Weekly Case

Title : Case 622

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







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

C5/6 with spinal cord compression



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)






- 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


   ð Homogeneous intermediate signal intensity on all sequences

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



  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

Correct Answer
Total applicants 22 Correct answers 1
Name Institution
김기욱 국군대전병원, 전문의
Semi-Correct Answer
Total applicants 22 Semi-Correct answers 16
강지희 서울대학교병원, 전문의
김동언 전공의
이준영 전공의
조은경 새움병원, 전문의
윤유성 순천향대 부천병원, 전문의
손상욱 군의관, 전문의
한진우 전공의
김유진 전문의
신재환 국군춘천병원, 전문의
장성원 중앙보훈병원, 전공의
한유비 병무청, 전문의
최형인 국군수도병원, 전문의
김보람 전문의
김형민 전문의
김동수 전공의
박병진 국군강릉병원, 전문의

  • 관리자 ( 2019-05-27 09:16:36 )
    benign peripheral nerve sheath tumor는 semicorrect answer로 하였습니다.