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Prabaharan H, Chandrasekaran S, Shetty N, Nayak K P. Benign paraspinal ganglioneuroma with paraneoplastic opsoclonus myoclonus syndrome. BMJ Case Rep 2024; 17:e256846. [PMID: 38417946 PMCID: PMC10900366 DOI: 10.1136/bcr-2023-256846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare immune-mediated movement disorder occurring as a paraneoplastic manifestation of neuroblastic tumours (NTs), especially neuroblastoma in infancy. Ganglioneuroma (GN), the benign tumour in the spectrum, is rarely associated with OMAS. We report the case of a child in her second year of life presenting with acute onset of progressive paraplegia and OMAS. MRI showed diffuse and infiltrating left paraspinal mass from T3-T9 levels with differentials of neuroblastoma or ganglioneuroblastoma. Histopathological and immunohistochemistry examination of the excised tumour showed maturing GN. The OMAS was managed with intravenous immunoglobulin and steroids. In the 6-month follow-up, the child has a residual motor weakness with myelomalacia in neuroimaging. The case report substantiates the occurrence of OMAS as paraneoplastic manifestation in NTs, including benign, in children younger than 2 years with a female predilection.
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Affiliation(s)
- Haritha Prabaharan
- Pediatrics, NITTE (Deemed to be University), Mangalore, Karnataka, India
| | | | - Niharika Shetty
- Pediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Praveen Nayak K
- Pediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India
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Alsaidan MS, Aljarbou OZ. Ganglioneuroma Arising in Congenital Melanocytic Nevus in a Patient with Cardiac Anomalies: A Case Report. Int J Surg Pathol 2024; 32:196-200. [PMID: 37143310 DOI: 10.1177/10668969231171130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A congenital melanocytic nevus is a benign melanocyte proliferation, that may be complicated by malignant transformation. We are reporting a three-year-old girl, who had a giant congenital melanocytic nevus on her back, that was treated by serial surgical excisions with tissue expander insertion. Histopathological examination confirmed the diagnosis of congenital melanocytic nevus with ganglioneuroma. Out of approximately 250 case reports on congenital melanocytic nevus, we identified only two reports of medium/large congenital melanocytic nevus with cutaneous ganglioneuroma. Due to the potential malignant transformation of congenital melanocytic nevus, reporting the features and characteristics of such rare findings may help in further understanding congenital melanocytic nevus, its associations, and prognosis.
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Affiliation(s)
- Mohammed Saud Alsaidan
- Internal Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ohoud Zaid Aljarbou
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Shi K, Zhao H, Li Y, Li X, Chen W. Anti-metabolic glutamate receptor 5 encephalitis with gangliocytoma: a case and review of the literature. BMC Neurol 2024; 24:27. [PMID: 38218780 PMCID: PMC10787404 DOI: 10.1186/s12883-024-03528-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND There are very limited reports on anti-metabolic glutamate receptor5 (mGluR5) encephalitis, especially lacking of pediatric research. The disease was mostly accompanied by tumors, mainly Hodgkin's lymphoma. No reports of other tumors, such as gangliocytoma have been reported to associate with anti-mGluR5 encephalitis so far. CASE PRESENTATION AND LITERATURE REVIEWS We reported a case of a 12-year-old boy with anti-mGluR5 encephalitis complicated with gangliocytoma. The patient suffered from mental disorders including auditory hallucination, and sleep disorders. His cranial magnetic resonance imaging (MRI) showed an abnormality in the right insular lobe. Autoimmune encephalitis antibodies testing was positive for mGluR5 IgG antibody both in cerebrospinal fluid and serum (1:3.2, 1:100 respectively). Abdominal CT indicated a mass in left retroperitoneal confirmed with gangliocytoma via pathology. The patient underwent resection of gangliocytoma. After first-line immunotherapy (glucocorticoid, gamma globulin), his condition was improved. Furthermore, we provide a summary of 6 pediatric cases of Anti-mGluR5 encephalitis. Most of them complicated with Hodgkin's lymphoma, except the case currently reported comorbid with gangliocytoma. The curative effect is satisfactory. CONCLUSIONS We report the first patient with anti-mGlur5 encephalitis complicated with gangliocytoma. It suggests that in addition to paying attention to the common lymphoma associated with anti-mGlur5 encephalitis, we should also screen the possibility of other tumors for early detection of the cause, active treatment and prevention of recurrence.
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Affiliation(s)
- Kaili Shi
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Huimin Zhao
- Department of Pediatrics, People's Hospital of Pidu, Sichuan, 611730, China
| | - Ying Li
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Xiaojing Li
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China.
| | - Wenxiong Chen
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China.
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Costa J, Jácome M, Souteiro P, Santos C, Cunha AL. Composite pheochromocytoma of the adrenal gland-a review of published cases. Virchows Arch 2023; 483:267-275. [PMID: 36645463 DOI: 10.1007/s00428-023-03492-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/26/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
Composite pheochromocytoma (CP) is a rare adrenal tumor, composed of ordinary pheochromocytoma and neuroblastic components. There is a paucity of information in the literature regarding this entity. We report the case of a 56-year-old woman with a CP of the left adrenal gland with a ganglioneuroma component. A review of the published literature found 110 cases of CP. The median age was 51.5 (5.86) years, and 59/110 (53.6%) were female. Association with genetic predisposition syndromes was found in 22/110 (20%), the most common of which was neurofibromatosis type 1, in 15/110 (13.6%). The most common histologic type of the neuroblastic component was ganglioneuroma in 83/110 (75.5%). Twenty-seven cases reported SDHB immunohistochemistry results; none of which was positive. Nine patients (8.2%) presented/developed metastatic disease, and 9 patients (8.2%) died from disease. To our knowledge, this is the largest review describing clinical, histopathological, molecular, and prognostic features of CP.
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Affiliation(s)
- João Costa
- Department of Pathology, Portuguese Institute of Oncology-Porto, Porto, Portugal.
| | - Manuel Jácome
- Department of Pathology, Portuguese Institute of Oncology-Porto, Porto, Portugal
| | - Pedro Souteiro
- Department of Endocrinology, Portuguese Institute of Oncology-Porto, Porto, Portugal
| | - Catarina Santos
- Department of Genetics, Portuguese Institute of Oncology-Porto, Porto, Portugal
- Cancer Genetics Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ana Luísa Cunha
- Department of Pathology, Portuguese Institute of Oncology-Porto, Porto, Portugal
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Zuraski CR, Wales C, Nguyen CV, Chan EF, Kovarik C, Seykora JT, Elenitsas R, Moshiri AS. Cutaneous Ganglioneuromas With Overlying Epidermal Hyperplasia: A Case Series Presentation and Proposal of Potential Etiopathogenesis. Am J Dermatopathol 2022; 44:812-816. [PMID: 35925148 DOI: 10.1097/dad.0000000000002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cutaneous ganglioneuromas (GNs) are exceptionally uncommon tumors, and many reported cases describe association with overlying epidermal hyperplasia that may be interpreted as seborrheic keratosis (SK) or SK-like proliferation. We report 5 cases of cutaneous GN in adult patients; all of which were discovered incidentally in the immediate vicinity of epidermal hyperplasia. A review of the literature demonstrates the current-although likely imperfect-understanding of the etiopathogenesis of both SK and GN in the skin. We explore the putative pathophysiologies of other common, well-characterized skin lesions and, taking them into account, provide rationale for the coexistence of cutaneous GN with overlying SK and SK-like epidermal changes. However, we ultimately acknowledge a dilemma of causality and, given the rarity of their co-occurrence, objectively question whether occasional cameo appearances by GN lying subjacent to SK and SK-like hyperplasia may be due merely to chance.
