Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report

Wang,Kai; Dai,Jianping

doi:10.3892/ol.2015.3815

Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report

Authors:
- Kai Wang
- Jianping Dai
View Affiliations

Affiliations: Department of Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China, Department of Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
Published online on: October 19, 2015 https://doi.org/10.3892/ol.2015.3815
Pages: 3803-3806

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Ganglioneuromas are rare, benign, well-differentiated tumors of the conus medullaris. Approximately 20 cases of spinal cord ganglioneuroma, and only 1 case of mixed chemodectoma‑ganglioneuroma of the conus medullaris have been previously reported. The present study presents the case of a 38‑year‑old man with a histopathological diagnosis of conus medullaris ganglioneuroma. The patient presented with hypoesthesia in the lower limbs, muscle atrophy of the right lower limb and dysuria. Magnetic resonance imaging analysis led to a diagnosis of ependymoma. Histopathological analysis of the excised mass revealed typical, well‑differentiated ganglion cells, consistent with a ganglioneuroma. The mass was associated with a neighboring syringomyelia. At an 18 month follow‑up the patient had recovered, although some remaining difficulty in walking and urinating remained. The aim of the present report was to raise awareness that when ganglioneuromas present in unusual locations, analogous radiological findings may mislead investigators to consider more common pathologies and thus result in misdiagnosis. The present case demonstrates the importance of considering the potential differential diagnoses for neural tissue neoplasms.

