Weekly Chest CasesArchive of Old Cases

Case No : 637 Date 2010-01-10

  • Courtesy of Eun Ho Jang, Joo Sung Sun, Kyung Joo Park / Ajou University Hospital
  • Age/Sex 19 / F
  • Chief ComplaintIncidentally found mass in the thorax in routine health check up.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Ganglioneuroma
Radiologic Findings
Plain radiographs show a left superior medistinal mass, obscured the boder of aortic arch. Enhanced CT scan reveals a mass between left supraclavicular and ipsilateral anterolateral mediastinal area. The mass show well defined border, homogenous enhancement and encasement of the greast vessels, including left common carotid, subclavian and vertebral arteries. At radiographic studies, parenchymal abnormality is not demonstrated.
Brief Review
Pathologic findings
Photomicrograph reveals mature ganglionic cells with abundant cytoplasm and schwannian stroma.

Brief review
Neurogenic tumors of thorax may arise from the paraspinal ganglion of the symphathetic chain or from the intercostals nerves of the thoracic cage. Gnagiloneuroma is one of neurogenic tumor, composed entirely of ganglion cell and Schwannian stroma. Ganglioneuroma often manifests as an symptomatic mass and so, it is discovered on a routine radiographic study as this case. Plain radiograph typically shows a posterior mediastinal mass. On US, it is homogenous, hypoechoic mass with well defined borders. CT scan reveals low attenuation and homogenous mass on unenhanced CT and slight to moderate enhancement. At MR imaging, ganglioneuroma has low signal intensity on T1WI and high on T2WI. Enhancement of ganglioneuroma varies from mild to marked.
References
1) Gael J. Lonergan, Cornelia M. Schwab, Eric S. Suarez, and Christian L. Carlson. Neuroblastoma, Ganglioneuroblastoma, and Ganglioneuroma: Radiologic-Pathologic Correlation. Radiographics 2002 22:911-934.
2) Mi-Young Jeung, Afshin Gangi, Bernard Gasser, Cornelia Vasilescu, Gilbert Massard, Jean-Michel Wihlm, and Catherine Roy. Imaging of Chest Wall Disorders. Radiographics 1999 19:617-637.
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 101

▶ Correct Answer : 9/101,  8.9%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - NASA SCANS , India RAKESH BHATIA
  • - IRSA rochefort , France Viviane Pages
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Yashoda Superspeciality hospital , India Pravin Mahadevappa
  • - SacrCoeur , Canada Andrea Ojanguren
▶ Correct Answer as Differential Diagnosis : 14/101,  13.9%
  • - radiologist, aditya imaging centre , India vivek patel
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - CHRU lille , France manuel toledano
  • - Montreal Chest Institute , Canada Faiz Khan
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
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