Ganglioneuroma

Case contributed by Dr Abdallah Al Khateeb

Presentation

Unknown.

Patient Data

Age: 28-year-old
Gender: Male
X-ray

A soft tissue opacity at the right paraspinal region, along with splaying of adjacent ribs and mild dorsolumbar scoliosis. The rib changes point to its posterior mediastinal position.

Hilum overlay sign demonstrated.

Right cardiac border is well visualized. 

CT

The CT scan adds that the mass is extra-pulmonary and of mixed density with a prominent fatty component. Ribs splaying and intervertebral foramina widening are also seen. Also, these ribs show thickening and hyperostosis at their head and neck.

 

MRI

The mass is of heterogeneous signal on both T1 and T2 and demonstrates heterogeneous enhancement. 

Mass effect is displacing the spinal cord to the left.

Case Discussion

HISTOPATHOLOGY

Microscopic description
- Spindle cells dispersed in a myxoid background, those cells show wavy and serpentine nuclei. Also there are ganglion cells with large round nuclei, prominent nucleoli and abundunt cytoplasm. The tumor contains an abundunt fatty component with myxoid degeneration. Some entrapped nerve fibers are noted. No atypia or mitotic activity is evident. The ganglion cells stain positive for chromogranin and the spindle cells represent Schwann cells positive for S-100 protein. 
Ki-67 index is estimated to be less than 1%.

Diagnosis
- Ganglioneuroma with fatty component.
- No malignancy seen.

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