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Affiliation(s)
- Connor R Zuraski
- Department of Pathology, University of California, San Diego, CA
| | - Cameron Wales
- Department of Pathology, University of California, Los Angeles, CA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University, Chicago, IL
| | - Edward F Chan
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - John T Seykora
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - Rosalie Elenitsas
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - Ata S Moshiri
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
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Eldredge JA, Manton N, Abu-Assi R. Pediatric Hematochezia Caused by Intestinal Ganglioneuromatous Polyposis. J Pediatr Gastroenterol Nutr 2022; 75:e87. [PMID: 35696713 DOI: 10.1097/mpg.0000000000003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jessica A Eldredge
- From the Department of Gastroenterology, Women's & Children's Hospital, North Adelaide, South Australia
| | - Nicholas Manton
- the Department of Surgical Pathology, SA Pathology (at Women's and Children's Hospital), North Adelaide, South Australia
| | - Rammy Abu-Assi
- the Department of Gastroenterology, Women's & Children's Hospital, South Australia School of Paediatrics, University of Adelaide, North Adelaide, South Australia
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Stavros S, Kathopoulis N, Drakakis P. A Common Tumor with an Unusual Finding: Mature Cystic Teratoma Containing a Ganglioneuroma. J Pediatr Adolesc Gynecol 2021; 34:92-93. [PMID: 32828965 DOI: 10.1016/j.jpag.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ganglioneuromas (GNs) arise from peripheral or central areas of the autonomic nervous system, being benign lesions of neuroblastic origin. CASE A 19-year-old Greek female patient was admitted to our clinic with symptoms of periodic lower abdominal pain and irritation since some months ago. Ultrasonography revealed a mass of 72 × 68 mm originating from the left ovary giving the characteristics of a typical dermoid cyst. Laparoscopic ovarian cystectomy was done. The histological diagnosis revealed a mature cystic teratoma with a small hidden GN. SUMMARY AND CONCLUSION Histology remains the gold standard for their confirmation. The coexistence of GN within a mature cystic teratoma happens extremely rarely. This is one of the few cases reported in the literature.
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Affiliation(s)
- Sofoklis Stavros
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece.
| | - Nikolaos Kathopoulis
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece; Athens Bioclinic Hospital, Athens, Greece
| | - Peter Drakakis
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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Harvengt J, Gernay C, Mastouri M, Farhat N, Lebrethon MC, Seghaye MC, Bours V. ROHHAD(NET) Syndrome: Systematic Review of the Clinical Timeline and Recommendations for Diagnosis and Prognosis. J Clin Endocrinol Metab 2020; 105:5837124. [PMID: 32407531 DOI: 10.1210/clinem/dgaa247] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation and neural crest tumor (ROHHHAD[NET]) is a rare and potentially fatal disease. No specific diagnostic biomarker is currently available, making prompt diagnosis challenging. Since its first definition in 2007, a complete clinical analysis leading to specific diagnosis and follow-up recommendations is still missing. OBJECTIVE The purpose of this work is to describe the clinical timeline of symptoms of ROHHAD(NET) and propose recommendations for diagnosis and follow-up. DESIGN We conducted a systematic review of all ROHHAD(NET) case studies and report a new ROHHAD patient with early diagnosis and multidisciplinary care. METHODS All the articles that meet the definition of ROHHAD(NET) and provide chronological clinical data were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis individual patient data guidelines. The data were grouped into 7 categories: hypothalamic dysfunction, autonomic dysregulation, hypoventilation, NET, psychiatric symptoms, other clinical manifestations, and outcome. RESULTS Forty-three individual patient data descriptions were analyzed. The timeline of the disease shows rapid-onset obesity followed shortly by hypothalamic dysfunction. Dysautonomia was reported at a median age of 4.95 years and hypoventilation at 5.33 years, or 2.2 years after the initial obesity. A NET was reported in 56% of the patients, and 70% of these tumors were diagnosed within 2 years after initial weight gain. CONCLUSION Because early diagnosis improves the clinical management and the prognosis in ROHHAD(NET), this diagnosis should be considered for any child with rapid and early obesity. We propose guidance for systematic follow-up and advise multidisciplinary management with the aim of improving prognosis and life expectancy.
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Affiliation(s)
- Julie Harvengt
- Department of Human Genetics, Sart-Tilman (Liège), Belgium
| | - Caroline Gernay
- Department of Paediatrics, Section Endocrinology, Sart-Tilman (Liège), Belgium
| | - Meriem Mastouri
- Department of Paediatrics, Section Pneumology, Sart-Tilman (Liège), Belgium
| | - Nesrine Farhat
- Department of Paediatrics, Section Cardiology, Sart-Tilman (Liège), Belgium
| | | | | | - Vincent Bours
- Department of Human Genetics, Sart-Tilman (Liège), Belgium
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Wang Y, Lu X, Zhang B. Ileal diffuse ganglioneurosis with jejunal malrotation. Asian J Surg 2020; 43:642-643. [PMID: 31980256 DOI: 10.1016/j.asjsur.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yang Wang
- Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Xiaofan Lu
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China.
