department of Pathology and Laboratory Medicine (Paediatric Anatomical Pathology), University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute (Owerko Centre), Calgary, Alberta, Canada
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Corrado S, Morgante C, Tassi S, Maccarrone F, Di Massa G, Pontecorvi A, Papi G. Neck Ganglioneuroma Mimicking a Thyroid Nodule in a Four-Year-Old Child: A Case Report and Review of the Literature. Int J Endocrinol Metab 2023; 21:e126486. [PMID: 37662645 PMCID: PMC10474842 DOI: 10.5812/ijem-126486] [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: 04/19/2022] [Revised: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Ganglioneuromas are tumors of neurogenic origin usually located in the abdomen, the adrenal glands, and the mediastinum but infrequently found in the neck region. Case Presentation We describe the case of a four-year-old Albanian girl presenting with an anterior neck mass initially suspected to be a thyroid nodule. From a clinical point of view, there was no evidence of compression on vital cervical structures. Lab tests detected normal serum thyrotropin, calcitonin, and parathormone concentrations. A neck ultrasound showed a huge mass apparently originating from the left thyroid lobe. Cytological examination of fine needle biopsy demonstrated a population of large cells with eosinophilic cytoplasm, regular nuclei, and prominent nucleoli and spindle cells without significant atypia, consistent with a benign lesion of neurogenic origin. Also, the neck MRI displayed a mass with well-defined margins, likely arising from the peripheral nervous system. The patient underwent surgical excision of the mass without complications. The histological exam was diagnostic for ganglioneuroma. Conclusions We discuss the cytological and histological features peculiar to such a rare neck lesion and review the differential diagnosis.
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Affiliation(s)
- Stefania Corrado
- Department of Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Cesare Morgante
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCSS, 00168 Rome, Italy
| | - Sauro Tassi
- Otolaryngology Unit, Azienda USL Modena, 41100 Modena, Italy
| | | | - Gianluca Di Massa
- Department of Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCSS, 00168 Rome, Italy
| | - Giampaolo Papi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCSS, 00168 Rome, Italy
- Endocrinology Unit, Azienda USL Modena, 41100 Modena, Italy
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Tanaka J, Sasaguri M, Yada N, Tanaka M, Habu M, Yoshiga D, Matsuo K, Tominaga K, Yoshioka I. A case of cervical ganglioneuroma incidentally detected during surgery for oral cancer. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Dahal A, Malla JJ, Neupane D, Lageju N, Jaiswal LS, Chaudhary S, Kandel A, Chhetri S, Pahari S. Large posterior mediastinal ganglioneuroma with intradural cervical spine extension: A rare case report and review of literature. Ann Med Surg (Lond) 2022; 84:104833. [PMID: 36582868 PMCID: PMC9793127 DOI: 10.1016/j.amsu.2022.104833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Ganglioneuroma (GN) is a rare benign tumor of ganglion cell origin and can occur anywhere along the sympathetic chain. These tumors can grow to a significant size without any symptoms unless they exert a mass effect on the region they grow and start showing symptoms. Spinal extensions are rare and they may produce neurological symptoms warranting further investigation. Case presentation We described a case of posterior mediastinal ganglioneuroma in a 4-year-old boy with cervical extension who presented with quadriparesis. The radiological scan revealed large ganglioneuroma having an intradural extramedullary extension with a large posterior mediastinal component compressing and displacing the surrounding structures. He underwent consecutive surgeries for complete excision of the tumor following which he regained his power in his upper and lower limbs over the period of 2 months. Conclusion Para spinal mass with consistent radiological features suggests ganglioneuroma but confirmation should be done with biopsy. Complete excision of the tumor is the treatment of choice with close follow-up for clinical improvement and recurrence.
