Age / Sex : 6 / F

Ganglioneuroma

Discussion

Findings:

Chest radiograph shows a bulging contour mass opacity at the right paraspinal area. MR images of thoracic spine reveals a right paravertebral mass that extended from T5 to T9. T2-weighted MR shows well-defined paravertebral mass with heterogeneous high signal intensity in right paravertebral region. T1-wieghted MR demonstrates intermediate to low signal intensity. Contrast-enhanced T1-weighted MR shows heterogeneous enhancement without extend through the right neural foramen. There is no evidence of infiltration or invasion into adjacent structures

Differential Diagnosis:

Ganglioneuroblastoma

Neuroblastoma
 

Diagnosis: 

Ganglioneuroma

Discussion:

Ganglioneuromas arise from the autonomic ganglion cells of the peripheral nervous system, usually the sympathetic ganglion. They represent the benign end of the spectrum for the ganglion cell lineage, whereas ganglioneuroblastomas and neuroblastomas comprise the malignant end of this spectrum. Ganglioneuromas most commonly occur within the posterior mediastinum and retroperitoneum and less commonly in the adrenal medulla, parapharyngeal region, visceral ganglia, or cranial nerve ganglia

Sympathetic ganglion tumors show a vertically oriented mass along the anterolateral aspect of several thoracic vertebrae compared with peripheral nerve tumors, which have a more horizontal orientation Ganglioneuromas manifest as a well-defined mass with heterogeneous high signal intensity on T2-weighted images. The relatively high signal intensity on T2-weighted images reflects myxomatous matrices in the tumors. The “whorled appearance” is due to curvilinear bands of low signal intensity that reflect collagenous fibrous tissue in the mass on T2-weighted images. Most ganglioneuromas show gradual and heterogeneous contrast enhancement. Neuroblastomas and ganglioneuroblastomas show a well- or ill-defined mass with typically more heterogeneous signal intensity and contrast enhancement on MRI due to tumor necrosis

References

1.     Takahiko Nakazono, Charles S. White, Fumio Yamasaki, et al. MRI Findings of Mediastinal Neurogenic Tumors. AJR 2011; 197:W643–W652

2.     Y B Guan, W D Zhang, Q S Zeng, et al. CT and MRI findings of thoracic ganglioneuroma. The british journal of radiology 2012;85:e365-e372