| | - Bing Zhang
- Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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11
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de la Fuente N, Rodríguez Blanco M, Cerdán G, Artigas V. Acute gastrointestinal bleeding, multiple GIST and intestinal ganglioneuromatosis in a patient with neurofibromatosis. Cir Esp 2018; 97:237-239. [PMID: 30293759 DOI: 10.1016/j.ciresp.2018.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Noa de la Fuente
- Unidad de Cirugía Hepatobiliopancreática y Cirugía Oncológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Manuel Rodríguez Blanco
- Unidad de Cirugía Hepatobiliopancreática y Cirugía Oncológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Gemma Cerdán
- Unidad de Cirugía Hepatobiliopancreática y Cirugía Oncológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Vicenç Artigas
- Unidad de Cirugía Hepatobiliopancreática y Cirugía Oncológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Abstract
RATIONALE Ganglioneuroma (GN) is a rare tumour arising from the sympathetic nervous system. GN is constantly asymptomatic, easily ignored and likely damages other organs during tumour progression. PATIENT CONCERNS The case report involved a 21-year-old girl who was admitted to a hospital because of a computed tomography result after her pregnancy examination showed retroperitoneal tumour and scoliosis. The scoliosis was considered as a tumour complication. DIAGNOSES The tumour was finally diagnosed as GN by pathological examination. INTERVENTIONS We carried out surgical treatment and performed a pathological examination on postoperative tumour specimens. OUTCOMES The patient was followed up for 19 months and did not show tumour recurrence. However, the condition of the scoliosis did not improve. LESSONS This paper reports a case of GN with scoliosis at the same time. GN is a benign tumour consisting of cells with a special origin. GN grows extensively and leads to different complications. Presently, pathological examination after an operation is the only approach to formulate an exact diagnosis. We should consider the possibility of retroperitoneal tumour, especially GN, if a patient suffers from scoliosis with an unknown cause. Thus, CT and MRI are needed to provide additional information that would help formulate a diagnosis.
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Affiliation(s)
| | - Lu Yang
- Department of Urology/Institute of Urology, West China Hospital/West China Medical School, Sichuan University, Chengdu, China
| | - Ming Shi
- Department of Urology/Institute of Urology, West China Hospital/West China Medical School, Sichuan University, Chengdu, China
| | | | - Ya Liu
- Department of Breast Surgery
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Iwamuro M, Omote R, Tanaka T, Sunada N, Nada T, Kondo Y, Nose S, Kawaguchi M, Otsuka F, Okada H. Diffuse Intestinal Ganglioneuromatosis Showing Multiple Large Bowel Ulcers in a Patient with Neurofibromatosis Type 1. Intern Med 2017; 56:3287-3291. [PMID: 29021449 PMCID: PMC5790715 DOI: 10.2169/internalmedicine.8671-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 67-year-old Japanese man with neurofibromatosis type 1 underwent right hemicolectomy owing to abscess formation around the cecum. A pathological analysis revealed diffuse intestinal ganglioneuromatosis in the cecum and colon. Colonoscopy performed eight months after hemicolectomy revealed multiple ulcers throughout the colon and rectum. The colorectal ulcers failed to respond to conservative treatment and ultimately required surgical resection. Diffuse ganglioneuromatosis was observed again in the resected specimen. This report illustrates a rare manifestation of diffuse intestinal ganglioneuromatosis in a patient with neurofibromatosis type 1.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Rika Omote
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | | | - Naruhiko Sunada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Takahiro Nada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Soichiro Nose
- Department of Anatomic Pathology, Okayama Saiseikai General Hospital, Japan
| | | | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Yano S, Hide T, Uekawa K, Honda Y, Mikami Y, Kuratsu JI. Mixed Pituitary Gangliocytoma and Prolactinoma Resistant to the Cabergoline Treatment. World Neurosurg 2016; 95:620.e17-620.e22. [PMID: 27535625 DOI: 10.1016/j.wneu.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A gangliocytoma rarely coexists with a pituitary adenoma in a sellar lesion. Herein, we describe our experience in treating a mixed gangliocytoma and prolactinoma of the pituitary gland. CASE DESCRIPTION A 16-year-old male presented with severe headache and vomiting. Magnetic resonance imaging showed a large pituitary tumor with hydrocephalus. Because of the increased levels of serum prolactin (PRL), we treated the patient with cabergoline, which decreased the tumor size and improved the hydrocephalus. Six months after the treatment, the tumor began to increase in size, despite the normalization of the PRL level with cabergoline treatment. An endoscopic transsphenoidal resection was performed and the tumor was mostly removed. Microscopic examination of the resected tumor showed a mixture of prototypical pituitary adenoma cells and the proliferation of mature ganglion cells. Immunohistochemistry showed that the ganglion cells were positively stained for synaptophysin, NeuN, and PRL as shown in the adenomatous component. A few cells were immunostained with both PRL and NeuN, and a few cells were immunopositive for nestin, but not PRL or synaptophysin. CONCLUSIONS Our findings showed the existence of cells that are phenotypically intermediate between ganglion cells and adenoma cells, and the existence of stem cell-like cells, which support the hypothesis that adenoma cells can transform into ganglion cells or that both ganglion and adenoma cells derive from common stem cells. Furthermore, the ganglion cells seemed to grow rapidly and independently of dopamine, which is in contrast to prototypical prolactinoma cells.
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Affiliation(s)
- Shigetoshi Yano
- Department of Neurosurgery, Faculty of Life Sciences Research, Kumamoto University Graduate School, Chuo-ku, Kumamoto, Japan.
| | - Takuichiro Hide
- Department of Neurosurgery, Faculty of Life Sciences Research, Kumamoto University Graduate School, Chuo-ku, Kumamoto, Japan
| | - Ken Uekawa
- Brain & Mind Research Institute, Weill Cornell Medical College, New York, New York, USA
| | - Yumi Honda
- Department of Diagnostic Pathology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
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Nielson C, Fischer T, Fischer R, Donald J, Rajpara A. Lhermitte-Duclos Disease in association with Cowden Syndrome. Dermatol Online J 2016; 22:13030/qt7qn7v4bf. [PMID: 27617518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023] Open
Abstract
Cowden syndrome (CS) is a rare genetic disorder with autosomal dominant inheritance, linked to germline mutations in the PTEN tumor suppressor gene on chromosome 10. Cowden syndrome often co-exists with Lhermitte-Duclos disease (LDD), with LDD included as a major criterion in CD diagnosis. This case involves a woman presenting with many of the classic diagnostic criterions and associations of CD, as well as with several comorbidities and unique objective findings.
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Zhang BY, Zhao M, Li B, Zhang JM. Diverse proportion in composite pheochromocytoma-ganglioneuroma may induce varied clinical symptom: comparison of two cases. Int J Clin Exp Pathol 2015; 8:15369-15374. [PMID: 26823896 PMCID: PMC4713682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/25/2015] [Indexed: 06/05/2023]
Abstract
Composite pheochromocytoma-ganglioneuroma is extremely rare. We described two cases of composite pheochromocytomas in the adrenal medullar. Case 1 was a 70-year-old male presenting with lower abdominal pain and normal blood electrolytes. Case 2 was a 48-year-old female with palpitation and back tenderness. Biochemical investigations showed hypocalcium, hypokalemia and high level of vma. The histological images and the immunohistochemical staining demonstrated the two cases composed of pheochromocytoma and ganglioneuromoma components. Ganglioneuroma component in case 2 accounted for more proportion than that in case 1. We speculated that the varied clinical symptoms were related with the diverse proportions in composite pheochromocytome-ganglioneuroma.