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Affiliation(s)
- Alok Dahal
- Department of Surgery (Division of Neurosurgery), B.P. Koirala Institute of Health Sciences, Dharan, Nepal,Corresponding author.
| | - Justin Jung Malla
- Department of Surgery (Division of Neurosurgery), B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Durga Neupane
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nimesh Lageju
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Lokesh Shekher Jaiswal
- Department of Surgery (Division of CTVS), B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sushant Chaudhary
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ashim Kandel
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sunit Chhetri
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Soumya Pahari
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Saadat S, Fritz C, Tran D, Parry N, Yuhan BT, Bolduan A, Thorpe E. A Systematic Review of Cervical Ganglioneuromas. OTO Open 2022. [DOI: 10.1177/2473974x221106784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To perform a systematic review of the literature evaluating clinical characteristics and management of cervical ganglioneuromas (CGNs). Data Sources PubMed, Embase, and Cochrane Library databases were searched. Data such as patient demographics, imaging, and treatments were obtained. Review Methods Pertinent studies were downloaded, and the full text was reviewed by 4 authors (N.P., S.S., C.F., D.T.). Results were reported via the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Results Fifty-two studies with 58 patients were identified in the literature. Of the 58 patients, 22 were adults and 36 were pediatric. The most common reported location of CGN was within the parapharyngeal space (76%), followed by the retropharyngeal (19%) and paravertebral/prevertebral (7%) spaces. The most common presenting symptoms included a nontender mass (29.3%), dysphagia (17.2%), and hoarseness (10.3%). Interestingly, the average tumor volume for patients with postoperative Horner’s syndrome was 183 mm3 (n = 21, 47.7%) vs 946 mm3 in patients without Horner’s syndrome (n = 23, 52.3%). This represents a statistically significant finding ( P = .018). There exists no significant difference in tumor volumes between adult and pediatric patients with Horner’s syndrome ( P = .645). Conclusion CGN is a rare tumor of the sympathetic nervous system. Management should involve complete surgical excision with biopsy. We found that patients with small-volume CGNs are significantly more likely to experience postoperative Horner’s syndrome. This finding is independent of age and should therefore be taken into consideration in any patient with suspected CGN.
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Affiliation(s)
- Saad Saadat
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Christian Fritz
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Deanna Tran
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Nathan Parry
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Brian T. Yuhan
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Alyssa Bolduan
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eric Thorpe
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
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Aslan M, Dogukan FM. A Rare Cause of Dysphagia: A Giant Ganglioneuroma in Parapharyngeal Space. J Maxillofac Oral Surg 2022; 21:99-101. [PMID: 35400909 PMCID: PMC8934885 DOI: 10.1007/s12663-021-01549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/13/2021] [Indexed: 11/28/2022] Open
Abstract
Parafarengeal ganglioneuroma is a very rare benign tumor originating from the sympathetic nervous system that produces mass and functional effects. Ganglioneuroma is most commonly caused by the posterior mediastinal, retroperitoneal area and adrenal glands. Generally, they do not present any additional signs or symptoms other than mass. Horner's syndrome may sometimes occur due to the compression of the sympathetic chain. A 41-year-old male patient with a long-standing mass in the lateral compartment of the left neck was admitted to our clinic. The patient was operated, and the pathological result of the mass was reported as ganglioneuroma. We present a rare case of ganglioneuroma in paraphryngeal space by reviewing the current literature.
