Retroperitoneal ganglioneuroma: a case report

A primary retroperitoneal ganglioneuroma was found incidentally in a 44-year-old man. Computed tomography revealed a homogeneous mass just above the right kidney. T1-weighted magnetic resonance imaging demonstrated the homogeneous mass, but T2-weighted imaging revealed a heterogeneous mass with a markedly high intensity area. The tumor was resected through a transabdominal approach. The resected specimen measured 11 x 9 x 4.5 cm and weighted 270 g. Histological examination showed that the lesion was a ganglioneuroma composed of mature ganglion cells and nerve fibers.     

A case of retroperitoneal ganglioneuroma]

A 50-year-old woman was admitted under a diagnosis of abdominal tumor. Ultrasonography and CT scanning were performed, and a right retroperitoneal tumor was detected. Absolute curative resection was performed. The resected tumor was 13.5 x 11.5 x 9.0 cm, and histologically diagnosed as ganglioneuroma. To our knowledge, 99 cases have been reported in Japan. During a twelve-month follow-up period, the postoperative course was uneventful and no recurrence had been noted.     

Incidentally Found Retroperitoneal Ganglioneuroma in an Adult

The ganglioneuroma is a very rare tumor arising from sympathetic nerve system. An asymptomatic retroperitoneal ganglioneuroma was found incidentally in a 35-year-old woman. Ultrasonography, computed tomography, and magnetic resonance imaging showed a retroperitoneal mass extending to the left adrenal gland, and surrounding abdominal aorta, celiac axis, left renal and adrenal arteries, and veins. The tumor was resected and histologic examination showed ganglioneuroma.     

Images in surgery: retroperitoneal ganglioneuroma

Ganglioneuroma is a differentiated tumor of the sympathetic nervous system. We describe a case of retroperitoneal ganglioneuroma without vascular invasion that was resected using laparotomy access. We also provide a short review of the ganglioneuroma as a clinical entity.     

Adrenal ganglioneuroma: a familial case

A 67-year-old woman was evaluated for asymptomatic microscopic hematuria. Intravenous urography and computed tomography demonstrated an adrenal mass, but the workup for a functional adrenal tumor was negative. The mass was surgically resected, with a histologic diagnosis of adrenal ganglioneuroma. No further treatment was necessary. After the diagnosis was made, the patient reported a family history positive for neuroblastic tumors. Two of her grandchildren had presented at early ages with a ganglioneuroblastoma and a third had presented with a ganglioneuroma. This presentation is unique because ganglioneuroma, especially that of adrenal origin, is rare in the adult population, and familial cases are extremely uncommon.     

A case of cystic ganglioneuroma of adrenal gland presenting as a huge retroperitoneal mass

A 35-year-old man presented with a 17-month history of abdominal distension and left upper quadrant pain. He had no episodes suggesting the presence of hypertension. Hormonal studies were insignificant. Imaging studies demonstrated a bulky tumor with cyst formation measuring 22 cm. Preoperative differential diagnoses included an adrenal tumor, extra-adrenal retroperitoneal tumor and pancreatic mucinous tumor. Intraoperatively, no abnormality was observed in the pancreas. A tight adhesion of the tumor to the left kidney necessitated an en bloc resection of the tumor with the left kidney. The resected specimen, 22 x 20 x 8 cm, weighed 5,050 g. Pathologically, the tumor was ganglioneuroma originating from the left adrenal gland. Convalescence was uneventful, and abdominal symptoms disappeared. The patient has been doing well without evidence of recurrece 48 months after the operation.     

Adrenal ganglioneuroma: a case report

A patient with an incidentally diagnosed adrenal ganglioneuroma is reported. A 37-year-old man who underwent abdominal computed tomography (CT) in the course of evaluating liver dysfunction was found to have a right adrenal tumor. Laboratory data including results of endocrinologic tests were normal except for a slight elevation of plasma aldosterone. With a preoperative diagnosis of non-functioning right adrenal tumor, resection was performed. The tumor specimen was noncystic weighing 150 g and measuring 10 x 8 x 3 cm. The histopathologic diagnosis was ganglioneuroma originating from the adrenal gland. Adrenal ganglioneuroma is relatively rare, 147 cases including ours have been reported in Japan. Increasing numbers of these tumors are being found incidentally by ultrasonography or CT. Ganglioneuroma is a benign tumor, and disagreement exists concerning diagnosis and indications for surgery.     

Ganglioneuroma of the adrenal gland: report of a case

A 38-year-old man was referred to our clinic with the complaint of upper abdominal discomfort. Ultrasonography and computerized tomography showed a mass occupying the left retroperitoneal space. Endoclinological results were within the normal range except for 17-OHCS and 17-KS. Preoperative diagnosis was left non-functioning adrenal tumor. Exploration was done via transperitoneal approach. The specimen weighed 100 g and was 11 x 6 x 5 cm in size. Histopathological diagnosis was ganglioneuroma of the left adrenal gland. There have been 35 reported cases with ganglioneuroma of the adrenal gland including our case in the Japanese literature and we reviewed the pathogenesis and treatment of this rare disease.     