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Affiliation(s)
- Bu-Yi Zhang
- Department of Pathology, School of Medicine, Second Affiliated Hospital of Zhejiang UniversityHangzhou, PR China
| | - Mingfei Zhao
- Department of Neurosurgery, School of Medicine, Second Affiliated Hospital of Zhejiang UniversityHangzhou, PR China
| | - Baizhou Li
- Department of Pathology, School of Medicine, Second Affiliated Hospital of Zhejiang UniversityHangzhou, PR China
| | - Jian-Min Zhang
- Department of Neurosurgery, School of Medicine, Second Affiliated Hospital of Zhejiang UniversityHangzhou, PR China
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Abstract
INTRODUCTION Pituitary gangliocytomas are uncommon neuronal tumours that may present with endocrine disorders, the most frequent being acromegaly caused by growth hormone hypersecretion. Cushing's syndrome is very rarely seen with gangliocytomas. MATERIAL AND METHODS We report the unique case of a 62 year-old woman whose clinical picture and endocrine testing clearly demonstrated adrenocorticotropin (ACTH)-dependent Cushing's syndrome. Pituitary magnetic resonance imaging showed a 12-mm homogeneous, infra- and retrosellar mass first diagnosed as pituitary macroadenoma. Transsphenoidal surgery was performed and allowed complete resection of the tumour with sparing of normal anterior pituitary. Very low postoperative serum cortisol and ACTH levels were observed in the early postoperative period and the patient is still in remission 18 months after surgery, thus demonstrating that the resected lesion was entirely responsible for the clinical picture. RESULTS Histological and immunocytochemical analyses demonstrated a benign tumour composed of mature neuronal cells suggestive of a gangliocytoma, expressing both ACTH and corticotropin-releasing hormone (CRH). The tumour was surrounded by a rim of pituitary tissue containing ACTH-producing endocrine cells. Careful analysis of the resected lesion did not reveal any pituitary microadenoma. We search literature for similar cases and retraced only nine cases of gangliocytomas associated with Cushing's syndrome. In most of them, the tumour was combined with either pituitary corticotroph adenoma or hyperplasia. CONCLUSIONS Our case represents a unique case of an infrasellar pituitary gangliocytoma which was able to cause Cushing's syndrome by both direct ACTH production and CRH-induced stimulation of neighbour normal corticotroph cells.
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Affiliation(s)
- Marie-Eve Domingue
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 54.74, 1200, Brussels, Belgium
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Kilincalp S, Hamamcı M, Akinci H, Çoban Ş, Köksal AŞ, Yüksel İ. Double-balloon enteroscopy for the detection of diffuse small-bowel polypoid ganglioneuromatosis mimicking Crohn's disease in a patient with von Recklinghausen disease. Endoscopy 2015; 47 Suppl 1 UCTN:E4-5. [PMID: 25603521 DOI: 10.1055/s-0034-1377434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Serta Kilincalp
- Department of Gastroenterology, Diskapi Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Mevlüt Hamamcı
- Department of Gastroenterology, Diskapi Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Hakan Akinci
- Department of Gastroenterology, Diskapi Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Şahin Çoban
- Department of Gastroenterology, Diskapi Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Aydın Şeref Köksal
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - İlhami Yüksel
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Abstract
Background:We report a case and review the recent literature describing 36 patients with both Lhermitte-Duclos disease (LDD) and Cowden disease (CD). Lhermitte-Duclos disease, or dysplastic gangliocytoma, is a benign hamartomatous condition involving the cerebellum. The presenting symptoms are usually headaches, gait ataxia, and symptoms of lower cranial nerve involvement. Cowden disease is a rare autosomal dominant disease that usually presents with multiple mucocutaneous lesions. Patients with CD are prone to multiple systemic malignancies, the most common of which is breast cancer. Recent studies have demonstrated an association between LDD and CD.Methods:A 44-year-old woman with a previous history of breast cancer, multiple benign skin lesions, Hashimoto's thyroiditis, and chronic headaches presented with exacerbation of her headaches during the previous year. Magnetic resonance imaging of the brain revealed a right cerebellar nonenhancing mass and an acquired tonsillar herniation.Results:The patient underwent resection of the right cerebellar mass, posterior fossa decompression, C1 and C2 laminectomies, and a duraplasty. Pathologic examination confirmed LDD. The patient recovered well after surgery, with immediate improvement of her headaches.Conclusion:The association between LDD and CD has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent monitoring of individuals with LDD and CD may lead to the early detection of systemic malignancies.
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Affiliation(s)
- Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, The Brain Tumor Center, Houston, Texas, USA
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Wang QM, Jiang D, Zeng HZ, Mou Y, Yi H, Liu W, Zeng QS, Wu CC, Tang CW, Hu B. A case of recurrent intestinal ganglioneuromatous polyposis accompanied with mesenteric schwannoma. Dig Dis Sci 2014; 59:3126-8. [PMID: 24927799 DOI: 10.1007/s10620-014-3232-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 05/26/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Qi-Ming Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, People's Republic of China
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21
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El Hammoumi M, Arsalane A, Kabiri EH. Posterior mediastinal ganglioneuroma. Arch Bronconeumol 2014; 51:50-1. [PMID: 24656481 DOI: 10.1016/j.arbres.2013.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Faculty of Medecine and Pharmacy, University Mohamed V Souissi, Rabat, Marruecos.
| | - Adil Arsalane
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Faculty of Medecine and Pharmacy, University Mohamed V Souissi, Rabat, Marruecos
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Faculty of Medecine and Pharmacy, University Mohamed V Souissi, Rabat, Marruecos
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Baïzri H, Zoubeir Y, Elhadri S, Elanzaoui J, Chahbi Z, Kaddouri S, Qacif H, Touiti D, Zyani M. [Hepatic cytolysis revealing adrenal ganglioneuroma]. Pan Afr Med J 2014; 17:224. [PMID: 25170368 PMCID: PMC4145279 DOI: 10.11604/pamj.2014.17.224.3744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/21/2014] [Indexed: 11/20/2022] Open
Abstract
Le ganglioneurome est une tumeur nerveuse bénigne rare, d'origine neuroectodermique et de localisation rétropéritonéale fréquente. Nous rapportons l'observation d'un patient de 55 ans dont la tumeur est révélée fortuitement sur une échographie abdominale demandée dans le cadre d'une cytolyse hépatique secondaire à une hépatite virale C. Le patient est opéré après la réalisation d'un scanner abdominal et d'un bilan hormonal. L'examen anatomopathologique de la pièce opératoire est en faveur d'un ganglioneurome. Devant une volumineuse masse rétropéritonéale avec état général conservé, on doit envisager le diagnostic de ganglioneurome car l'exérèse chirurgicale complète permet une guérison sans récidive. Préalablement, l'ensemble des autres diagnostics différentiels doit être éliminé.