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Affiliation(s)
- Mehmet Aslan
- Department of Otorhinolaryngology Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, 44000 Turkey
| | - Fatih Mert Dogukan
- Mardin State Hospital, Department of Pathology, Vali Ozan cad., Artuklu, Mardin, Turkey
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McCrory D, Kelly A, Korda M. Postoperative Horner's syndrome following excision of incidental cervical ganglioneuroma during hemithyroidectomy and parathyroid gland exploration. BMJ Case Rep 2020; 13:13/1/e231514. [PMID: 31969402 DOI: 10.1136/bcr-2019-231514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This 49-year-old woman was referred to ear, nose and throat (ENT) with primary hyperparathyroidism. Imaging studies failed to localise the adenoma so she required four-gland parathyroid exploration. She also required diagnostic left hemithyroidectomy as she had a U3 nodule with multiple insufficient fine needle aspirations (FNAs). Intraoperatively, the left thyroidectomy proceeded uneventfully. No convincing left inferior parathyroid gland was identified however palpation revealed a 1 cm mass just medial to carotid artery. This was excised as probable ectopic parathyroid gland. She was discharged two days later. Thirteen days postoperatively she attended Eye Casualty with a left-sided Horner's syndrome. A CT angio of aortic arch was normal. She was reviewed at ENT outpatients. Histopathology report of the expected ectopic parathyroid gland returned as benign ganglioneuroma, likely arising from her left sympathetic chain. Horner's syndrome is a common side effect from excision of ganglioneuromas, but an incredibly rare side effect from thyroid or parathyroid surgery.
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Affiliation(s)
- David McCrory
- ENT, Southern Health and Social Care Trust, Portadown, Ulster, UK
| | - Andrew Kelly
- ENT, Southern Health and Social Care Trust, Portadown, Ulster, UK
| | - Marian Korda
- ENT, Southern Health and Social Care Trust, Portadown, Ulster, UK
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Abstract
RATIONALE Ganglioneuromas are benign neoplasm of neuroblastic origin which arise from central or peripheral parts of the autonomic nervous system. They are normally found at posterior mediastinum, retroperitoneum, and the adrenal gland but ganglioneuromas are rarely found in the cervical region. PATIENT CONCERNS A 12-year-old boy was admitted with a left-lateral neck mass slow growing over a 7-days duration. The tumor was painless and was not associated with any systemic or compression-related symptoms. No symptoms of Horner's syndrome, including ptosis, myosis, ipsilateral facial anhidrosis, and flushing, were observed. Laboratory routine tests were within normal limits, and magnetic resonance imaging demonstrated a solid and well-circumscribed mass in the carotid space. DIAGNOSIS Due to the patient's symptoms, laboratory test results together with radiographic investigation findings, the 12 years old boy was diagnosed with cervical ganglioneuroma combined with tetralogy of Fallot. INTERVENTIONS Surgical excision. OUTCOMES The postoperative period was uneventful with the exception of Horner's syndrome on the left side in short period, and it was finally resolved after 8 months recovery. The patient is now in stable condition after operation, with improvement in symptoms during follow-up recovery. LESSONS Ganglioneuromas should be accounted as the differential diagnosis of pediatric soft tissue tumors of the head and neck. The diagnosis for ganglioneuromas in cervical region can only be ascertained with postoperative pathologic examination, and excision is considered as the only effective treatment modality known so far which may cause Horner's syndrome at times. However, patients have a favorable prognosis without recurrence overall.
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Helal AA, Badawy R, Mahfouz M, Hussien T. Adjacent cervical ganglioneuromas. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Dias RB, Rosa D, Rito M, Borges A. Ganglioneuroma of the retropharyngeal space in a patient with glottic cancer. BMJ Case Rep 2017; 2017:bcr-2017-220966. [PMID: 28882936 DOI: 10.1136/bcr-2017-220966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 71-year-old man with a ganglioneuroma of the retropharyngeal space. The patient presented with a submucosal bulge of the left oropharyngeal wall during follow-up examination of a treated vocal cord carcinoma. CT and MRI revealed a non-specific, well-defined retropharyngeal soft tissue lesion. Positron emission tomography-CT did not show relevant metabolic activity, excluding the hypothesis of metastatic nodal disease. Surgical biopsy of the lesion was compatible with ganglioneuroma. Ganglioneuromas are well-differentiated tumours composed of mature sympathetic ganglion cells that account for approximately 1% of spinal and paraspinal tumours. Peripherally, ganglioneuromas are predominantly found in the posterior mediastinum and retroperitoneal space. Only nine ganglioneuromas of the retropharyngeal space have been reported in the English literature since the early 1980s.