View Figures

View References

1	Mounasamy V, Thacker MM, Humble S, Azouz ME, Pitcher JD, Scully SP, Temple HT and Eismont F: Ganglioneuromas of the sacrum - a report of two cases with radiologic-pathologic correlation. Skeletal Radiol. 35:117–121. 2006. View Article : Google Scholar : PubMed/NCBI
2	Modha A, Paty P and Bilsky MH: Presacral ganglioneuromas. Report of five cases and review of the literature. J Neurosurg Spine. 2:366–371. 2005. View Article : Google Scholar : PubMed/NCBI
3	MacCarty CS, Waugh JM, Coventry MB and Cope WF Jr: Surgical treatment of sacral and presacral tumors other than sacrococcygeal chordoma. J Neurosurg. 22:458–464. 1965. View Article : Google Scholar : PubMed/NCBI
4	Spinelli C, Rossi L, Barbetta A, Ugolini C and Strambi S: Incidental ganglioneuromas: A presentation of 14 surgical cases and literature review. J Endocrinol Invest. 38:547–554. 2015. View Article : Google Scholar : PubMed/NCBI
5	Shephard RH and Sutton D: Dumb-bell ganglioneuromata of the spine with a report of four cases. Br J Surg. 45:305–317. 1958. View Article : Google Scholar : PubMed/NCBI
6	Oro JJ and Geise AW: Dumbbell ganglioneuroma of the lumbar spine associated with a herniated intervertebral disc: Case report. Neurosurgery. 13:711–714. 1983. View Article : Google Scholar : PubMed/NCBI
7	Li L, Shao J, Gu J, Wang X and Qu L: Adrenal ganglioneuromas: Experience from a retrospective study in a Chinese population. Urol J. 11:1485–1490. 2014.PubMed/NCBI
8	Okudera Y, Miyakoshi N, Sugawara T, Hongo M, Kasukawa Y, Ishikawa Y and Shimada Y: Ganglioneuroblastoma of filum terminale: Case report. J Neurosurg Spine. 21:270–274. 2014. View Article : Google Scholar : PubMed/NCBI
9	Schmitt HP, Wurster K, Bauer M and Parsch K: Mixed chemodectoma-ganglioneuroma of the conus medullaris region. Acta Neuropathol. 57:275–281. 1982. View Article : Google Scholar : PubMed/NCBI
10	Liu WH and Du YH: Therapeutic observation of needling three hand yang meridian acupoints to treat postapoplectic finger contracture. J Acupunct Tuina Sci. 5:301–303. 2007. View Article : Google Scholar
11	Kyoshima K, Sakai K, Kanaji M, Oikawa S, Kobayashi S, Sato A and Nakayama J: Symmetric dumbbell ganglioneuromas of bilateral C2 and C3 roots with intradural extension associated with von Recklinghausen's disease: Case report. Surg Neurol. 61:468–473. 2004. View Article : Google Scholar : PubMed/NCBI
12	Geoerger B, Hero B, Harms D, Grebe J, Scheidhauer K and Berthold F: Metabolic activity and clinical features of primary ganglioneuromas. Cancer. 91:1905–1913. 2001. View Article : Google Scholar : PubMed/NCBI
13	Dimou J, Russell JH, Jithoo R and Pitcher M: Sacral ganglioneuroma in a 19-year-old woman. J Clin Neurosci. 16:1692–1694. 2009. View Article : Google Scholar : PubMed/NCBI
14	Ma J, Liang L and Liu H: Multiple cervical ganglioneuroma: A case report and review of the literature. Oncol Lett. 4:509–512. 2012.PubMed/NCBI
15	Hayes FA, Green AA and Rao BN: Clinical manifestations of ganglioneuroma. Cancer. 63:1211–1214. 1989. View Article : Google Scholar : PubMed/NCBI
16	Esiri M: Russell and Rubinstein's pathology of tumors of the nervous system. Sixth edition. J Neurol Neurosurg Psychiatry. 68:538D2000. View Article : Google Scholar : PubMed/NCBI
17	Ghali VS, Gold JE, Vincent RA and Cosgrove JM: Malignant peripheral nerve sheath tumor arising spontaneously from retroperitoneal ganglioneuroma: A case report, review of the literature and immunohistochemical study. Hum Pathol. 23:72–75. 1992. View Article : Google Scholar : PubMed/NCBI
18	Andersen HJ, Hansen LG, Lange P and Teglbjaerg PS: Presacral ganglioneuroma. Case report. Acta Chir Scand. 152:777–778. 1986.PubMed/NCBI
19	Levy DI, Bucci MN, Weatherbee L and Chandler WF: Intradural extramedullary ganglioneuroma: Case report and review of the literature. Surg Neurol. 37:216–218. 1992. View Article : Google Scholar : PubMed/NCBI
20	Cerullo G, Marrelli D, Rampone B, Miracco C, Caruso S, Di Martino M, Mazzei MA and Roviello F: Presacral ganglioneuroma: A case report and review of literature. World J Gastroenterol. 13:2129–2131. 2007. View Article : Google Scholar : PubMed/NCBI
21	Kariev GM, Halikulov ES and Rasulov SO: Unspecific clinical manifestation of cauda equina myxopapillary ependymoma. Asian J Neurosurg. 10:256–258. 2015. View Article : Google Scholar : PubMed/NCBI
22	Deng X, Wang K, Wu L, Yang C, Yang T, Zhao L, Yang J, Wang G, Fang J and Xu Y: Intraspinal hemangioblastomas: analysis of 92 cases in a single institution: Clinical article. J Neurosurg Spine. 21:260–269. 2014. View Article : Google Scholar : PubMed/NCBI
23	Lmejjati M, Parker F, Lacroix C and Tadie M: Paraganglioma of the sacral spinal canal. Neurosciences (Riyadh). 16:270–272. 2011.PubMed/NCBI
24	Midi A, Yener AN, Sav A and Cubuk R: Cauda equina paraganglioma with ependymoma-like histology: A case report. Turk Neurosurg. 22:353–359. 2012.PubMed/NCBI
25	Young WF, Tuma R and O'Grady T: Intraoperative measurement of spinal cord blood flow in syringomyelia. Clin Neurol Neurosurg. 102:119–123. 2000. View Article : Google Scholar : PubMed/NCBI
26	Klekamp J: The pathophysiology of syringomyelia - historical overview and current concept. Acta Neurochir (Wien). 144:649–664. 2002. View Article : Google Scholar : PubMed/NCBI
27	Levine DN: The pathogenesis of syringomyelia associated with lesions at the foramen magnum: A critical review of existing theories and proposal of a new hypothesis. J Neurol Sci. 220:3–21. 2004. View Article : Google Scholar : PubMed/NCBI
28	Schaller B, Mindermann T and Gratzl O: Treatment of syringomyelia after posttraumatic paraparesis or tetraparesis. J Spinal Disord. 12:485–488. 1999. View Article : Google Scholar : PubMed/NCBI