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Affiliation(s)
- Hicham Baïzri
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Youssef Zoubeir
- Laboratoire d'Anatomie Pathologique, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Sanae Elhadri
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Jihad Elanzaoui
- Service d'Urologie, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Zakaria Chahbi
- Service de Médecine Interne, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Said Kaddouri
- Service de Médecine Interne, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Hassan Qacif
- Service de Médecine Interne, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Driss Touiti
- Service d'Urologie, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Mohammad Zyani
- Service de Médecine Interne, Hôpital Militaire Avicenne, Marrakech, Maroc
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Lewitowicz P, Wincewicz A, Horecka-Lewitowicz A, Matykiewicz J, Kozieł D, Głuszek S, Sulkowski S. Coexistence of renal cell carcinoma of clear cell type with sarcomatoid cell type component and adrenal mature ganglioneuroma with myelolipoma - a case of 69-year-old female patient. Rom J Morphol Embryol 2014; 55:425-432. [PMID: 24969996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This report presents a case of 69-year-old woman, who was operated due to renal tumor. Apart from renal neoplasm, the adjacent adrenal gland contained another one tumor in medulla of the organ. The renal lesion was diagnosed renal cell carcinoma, clear cell type with undifferentiated cell sarcomatoid component. The adrenal neoplasm was composed of wavy S100-positive, Schwann-like cells and dispersed chromogranin A-reactive ganglion cells to be consistent with mature ganglioneuroma. It was accompanied by coexistent myelolipoma that contained hematopoietic cells including clearly visible megakaryocytes and foci of fat. To our knowledge, our paper is the first to report sporadic clear cell renal cell carcinoma with sarcomatoid cell type component and mature adrenal ganglioneuroma with myelolipoma in the same patient.
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Affiliation(s)
- Piotr Lewitowicz
- Department of Anatomy, Faculty of Health Sciences, Jan Kochanowski Memorial University, Kielce, Holy Cross District, Poland; ,
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Mateş I, Iosif C, Dinu D, Constantinoiu S. Solitary ganglioneuromatosis of the descending colon, presenting as giant retroperitoneal tumour. Chirurgia (Bucur) 2013; 108:584-588. [PMID: 23958108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
Ganglioneuroma (GN) is a benign neoplasia of the autonomous nervous system, colonic GN is uncommon in adults. There are three subgroups: polypoid GN, ganglioneuromatous polyposis and diffuse ganglioneuromatosis. Ganglioneuromatosis is highly-associated to neurofibromatosis type 1 (NF1) and multiple endocrine neoplasia type 2b (MEN2B). A 68-year-old female, with a discrete retarded emission of stools, was admitted for a large tumor in the left flank; CT scan, urography and barium enema demonstrated a large retroperitoneal mass, presumed as sarcoma. Open surgery discovered a 16 10 11 cm solid and encapsulated tumor, attached to the retroperitoneal descending colon, with no macroscopic mucosal involvement; the pathologic diagnosis of the resected specimen (en-bloc tumorectomy with limited colectomy) was intramural colonic ganglio-neuromatosis. Anamnesis, physical examination and complete endoscopic explorations showed no evidence of personal bearing or familial aggregation of genetic syndromes. In adults, association of transmural ganglioneuromatosis to NF1 or MEN2B is not mandatory; presentation often mimics obstructive carcinoma and positive diagnosis is provided by pathological examination of the resected specimen. In this peculiar case, the loose tissue of the retroperitoneal space favoured a slow development of intramural ganglioneuromatosis, presenting as a gigantic retroperitoneal mass with no radiological evidence of its colonic origin.
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Affiliation(s)
- In Mateş
- St. Mary Department of General and Esophageal Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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25
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Abstract
A young girl presented to the ENT acute clinic with a persistent cough and a bulge in the left oropharynx. As there were no clinical signs suggestive of a quinsy, an MRI was performed that showed a large mass extending from the base of the skull to the epiglottis medialising the lateral and posterior pharyngeal walls. The patient subsequently underwent an excision biopsy which demonstrated a ganglioneuroma, however developed a left-sided Horner's syndrome and mild vocal cord palsy after.
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Montaruli E, Rosa FM, Martelli H, Guérin F, Paul A, Guettier C, Dufour C. Mediastinal extramedullary hematopoiesis mimicking a neuroblastic tumor in a patient with beta-thalassemia. Pediatr Blood Cancer 2013; 60:711-2. [PMID: 23303558 DOI: 10.1002/pbc.24455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 11/03/2012] [Indexed: 11/06/2022]
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Kara T, Oztunali C. Radiologic findings of thoracic scoliosis due to giant ganglioneuroma. Clin Imaging 2013; 37:767-8. [PMID: 23313187 DOI: 10.1016/j.clinimag.2012.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/07/2012] [Accepted: 11/07/2012] [Indexed: 11/19/2022]
Abstract
A 28-year-old male with scoliosis presented with complaints of dyspnea and vomiting. His medical history revealed a mediastinal ganglioneuroma resection at the age of 2. After the surgery, he had not been followed up until his admission to our hospital. Computed tomography and MRI showed severe scoliosis of the thoracic spine and a paravertebral mass extending from the upper thoracic level to the level of renal arteries. Based on its radiological findings and the patient's history, the tumor was considered to be a recurrent ganglioneuroma. Paravertebral ganglioneuromas may cause progressive scoliosis, and a careful examination for patients with progressive scoliosis is mandatory.
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Affiliation(s)
- Taylan Kara
- Department of Radiology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
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Demir HA, Ozdel S, Kaçar A, Senel E, Emir S, Tunç B. Ganglioneuroma in a child with hereditary spherocytosis. Turk J Pediatr 2012; 54:187-190. [PMID: 22734309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hereditary spherocytosis (HS) is the most frequent cause of congenital hemolytic anemia. Extramedullary hematopoiesis (EMH) mimicking a mass may develop in the lymph nodes, kidneys, pleura, mediastinum, adrenal gland, and in particular the spleen and liver. Other than EMH, B-cell lymphoma, acute lymphoblastic leukemia, and pancreatic schwannoma cases were reported in patients with HS. We present a 13-year-old female patient with HS and ganglioneuroma in the adrenal gland. This association is probably coincidental; however, with increasing cancer cases in HS and the genetic studies being made, this association will be clarified.
