Ganglioneuroma

Case contributed by Dr Saeed Soltany Hosn

Presentation

Acute onset lower back pain radiating into his right leg. On examination, the patient has scoliosis.

Patient Data

Age: 11 years
Gender: Male
X-ray

AP and lateral view of the spinal column reveals scoliosis with a sharp angular bend associated with posterior scalloping of the vertebral bodies.

Ultrasound
Transverse US image shows a retroperitoneal lobulate border heterogenous echogenicity mass with average volume of 260 cc.

Whole-Body Bone Scan With Tc-99m-MDP

Nuclear medicine

On the dynamic phase,normal perfusion and blood pool activity was noted at the region of lumbar and thoracic spine. On the static phase,severe lumbar scoliosis with focal heterogeneous increased uptake of L1 to L3 as well as T4 were detected. Other parts of skeletal system revealed normal activity.There is retention of activity in the region of left kidney.

CT

Fusiform longitudinal soft tissue density mass is present against T12 - L2 vertebrae associated with extension in to the spinal canal which causes canal widening and posterior scalloping of mentioned vertebrae. Scoliosis with convexity to the left side is noted. There are also infiltration of left iliopsoas muscle and anterior displacement of left kidney. In addition there are bilateral widening of neuoroforamina in T12-L2 vertebrae. 

Case Discussion

Findings are consistent with neurofibromatosis and sudden onset of patient's symptoms is suggestive of neurofibrosarcoma. Patient went on to have a biopsy, but histopathology confirmed ganglioneuroma.

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