Age / Sex : 41 / M

Chief complaint :

Right arm pain and right hand numbness

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Hee Seok Jeong, Pusan National University Yangsan Hospital

Discussion

Answer:

 Ganglioneuroma  

Findings:

CT:

About 2.5cm sized, ill-defined, subtle high density lesion(compared with spinal cord) at Rt. formen of

C5/6 with spinal cord compression

MR:

About 2.5cm sized, dumbbell shaped, high SI lesion on T2W1 and low SI on T1WI with subtle rim

enhancement at intradural extramedullary and extradural space of Rt. side of C4/5  

- with spinal cord compression

Differential Diagnosis:

schwannoma, neurofibroma, meningioma

(lymphomas, soft-tissue sarcomas, Ewing’s sarcoma, chondrosarcomas, and bone metastases à

involve, invade and erode bones)

Diagnosis:  

Ganglioneuroma

Discussion:

- Rare benign tumours

- Ganglia of the sympathetic system

- Most common location

   ð retroperitoneum and posterior mediastinum

- Cervical nerve root within the intervertebral foramen

   ð extremely uncommon

- Ganglioneuroma dumbbell tumor

   ð 0.8 to 3.5%

- Associations demonstrated with Neurofibromatosis type 1 (NF-1)

- occur more frequently in children or young adults

   ð recent study (mean age) ☞ around 40 to 50 years old

- Prognosis

   ð generally favorable

    ☞ but, local recurrence, regional lymph node metastasis

    ☞ transformation into malignant peripheral nerve sheath tumors

- CT

   ð Low internal attenuation relative to skeletal muscle

     (abundant myxoid matrix), 20% may show calcification

- MRI

   ð Homogeneous intermediate signal intensity on all sequences

   ð occasional whorled appearance of low signal intensity on T1 and T2

References:

1. Son DW, Song GS, Kim YH, Lee SW. Ventrally located cervical dumbbell ganglioneuroma producing spinal cord compression. Korean J Spine. 2013 Dec;10(4):246-248


2. Pavlus JD, Carter BW, Tolley MD et al. Imaging of thoracic neurogenic tumors. AJR Am Roentgenol 2016;207:552–561


3. Huang Y, Liu L, Li Q, Zhang S. Giant Ganglioneuroma of Thoracic Spine: A Case Report and Review of Literature. J Korean Neurosurg Soc. 2017 May;60(3):371-374


4. Badri M, Gader G, Bahri K, Zammel I. Cervical ganglioneuroma: clinical and radiological features of a rare tumour. BMJ Case Rep. 2018 Jan 10;2018. pii: bcr-2017-223412