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Affiliation(s)
- Haci Ahmet Demir
- Divisions of Pediatric Oncology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
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29
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Papathanasiou ES. Brainstem lesions and epilepsy. Epilepsia 2012; 53:393. [PMID: 22280470 DOI: 10.1111/j.1528-1167.2011.03367.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abdullah O, Alabbas H, Abdel Khalek M, Jaffe BM, Kandil E. Retroperitoneal ganglioneuroma: an unusual cause for abdominal pain. TROPICAL GASTROENTEROLOGY : OFFICIAL JOURNAL OF THE DIGESTIVE DISEASES FOUNDATION 2011; 32:335-337. [PMID: 22696923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Obai Abdullah
- Department of Surgery, Tulane University School of Medicine, New Orelans, LA 70112, USA
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Noguchi S, Kaga Y, Takahashi Y, Aoyagi K, Nakamura K, Kamiya Y, Nakane T, Kanemura H, Sugita K, Aihara M. [A case of recurrent paraneoplastic cerebellar ataxia with antibodies to GluR epsilon 2 causally related to ganglioneuroma]. No To Hattatsu 2010; 42:297-301. [PMID: 20666137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Acute cerebellar ataxia (ACA) in childhood following viral infection is a self-limited disease. We present a boy with recurrent episodes of paraneoplastic cerebellar ataxia associated with a ganglioneuroma. A 20-month-old boy developed the first episode of cerebellar ataxia after nonspecific respiratory tract infections. During this episode he showed a wide gait and truncal ataxia with intention tremor and horizontal nystagmus. Our initial diagnosis was ACA, and gradual improvement of ataxia was observed thereafter. At 2 years and 6 months, similar cerebellar symptoms recurred after respiratory tract infections. Speech difficulty and cognitive problems developed thereafter. We suspected paraneoplastic syndrome. Computed tomography revealed a retroperitoneal tumor, and autoantibodies against GluR epsilon 2 were detected in the cerebrospinal fluid. After the tumor resection, the cerebellar symptoms did not recur and speech difficulty and cognitive problems improved gradually. Recent neuroimaging and neuropsychological studies have revealed that cerebellar function contributes to higher brain functions including cognition and learning. We will follow up this patient's long-term cognitive function and consider special educational support and programs.
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Affiliation(s)
- Sayaka Noguchi
- Department of Pediatrics, Faculty of Medicine, Yamanashi University, Chuo, Yamanashi
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Leleiko NS, Gee MS, Sadow PM. Case records of the Massachusetts General Hospital. Case 13-2010. An 18.5-month-old girl with watery diarrhea and poor weight gain. N Engl J Med 2010; 362:1619-26. [PMID: 20427811 DOI: 10.1056/nejmcpc0910932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Neal S Leleiko
- Department of Pediatrics, Alpert School of Medicine, Brown University, and the Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children's Hospital-Rhode Island Hospital, Providence, USA
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Miyakoshi N, Hongo M, Kasukawa Y, Misawa A, Shimada Y. Bilateral and symmetric C1-C2 dumbbell ganglioneuromas associated with neurofibromatosis type 1 causing severe spinal cord compression. Spine J 2010; 10:e11-5. [PMID: 20362242 DOI: 10.1016/j.spinee.2010.01.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 01/15/2010] [Accepted: 01/27/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ganglioneuromas are rarely located in the cervical region compressing the spinal cord. Only two cases of bilateral and symmetric dumbbell tumor have been reported previously. PURPOSE The purpose of the study was to present an additional case with bilateral and symmetric dumbbell ganglioneuromas of the cervical spine as part of multiple ganglioneuromas of the spine in a patient with neurofibromatosis type 1 (NF-1). STUDY DESIGN The study design was a case report. METHODS A 15-year-old boy with NF-1 presented with a 6-month history of progressive tetraparesis. Magnetic resonance imaging showed voluminous bilateral and symmetric dumbbell masses at the C1-C2 level severely compressing the spinal cord. The spinal cord was also indented by a dumbbell mass at the left C3-C4 level. A systemic imaging survey of the patient showed numerous asymptomatic foraminal and extraforaminal tumors at all neuroforamina of the spine. RESULTS The result was found to be surgical decompression of the spinal cord by subtotal resections of bilateral tumors at the C1-C2 level and unilateral tumor at the left C3-C4 level alleviated patient symptoms. Histopathological diagnosis was ganglioneuroma for all resected tumors. CONCLUSION Multiple ganglioneuromas, particularly bilateral and symmetric dumbbell tumors, are extremely rare but could be associated with NF-1.
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Affiliation(s)
- Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
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Kamoun M, Mnif MF, Rekik N, Belguith N, Charfi N, Mnif L, Elleuch M, Mnif F, Kamoun T, Mnif Z, Kamoun H, Sellami-Boudawara T, Hachicha M, Abid M. Ganglioneuroma of adrenal gland in a patient with Turner syndrome. Ann Diagn Pathol 2009; 14:133-6. [PMID: 20227019 DOI: 10.1016/j.anndiagpath.2009.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 05/30/2009] [Accepted: 06/15/2009] [Indexed: 12/16/2022]
Abstract
A 15-year-old girl with Turner syndrome was unexpectedly found to have a left suprarenal mass. Extensive investigations showed a clinically and biochemically inapparent mass. Computed tomography disclosed a well-defined solid lesion in the left adrenal measuring 6.5 x 5 cm with minimal contrast enhancement. Laparoscopic adrenalectomy was done. Histologic examination revealed an encapsulated mass originated from the left adrenal medulla. Tumor tissue comprised abundant collagen fibers and spindloid cells admixed with mature ganglion cells. The tumor was diagnosed as left adrenal ganglioneuroma. According to literature, we report the eighth case of ganglioneuroma complicating Turner syndrome. Patients with this syndrome are predisposed to the development of neuroblastoma and related tumors. Reasons for this predisposition might relate to genetic and hormonal factors. Given that these tumors are often limited stage and of good prognosis, we recommend their screening in all patients with Turner syndrome.
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Affiliation(s)
- Mahdi Kamoun
- Endocrinology Department, Hedi Chaker Hospital, 3029 Sfax, Tunisia
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Kirches E, Steiner J, Schneider T, Vorwerk CK, Scherlach C, Holtkamp N, Keilhoff G, Eng C, Mawrin C. Lhermitte-Duclos disease caused by a novel germline PTEN mutation R173P in a patient presenting with psychosis. Neuropathol Appl Neurobiol 2009; 36:86-9. [PMID: 19719509 DOI: 10.1111/j.1365-2990.2009.01041.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Soccorso G, Puls F, Richards C, Pringle H, Nour S. A ganglioneuroma of the sigmoid colon presenting as leading point of intussusception in a child: a case report. J Pediatr Surg 2009; 44:e17-20. [PMID: 19159704 DOI: 10.1016/j.jpedsurg.2008.10.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 10/02/2008] [Accepted: 10/02/2008] [Indexed: 01/02/2023]
Abstract
We present a case of intestinal ganglioneuroma (GN) of the sigmoid colon in a 5-year-old girl, which caused intermittent colocolic intussusception. Ganglioneuromas are rare benign tumors of the autonomic nervous system composed of mature ganglion cells and satellite cells. Colonic GNs are uncommon. The unusual intramural proliferation of neural elements in this case resembled the diffuse intestinal ganglioneuromatosis, which is known to be associated with multiple endocrine neoplasia type 2B. However, the specific mutations of multiple endocrine neoplasia type 2B were not found by genetic sequencing. This is the first pediatric case described in the literature of a solitary polypoid GN presenting as a colocolic intussusception. We present a brief overview of intestinal ganglioneuromatous lesions and associated conditions.
