Ganglioneuroma of the Bladder in Association with Neurofibromatosis Type 1

Abstract

Neurofibromatosis type 1 (NF1) is a genetic disease, with autosomal dominant transmission, related to pathogenic variant of the tumor suppressor gene NF1 (17q11.2), predisposing affected subjects to a variety of benign (neurofibromas and plexiform neurofibromas) and malignant tumors. The lack of the NF1-neurofibromin gene product can cause uncontrolled cell proliferation in the central or peripheral nervous system and multisystemic involvement, and so the disease includes a heterogeneous group of clinical manifestations. Ganglioneuromas are benign tumors developing from the neural crest cells of the autonomic nervous system, considered to be part of neuroblastic tumors. Bladder localization is extremely rare in adults, and only three such cases were reported in children so far. The aim of our study, in addition to a brief review of the literature of these pathologies, is to bring to your attention the case of a sixteen year old patient with a very rare association of NF1 and bladder ganglioneuroma, who presented at the hospital with gross hematuria. Since bladder ganglioneuroma is a rare pathological condition, the differential diagnosis is difficult and imaging investigations and pathological investigations are the ones that elucidate this disease. The clinical approach of the medical multidisciplinary team involved should help the patient in managing her medical and surgical situation.

Keywords: bladder ganglioneuroma; hematuria; neurofibromatosis.

Figure 1

Hypertrophy of the labia majora (plexiform neurofibroma).

Figure 2

Short stature for age, subcutaneous nodules, and kyphoscoliosis.

Figure 3

Uro-CT showing an infiltrative contrast enhancing mass located at the level of the posterior bladder wall.

Figure 4

Uro-CT–lateral view.

Figure 5

Micturition urethrocystography showing vesical diverticula.

Figure 6

“Fighting” appearance of the bladder wall, with “cells and columns”.

Figure 7

Mature ganglion cells admixed with stroma, HE × 100.

Figure 8

Scattered mature ganglion cells, HE ×100.

Figure 9

Mature ganglion cells, HE × 200.