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Weekly Chest CasesArchive of Old Cases

Case No : 807 Date 2013-04-15

  • Courtesy of Hyun-ju Lim, Soo-Youn Ham / Korea Univisity Anam Hospital
  • Age/Sex 12 / M
  • Chief Complaintabnormal chest radiagraphic finding
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Ganglioneuroma
Radiologic Findings
Posteroanterior radiograph shows well-marginated right paraspinal mass.
Noncontrast CT shows a low attenuating mass in posterior mediastinum with internal coarse calcifications. Contrast-enhanced CT (axial, coronal and sagittal) images show a heterogeneously enhancing oblong mass lesion.
Axial MR images show a mass of T1 hypointensity, T2 heterogeneously hyperintensity (dark foci correlate to calcifications) and mild, heterogeneous enhancement.
Brief Review
Ganglioneuromas are benign tumors that originate from neural crest cells that make up the sympathetic ganglia along the spinal column and adrenal glands. Ganglioneuromas share a common histogenic lineage with ganlioneuroblastoma and neuroblastoma and represent the most benign and differentiated of this group. Neuroblastoma and ganglioneuroblastoma are essentially tumors of childhood (less than 10% occur in patients older than 20 years of age). Ganglioneuroma is often seen in children and adolescents but has a broader and more even age distribution, ranging from 1 to 50 years. There is no distribution difference between males and females.
Ganglioneuromas typically are well-encapsulated mass with a fibrous capsule that arise in the posterior mediastinum. .On chest radiograph, these tumors are elongated along axis of spine. CT scan shows hypodense and non-enhancing or mild enhancing mass in the early phase. Guan et al. reported 6 ganglioneuroma cases with MR findings and these tumors showed T1 hypointensity, T2 heterogenously hyperintensity and mild heterogeneous enhancement.
Surgical resection is the treatment of choice. Although these tumors are histologically benign, they may behave aggressively and compress or invade local neural foramina as well as adjacent mediastinal structures. Given this potential, theses tumors are resected and the recurrence rate is near zero.
Please refer to
Case 91, Case 637, Case 641,
References
1. Forsythe A, Volpe J, Muller R. Posterior mediastinal ganglioneuroma. Radiographics 2004;24:594-597
2. Gaun YB, Zhang WD, Zeng QS, Chen GQ, He JX. CT and MRI findings of thoracic ganglioneuroma. BJR 2012 DOI:10.1259/bjr/53395088
3. Imaging of diseases of the chest. Hansell DM, Lynch DA, McAdams HP, Bankier A. Mosby 2010
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 104

▶ Correct Answer : 43/104,  41.3%
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Kasturba Medical College , India Chandan Kakkar
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - kyung-hee university of medicine , Korea (South) yunkyung shin
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Ewha Womans University Mokdong Hospital , Korea (South) Jin Sil Kim
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Saint Malo , France jean-baptiste Noel
  • - Osaka university , Japan Akio Tsukabe
  • - Dae-jeon Bohun Veterans Hospital , Korea (South) KI-TAE HAN
  • - Kyoto University , Japan Akihiko Sakata
  • - kasturba medical college , India mugil varman
  • - Columbia Asia , India John Joseph
  • - KMC,Manipal , India satish maddukuri
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - SRM medical college , India ram s
  • - Department of Radiology, Tseung Kwan O Hospital, Hospital Authority, Hong Kong Special Administrative Region, China , China Wai Pong CHU
  • - CBNUH , Korea (South) jihyung lee
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - 異⑸ , Korea (South) sooncheul baek
  • - Chungbuk national university hospital , Korea (South) Jisun Lee
  • - chungbuk national university hospital , Korea (South) jeehye kim
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - All India Institute of medical sciences , India Justin Moses
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - ESIC SUPERSPECIALITY HOSPITAL,KOLLAM,INDIA , India rohith babu
  • - McGill university , Canada Badriya Al-Qassabi
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Chonnam national university hospital , Korea (South) Wongi Jeong
  • - NASA SCANS , India RAKESH BHATIA
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - CNUH , Korea (South) Kim Soo Hyun
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
▶ Correct Answer as Differential Diagnosis : 13/104,  12.5%
  • - SNUH , Korea (South) Euijin Hwang
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan medical center , Korea (South) yoonyoung choi
  • - GHICL , France manuel toledano
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Mashhad University of Medical Sciences , Iran Bita Abbasi
  • - Private sector , Greece Vasilios Tzilas
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
  • - , Korea (South) Chan Park
  • - Okayama university , Japan Mayu Uka
▶ Semi-Correct Answer : 34/104,  32.7%
  • - radiologist, aditya imaging centre , India vivek patel
  • - Chernomorska , Bulgaria VLADISLAV RUSINOV
  • - CHU Poitiers , France CHAN paul
  • - aarthi scans , India abirami mahadevan
  • - Chungnam National University hospital , Korea (South) sunkyoung you
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - Severance hospital, shinchon , Korea (South) yeojin lee
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - UWO , Canada S Lee
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - McGill University Health Center , Canada Alexandre Semionov
  • - University of British Columbia , Canada Amr Ajlan
  • - SKG radiology , Australia Yuranga Weerakkody
  • - NDMVP Nashik , India Imran Jindani
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - , Korea (South) park ji hoon
  • - Pulmonary Institute, Shaare Zedek Medical Center , Israel Abraham Bohadana
  • - McGill University - Cairo University , Canada Hisham Mikhael
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Myongji , Korea (South) soon-young Moon
  • - bjmc, pune , India rahul arkar
  • - GHTM ,STANLEY MEDICAL COLLEGE,CHENNAI , India siva raja
  • - TCM HOSPITAL OF ZIGONG , China Cao Cunyou
  • - chp st martin , France Mariotte benoit
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Alswaida- zaid alsherity hospital , Syria jehad alakabani
  • - CAC Rennes , France nicolas gautier
  • - Chonnam National Univ. Hospital , Korea (South) Jaemyeong Jo
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - Medicheck health care , Korea (South) Chae Lim
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