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Affiliation(s)
- Giampiero Soccorso
- Department of Paediatric Surgery, University Hospitals of Leicester, United Kingdom.
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Abstract
Paragangliomas may have composite forms in which they combine features of a typical paraganglioma with those of a neural component consisting of either neuroblastoma, ganglioneuroblastoma, or ganglioneuroma. These variants are rare and generally located in the adrenal. Herein, we describe a retroperitoneal, extra-adrenal composite paraganglioma-ganglioneuroma of a 57-year-old woman. Radiological evaluation revealed a nodular mass with apparent pancreatic location, with findings suggestive of an endocrine tumor, yielding the diagnosis of a pancreatic endocrine tumor. At histology the neoplasm, strictly adhering to the external surface of the pancreatic gland but well demarcated, displayed a main central region with typical paraganglioma features and cells arranged in cords and in a nesting "zellballen" pattern, positive for neuroendocrine markers, and a distinct peripheral area consisting of dense bundles of wavy spindled Schwann cells, with scattered ganglionic cells.
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Affiliation(s)
- Frediano Inzani
- Department of Pathology, University of Parma, Via Gramsci 14, 43100, Parma, Italy.
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Minkin K, Tzekov C, Naydenov E, Ivanov I, Kulev O, Romansky K, Busarsky V. Cerebellar gangliocytoma presenting with hemifacial spasms: clinical report, literature review and possible mechanisms. Acta Neurochir (Wien) 2008; 150:719-24; discussion 724. [PMID: 18509586 DOI: 10.1007/s00701-008-1597-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 04/23/2008] [Indexed: 11/25/2022]
Abstract
Cerebellar lesions have classically been considered not to cause epilepsy. However, previous reports have attributed seizures, beginning as hemifacial spasms to lesions of the cerebellar peduncles. We report an example of paroxysmal facial contractions associated with a cerebellar gangliocytoma. The seizures began on the first day of life and consisted of paroxysmal contractions involving the left orbicularis oculi, often the left forehead and lower facial muscles, sometimes accompanied by nystagmoid eye movements to the right and by head deviation to the left. Video-EEG monitoring showed only artifacts from muscle contractions. Magnetic resonance imaging showed a mass arising from the left superior cerebellar peduncle and partially occupying the fourth ventricle. The lesion was removed subtotally and partial seizure control was achieved. The neuropathological findings were consistent with a gangliocytoma. The literature in the association of cerebellar lesions with hemifacial spasms is reviewed and its possible mechanisms discussed.
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Affiliation(s)
- K Minkin
- Department of Neurosurgery, Medical University of Sofia, University Hospital Saint Ivan Rilski, Sofia.
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Türeyen K, Senol N, Sav A. Gangliocytoma associated with focal cortical dysplasia in a young-adult: a case report. Turk Neurosurg 2008; 18:259-263. [PMID: 18814115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Neoplasms and (non-neoplastic) focal dysplasias may coexist as a cause of seizures in both the developing and mature brain. Low grade neoplastic lesions (ganglioglioma/gangliocytoma) may present with seizures, and distinction of these lesions from focal cortial dysplasia is difficult on standard radiological imaging. We report a 24-year-old man who had complaints of tonic-clonic seizures for one week duration and was admitted to department of neurosurgery. He did not have any neurological deficit on his examination. Cranial computerized tomography and magnetic resonance imaging of the patient revealed a calcified, cystic lesion with contrast enhancement, in the left temporoparietal region. Subtotal resection of the mass was performed. Pathological examination revealed focal cortical dysplasia associated with gangliocytoma.
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Suárez-Peñaranda JM, Gómez-Otero I, Muñoz JI, Pedreira-Pérez M. [Cardiac death associated with an adrenal ganglioneuroma]. Rev Esp Cardiol 2008; 61:551-552. [PMID: 18462665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
Gangliocytomas of the pituitary gland are rare lesions that often occur in combination with pituitary adenomas, which are frequently associated with the hypersecretion of pituitary hormones, particularly growth hormones. We report a case of combined gangliocytoma and prolactinoma of the pituitary gland. A 49-year-old male presented with vertigo. Radiological examination revealed an intrasellar tumor with a suprasellar extension, which was removed via the trans-sphenoidal approach. Histologically, the tumor was composed of adenoma cells, mature ganglion cells and cells with features intermediate between those of adenoma cells and ganglion cells (intermediate cells). Immunohistochemical analysis revealed the ganglion cells and intermediate cells as well as adenoma cells to be positive for prolactin. No growth hormone-positive tumor cells were observed. The ganglion cells were positive for synaptophysin and neurofilament. The findings in this case are discussed in relation to hypotheses proposed for histogenesis, and the presence of intermediate cells supports three hypotheses. The first is that adenoma cells transform into ganglion cells, and the second is that both components originate from the embryonal pituitary cell rests, showing intermediate features between ganglion cells and adenoma cells. The last is that their common origin may be the same stem/progenitor cells in normal adult pituitaries.
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Affiliation(s)
- Shuji Mikami
- Division of Diagnostic Pathology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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Erem C, Kocak M, Cinel A, Erso HO, Reis A. Dopamine-secreting adrenal ganglioneuroma presenting with paroxysmal hypertension attacks. Saudi Med J 2008; 29:122-125. [PMID: 18176686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Adrenal ganglioneuromas are rare tumors originating from the neural crest tissue of the sympathetic nervous system. The clinical presentation for most patients is asymptomatic, and most of these tumors are hormone silent. We report a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient. A 46-year-old woman was admitted to our hospital with a 2-month history of right flank pain, and a 2-year history of paroxysmal hypertensive attacks associated with headaches, palpitations, nervousness, and sweating. Abdominal CT and MRI revealed a solid round tumor approximately 4 cm in diameter on the upper pole of the right kidney. Urinary levels of dopamine and homovanillic acid were slightly elevated, although urinary levels of metanephrine and normetanephrine were suppressed. The urinary levels of epinephrine, norepinephrine, and vanillylmandelic acid were within normal limits. Right adrenalectomy was performed for treatment purposes. Histological diagnosis of the tumor was a ganglioneuroma originating from the adrenal medulla. In conclusion, this is a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient.
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Affiliation(s)
- Cihangir Erem
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, 61080, Trabzon, Turkey.