Malignant peripheral nerve sheath tumor of the urinary bladder in von Recklinghausen disease

A case of malignant peripheral nerve sheath tumor of the bladder in a 57-year-old man with multiple neurofibromatosis type 1 is presented. The patient had a recent history of a transurethrally resected bladder ganglioneuroma. A probable histogenetic association between these two extremely rare neoplasms is proposed.     

Two cases of ganglioneuroma

Ganglioneuroma is relatively rare, and difficult to distinguish from other tumors due to lack of image findings specific for ganglioneuromas. In this report, two cases of ganglioneuroma preoperatively diagnosed as non-functioning adrenal tumor and retroperitoneal tumor are reported. A 25-year-old male and a 29-year-old male visited our institute with chief complaints of upper abdominal pain and asymptomatic microscopic hematuria, respectively. Computed tomographic scan and magnetic resonance imaging showed a 7 x 6 x 5 cm solid tumor above the upper pole of the right kidney in the former case, 8 cm poorly enhanced tumor grown surrounding the left renal artery in the latter case. Surgical resection was performed in both cases. In the latder case, since intraoperative histological examination showed no malignant finding, renal vessels penetrating in the tumor were preserved by transecting the tumor. Postoperative histological examination revealed an adrenal ganglioneuroma and a retroperitoneal ganglioneuroma in the former and latter cases, respectively. A ganglioneuroma can be surgically dissected with favorable prognosis, but preoperative differential diagnosis is sometimes difficult due to few specific radiological and laboratory findings.     

肾上腺节细胞神经瘤的临床诊治特点（附20例报告）

目的 总结肾上腺节细胞神经瘤的临床诊治特点.方法 对20例肾上腺节细胞神经瘤患者分别行后腹腔镜下肿瘤摘除术（18例）及行开放手术（2例）.结果 切除肿瘤大小3.6cm×2.7cm×1.8cm～9.2cm×5.5cm×4.2cm.所有患者术中血压均无明显波动,术后无并发症发生,恢复较好.其中12例随访1～36个月肿瘤无复发和转移,8例失访.结论 肾上腺节细胞神经瘤是一种较少见的良性肿瘤,确诊主要依靠病理学检查,主要治疗方法为外科手术,包括腹腔镜或开放手术,一般预后较好.     

Intrathoracic ganglioneuroma in an elderly patient over 70 years of age

We herein present an exceedingly rare case of intrathoracic ganglioneuroma that was surgically resected in an elderly patient over 70 years of age. A 74-year-old woman was asymptomatic, but a computed tomography (CT) scan of the thorax indicated the presence of a posterior mediastinal mass paravertebrally. A thoracotomy was thus performed under a strongly suggested diagnosis of a neurogenic tumor because of the appearance and position of the mass on the chest CT and magnetic resonance imaging findings, and measuring 6.9 × 5.8 × 1.6 cm. Not only tumors originating from the nerve sheath, but also neurogenic tumors occurring in young patients such as ganglioneuroma, should be included in the different diagnosis of posterior mediastinal tumor occurring in elderly patients.     

复杂性腹膜后节细胞神经瘤的诊断与治疗

腹膜后节细胞神经瘤是一种罕见的神经源性良性肿瘤,行手术彻底切除,预后良好,但手术难度较大.2013年3月重庆医科大学附属第一医院收治1例复杂性腹膜后节细胞神经瘤患者,入院前9个月彩色多普勒超声检查发现胰头部低回声包块影,大小为6.5 cm×4.5 cm,无任何临床症状.术前腹部CT检查及术中发现肿瘤大小为8.5 cm×7.5 cm×4.5 cm,位于胰腺后方,包绕腹腔干、肝总动脉、脾动脉及肠系膜上动脉等重要血管,包绕胰头部及钩突部,无法分离;与门静脉、肠系膜上静脉、脾静脉、左肾静脉关系密切.术中将肿瘤与各重要血管及胰腺体尾部分离、解剖,但肿瘤与胰头部无法分离,遂行肿瘤切除及胰十二指肠切除术.虽手术难度大,但肿瘤切除彻底,重要血管得到保护,患者术后恢复良好.     

Retroperitoneal ganglioneuroma: a case report

A 67-year-old male presented for examination of a retroperitoneal tumor, incidentally found by abdominal computed tomography (CT). CT and magnetic resonance imaging (MRI) revealed a round heterogeneous tumor, 10 cm in diameter, at the left renal hilus and involving the left renal vein. The tumor was low-intensity on T1-weighted MRI imaging, and high-intensity on T2-weight MRI imaging. The tumor was easily resected via a transabdominal approach. The pathological diagnosis was ganglioneuroma.     