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Affiliation(s)
- Raquel Baptista Dias
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Duarte Rosa
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Miguel Rito
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Alexandra Borges
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Bakshi J, Mohammed AW, Lele S, Nada R. Ganglioneuromas involving the hypoglossal nerve and the vagus nerve in a child: Surgical difficulties. EAR, NOSE & THROAT JOURNAL 2017; 95:E22-4. [PMID: 26930339 DOI: 10.1177/014556131609500207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ganglioneuromas are benign tumors that arise from the Schwann cells of the autonomic nervous system. They are usually seen in the posterior mediastinum and the paraspinal retroperitoneum in relation to the sympathetic chain. In the head and neck, they are usually related to the cervical sympathetic ganglia or to the ganglion nodosum of the vagus nerve or the hypoglossal nerve. We describe what we believe is the first reported case of multiple ganglioneuromas of the parapharyngeal space in which two separate cranial nerves were involved. The patient was a 10-year-old girl who presented with a 2-year history of a painless and slowly progressive swelling on the left side of her neck and a 1-year history hoarseness. She had no history of relevant trauma or surgery. Intraoperatively, we found two tumors in the left parapharyngeal space-one that had arisen from the hypoglossal nerve and the other from the vagus nerve. Both ganglioneuromas were surgically removed, but the affected nerves had to be sacrificed. Postoperatively, the patient exhibited hypoglossal nerve and vocal fold palsy, but she was asymptomatic. In addition to the case description, we discuss the difficulties we faced during surgical excision.
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Affiliation(s)
- Jaimanti Bakshi
- Corresponding author: Dr. Abdul Wadood Mohammed, Valiyatharayil House, (PO) Edakkazhiyur, (DT) Thrissur, Kerala, India 680515. From the Department of Otolaryngology-Head and Neck Surgery (Dr. Bakshi) and the Department of Histopathology (Dr. Nada), Post Graduate Institute of Medical Education and Research, Chandigarh, India; the Department of ENT, King Faisal University College of Medicine, Al-Ahsa, Kingdom of Saudi Arabia (Dr. Mohammed); and the Vijaya E.N.T. Care Centre, Bangalore, India (Dr. Lele)
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Wang K, Dai J. Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report. Oncol Lett 2016; 10:3803-3806. [PMID: 26788212 DOI: 10.3892/ol.2015.3815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 10/01/2015] [Indexed: 12/18/2022] Open
Abstract
Ganglioneuromas are rare, benign, well-differentiated tumors of the conus medullaris. Approximately 20 cases of spinal cord ganglioneuroma, and only 1 case of mixed chemodectoma-ganglioneuroma of the conus medullaris have been previously reported. The present study presents the case of a 38-year-old man with a histopathological diagnosis of conus medullaris ganglioneuroma. The patient presented with hypoesthesia in the lower limbs, muscle atrophy of the right lower limb and dysuria. Magnetic resonance imaging analysis led to a diagnosis of ependymoma. Histopathological analysis of the excised mass revealed typical, well-differentiated ganglion cells, consistent with a ganglioneuroma. The mass was associated with a neighboring syringomyelia. At an 18 month follow-up the patient had recovered, although some remaining difficulty in walking and urinating remained. The aim of the present report was to raise awareness that when ganglioneuromas present in unusual locations, analogous radiological findings may mislead investigators to consider more common pathologies and thus result in misdiagnosis. The present case demonstrates the importance of considering the potential differential diagnoses for neural tissue neoplasms.