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Dagcinar A, Hilmi Kaya A, Ali Taşdemir H, Kuruoglu E, Sabancilar Z, Sav A. A fourth ventricular ganglioneurocytoma representing with cerebellar epilepsy: a case report and review of the literature. Eur J Paediatr Neurol 2007; 11:257-60. [PMID: 17418600 DOI: 10.1016/j.ejpn.2007.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 02/12/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
Fourth ventricular low-grade tumoral or dysplastic neuronal lesions have been reported as an epileptic focus for recently described cerebellar epilepsy in the form of repetitive and stereotyped attacks of hemifascial spasm, eye blinking, fascial movements, head deviation and dysautonomic manifestations. The case of a 3-month old infant having fourth ventricular mass with similar symptoms such as paroxysmal facial movements, eye blinking, eyelid contractions and abnormal head posture is reported in this article. After a few days of her admission, her attacks displayed a new form with altered consciousness and left limb jerks which were unresponsive to medical therapy. Following the surgical excision of the lesion 10 months ago, attacks disappeared and she is still seizure free. Histopathological diagnosis was ganglioneurocytoma. The seizures (which may be intractable in cerebellar epilepsy) are thought to have arisen from subcortical structures such as cerebellum, brain stem nuclei or the lesion itself. In the case of intractable episodes, surgical excision may prevent further seizures and help patients have a normal cognitive and motor development.
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Affiliation(s)
- Adnan Dagcinar
- Medical Faculty, Department of Neurosurgery, Ondokuz Mayis University, Kurupelit, Samsun, Turkey.
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Abstract
We report a female teenager who presented with a gastrointestinal stromal tumor of the stomach and a paraganglioneuroma. She later developed a pulmonary chondroma, fulfilling the requirements of Carney's triad. This patient demonstrates the course of the disease, which included severe emotional symptoms. She died, at 30 years of age, 16 years after the onset of disease, riddled with metastases. Many patients with Carney's triad survive for many years, but we can not predict the prognosis in any patient. During her lifetime, the patient had considerable emotional suffering, perhaps because of her disease.
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Affiliation(s)
- John Raffensperger
- Division of Pediatric Surgery, Children's Memorial Hospital, Chicago, IL, USA.
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Abstract
Lhermitte-Duclos disease or dysplastic gangliocytoma of the cerebellum, is a rare cerebellar lesion, which can cause mass effects in the posterior fossa. It may occur sporadically, or in association with Cowden syndrome. Cowden syndrome or multiple hamartoma-neoplasia syndrome, is an uncommon autosomal dominant condition characterized by mucocutaneous lesions and systemic malignancies. We report two patients with Lhermitte-Duclos disease and associated Cowden syndrome. The clinical, radiological and histopathological features and management strategies of this rare disease complex are discussed.
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Affiliation(s)
- Tze-Ching Tan
- Department of Neurosurgery, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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Lorenceau-Savale C, Savoye G, Pouzoulet J, Le Pessot F, Savoye-Collet C, Leblanc-Louvry I, Lerebours E. Ganglioneuromatosis: an unusual cause of ileal stricture mimicking Crohn's disease. Dig Dis Sci 2007; 52:1806-9. [PMID: 17404862 DOI: 10.1007/s10620-006-9603-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 09/05/2006] [Indexed: 12/29/2022]
Abstract
Ileal idiopathic forms of ganglioneuromatosis in adults are extremely rare and represent a challenging pathologic condition for the clinician. We present two cases of ileal ganglioneuromatosis consisting of stricturing lesions that mimicked clinical and radiologic features commonly observed in Crohn's disease patients with ileal involvement.
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Affiliation(s)
- C Lorenceau-Savale
- Department of Gastroenterology and Hepatology, ADEN EA 32 34, University Hospital C. Nicolle, 1 rue de Germont, 76031, Rouen, France.
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Abstract
Ganglioneuromas (GN) are neural crest cell-derived tumors which may coexist with pheochromocytomas, secrete various neuropeptides or the symptoms may mimic that of a pheochromocytoma, producing hypertension or a hypotensive crisis during anesthesia for these tumors. We report here the case of a 7-year-old female child with an adrenal tumor suspected to be a pheochromocytoma, later confirmed by histology as a GN. This child presented with episodic headache, anxiety, palpitations and 3D helical (spiral) computed tomography of the abdomen revealed an adrenal tumor. In addition, the child was diagnosed to have a seizure disorder. She was managed as a pheochromocytoma. Although the child's preoperative catecholamine levels were normal, tumor manipulation caused a hypertensive crisis. We discuss the clinical characteristics of this unusual case, anesthesia management, and the postoperative course.
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Affiliation(s)
- Yatindra Kumar Batra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
STUDY DESIGN Case report with review of literature. OBJECTIVE To report 2 cases of adolescent thoracic scoliosis secondary to paraspinal ganglioneuroma. SUMMARY OF BACKGROUND DATA There are many types of scoliosis caused by known etiological factors. However, to our knowledge, adolescent thoracic scoliosis caused by paraspinal ganglioneuroma is seldom reported. METHODS Case report. RESULTS The deformity of these 2 patients was well corrected, and the tumor mass of ganglioneuroma was resected intact. Minor loss of correction was recorded in the 2 patients at 6-month and 2.5-year follow-up, respectively. No recurrence of tumor was found. CONCLUSION Combination of scoliosis correction and tumor mass resection was a successful treatment for this kind of clinicopathological entity.
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Affiliation(s)
- Yong Qiu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
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Lavín Castejón I, Mut Oltra J, Trillo Balizón C, Maldonado Barrionuevo A. [Lhermitte-Duclos's disease associated to Cowden s disease: a case report]. An Med Interna 2007; 24:239-41. [PMID: 17907890 DOI: 10.4321/s0212-71992007000500008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Cowden's disease is a rare genodermatosis that is characterized for multiple cutaneous and visceral hamartoma . Lhermitte-Duclos's disease is a cerebelous lesion that consists in the displasic enlargement of the cerebelous circumvolution. It's incluyed in phacomatosis and usually presents associated to Cowden's disease, tuberous sclerosis and overlap syndromes.A 56 years old man, diagnosed in Dermatology with Cowden's disease ten years ago. In the extension study, he had hamartoma intestinal polip, esophagic glucogenic acanthosis and two solid thyroid nodules. The craneal TC didn't show significant alteration. Ten years after diagnosis a cerebral magnetis resonance was performed for intense cephalea, and it was found a bad-defined mass in right cerebelous hemisphere without contrast captation, compatible with cerebelous glangliocytoma.
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Affiliation(s)
- I Lavín Castejón
- Servicio Aparato Digestivo, Hospital Clínico Virgen de la Victoria, Malaga.
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Abstract
Ganglioneuroma is a rare benign tumor, usually seen in children and young adults, arising in the central nervous system. Ganglioneuroma of the mesentery is extremely rare; only one case has been recorded. We report the second case of a primary mesentery ganglioneuroma. The patient underwent surgical intervention for diagnostic and therapeutic purposes.
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Affiliation(s)
- Akshay Pratap
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
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