An unusual etiology of hypertension in a 5-year-old boy

Ganglioneuromas are rare benign tumors of neural crest origin, arising from ganglia of the sympathetic nervous system and adrenal medulla. These masses are usually detected during the first 2 decades of life and are generally discovered incidentally. We present a 5-year-old boy with sickle beta-thalassemia whose hypertension is caused by a perihilar ganglioneuroma encasing the right renal artery and distorting the right renal vein. The tumor was resected and the child's blood pressure subsequently normalized.     

Laparoscopic resection of a large nonadrenal ganglioneuroma adhered to the aorta and inferior mesenteric artery: A case report and literature review

IntroductionGanglioneuromas are well-differentiated benign tumors that arise from sympathetic ganglion cells. In ganglioneuromas of the retroperitoneum, nonadrenal cases are resected by laparotomy due to the proximity to major vessels. There have been few reports of laparoscopic resection for retroperitoneal paraaortic ganglioneuromas. We experienced a case in which laparoscopic resection was required for a 90-mm ganglioneuroma adhered to the aorta and inferior mesenteric artery.Presentation of caseA 49-year-old female patient presented with epigastric pain. Computed tomography showed a 90 mm retroperitoneal tumor, partially located between the aorta and inferior mesenteric artery. A definitive diagnosis was not obtained, and laparoscopic excision of the retroperitoneal tumor was performed transabdominally. The patient recovered without postoperative complications and left the hospital on postoperative day 8. Postoperative pathological findings revealed a ganglioneuroma from the abdominal periaortic plexus.DiscussionWe searched the literature for nonadrenal ganglioneuromas resected laparoscopically using a transabdominal approach and summarized the tumor locations. The median age was 33 years, and the median tumor size was 50 mm. Regarding the surgical results, the median operative time was 170.5 min, median blood loss was 21.5 mL, and median postoperative stay was 7 days.ConclusionLaparoscopic resection of nonadrenal ganglioneuromas is feasible even when a tumor adheres to major blood vessels.     

Idiopathic aneurysm of inferior vena cava associated with retroperitoneal ganglioneuroma: case report

Idiopathic aneurysm of the inferior vena cava is rare. Many aneurysms are asymptomatic; others are diagnosed after complications develop. Ganglioneuroma is an infrequently occurring benign tumor preferentially located in the mediastinum and retroperitoneum. Generally the clinical manifestations are symptoms of compression related to growth of the mass. We present a case report of idiopathic aneurysm of the inferior vena cava associated with retroperitoneal ganglioneuroma. The tumor was resected in combination with a procedure to correct the aneurysm that has not previously been described, ie, tangential resection and primary lateral venorrhaphy. The technique provided excellent short-term results.     

Laparoscopic resection of large adrenal ganglioneuroma

We report on a 23-year-old woman with a right adrenal tumor 13 cm in diameter who was treated by laparoscopy. The patient was asymptomatic, and the tumor was incidentally diagnosed on abdominal ultrasonography. A subsequent computed tomography (CT) of the abdomen confirmed a 12 x 7 x 8-cm homogenous mass of the right adrenal. Magnetic resonance imaging (MRI) showed a solid mass measuring 13 x 7 x 7.5 cm arising from the right adrenal. Laparoscopic complete excision of the mass was accomplished through a transabdominal lateral approach. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. Histology was consistent with an adrenal ganglioneuroma. Two years later, there is no evidence of recurrence on abdominal CT scan.     

Adrenal ganglioneuroma in a 14-year-old girl: a case report

A 14-year-old girl was referred to our hospital for examination of a right adrenal tumor, incidentally found by abdominal ultrasound sonography. Computed tomographic scan and magnetic resonance imaging showed a 44 x 20 mm solid tumor in the right adrenal region. Endocrinological examination were within normal limits except for slightly increased serum aldosterone. Laparoscopic adrenalectomy was performed and the tumor was histologically diagnosed as ganglioneuroma originated from the right adrenal medulla.     

原发性肾上腺节细胞神经瘤的诊治分析

目的：总结肾上腺节细胞瘤的诊治方法。方法：回顾性分析1992年10月～2011年1月诊治19例肾上腺节细胞瘤患者的临床资料,并复习相关文献资料。结果：19例患者中12例经开放手术切除肾上腺肿瘤,7例行腹腔镜肾上腺肿瘤切除术,术后病理均证实为肾上腺节细胞神经瘤,术后随访2个月～14年,因心脏疾病死亡4例,脑出血死亡1例,车祸伤死亡1例,无一例患者因原发性肾上腺节细胞神经瘤死亡,随访期间肿瘤无复发和转移,预后良好。结论：肾上腺节细胞神经瘤为神经源性良性肿瘤,临床主要与静息型嗜铬细胞瘤相鉴别,对伴有疑似嗜铬细胞瘤临床表现的患者,且实验室检查与嗜铬细胞瘤相关的指标有异常时,术前准备需按嗜铬细胞瘤的要求。腹腔镜肿瘤切除可作为一线治疗方法,对于伴有周围血管脏器界限不清的肿瘤,建议行开放手术治疗。