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Affiliation(s)
- Kai Wang
- Department of Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jianping Dai
- Department of Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
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Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review. J Endocrinol Invest 2015; 38:547-54. [PMID: 25501841 DOI: 10.1007/s40618-014-0226-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Ganglioneuromas are benign tumors which originate from the neural crest. This tumor affects mainly young patients rather than adult ones, and its most frequent localizations are mediastinum, retroperitoneum, adrenal glands and cervical region. Usually, ganglioneuromas are discovered as incidentalomas since they are often asymptomatic, even if they could present sympathetic or mass-related symptoms. To obtain a definitive diagnosis, histological exam is necessary since CT scan and MRI are not capable of distinguishing ganglioneuromas from other tumors, such as neuroblastomas or pheocromocytomas. The surgical excision is the chosen treatment and it offers an excellent prognosis. METHODS We conducted a retrospective analysis of our cases of ganglioneuroma from 2004 to 2014; this study aims to compare our experience with literature review (2000-2014). Data about patients' features, tumor localization, symptoms, treatment and follow-up were analyzed and reported in detailed tables. RESULTS Between 2004 and 2014 we treated 14 patients affected by ganglioneuroma. For all of them the diagnosis was incidental; 9 out of 12 (64.3 %) patients presented an adrenal mass; in 2 patients (14.3 %) the tumor was localized in cervical region; in other 2 patients (14.3 %) the tumor was in the retroperitoneum and one patient (7.1 %) presented a ganglioneuroma in the costo-vertebral space. All our patients underwent surgical removal and none of them present surgery-related complications or recurrences to date. CONCLUSIONS Our data widen the knowledge about ganglioneuroma and confirm that the surgical approach has an excellent prognosis with very low incidence of surgery-related complications and recurrences.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A Barbetta
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - C Ugolini
- Department of Laboratory Medicine and Integrated Diagnostics, Section of Experimental Pathology, University of Pisa, Pisa, Italy.
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Multiple Ganglioneuroma With Cervical Involvement. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2013.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ozturk H. Adrenal Ganglioneuroma Presenting As Left Renal Mass. World J Oncol 2014; 5:90-92. [PMID: 29147384 PMCID: PMC5649880 DOI: 10.14740/wjon783w] [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] [Accepted: 02/05/2014] [Indexed: 11/21/2022] Open
Abstract
Ganglioneuromas (GNs) are benign tumors resulting from neural crest tissue. GNs contain mature ganglion cells and Schwann cells. GNs most commonly occur in the retroperitoneum and posterior mediastinum. GNs rarely occur in the adrenal gland. A 45-year-old asymptomatic patient presented with an incidental finding of left renal mass. A 10 cm mass lesion located in the upper pole of the left kidney and lymphadenopathy in renal hilus were detected. The patient underwent transperitoneal radical nephrectomy involving the removal of left adrenal gland. The immunohistochemical examination showed strong positive staining for S100, neuron-specific enolase, synaptophysin and chromogranin. The diagnosis of mature GN was established. GNs are among the rare diseases that should be considered in the evaluation of renal masses, particularly in the differential diagnosis of upper pole tumors of the kidneys. It can be confused with renal cell carcinomas.
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Affiliation(s)
- Hakan Ozturk
- Department of Urology, Sifa University School of Medicine, Izmir, Turkey
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Cazorla Ramos ÓE, Aguilar Conde MD, Flores Carmona E, Solano Romero JR. [Multiple ganglioneuroma with cervical involvement]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 66:120-1. [PMID: 24342697 DOI: 10.1016/j.otorri.2013.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/08/2013] [Accepted: 08/26/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Óscar E Cazorla Ramos
- Servicio de Otorrinolaringología, Hospital Virgen de la Victoria, Instituto Biomédico de Málaga, Málaga, España.
| | - María Dolores Aguilar Conde
- Servicio de Otorrinolaringología, Hospital Virgen de la Victoria, Instituto Biomédico de Málaga, Málaga, España
| | - Eva Flores Carmona
- Servicio de Otorrinolaringología, Hospital Virgen de la Victoria, Instituto Biomédico de Málaga, Málaga, España
| | - José R Solano Romero
- Servicio de Otorrinolaringología, Hospital Virgen de la Victoria, Instituto Biomédico de Málaga, Málaga, España
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