Imaging of Ganglioneuroma: A Literature Review and a Rare Case of Cystic Presentation in an Adolescent Girl

Abstract

Retroperitoneal ganglioneuroma is a rare neuroectodermal tumor with a benign nature. We performed a literature review among 338 studies. We included 9 studies, whose patients underwent CT and/or MRI to characterize a retroperitoneal mass, which was confirmed to be a ganglioneuroma by histologic exam. The most common features of ganglioneuroma are considered to be a solid nature, oval/lobulated shape, and regular margins. The ganglioneuroma shows a progressive late enhancement on CT. On MRI it appears as a hypointense mass in T1W images and with a heterogeneous high-intensity in T2W. The MRI-"whorled sign" is described in the reviewed studies in about 80% of patients. The MRI characterization of a primitive retroperitoneal cystic mass should not exclude a cystic evolution from solid masses, and in the case of paravertebral location, the differential diagnosis algorithm should include the hypothesis of ganglioneuroma. In our case, the MRI features could have oriented towards a neurogenic nature, however, the predominantly cystic-fluid aspect and the considerable longitudinal non-invasive extension between retroperitoneal structures, misled us to a lymphatic malformation. In the literature, it is reported that the cystic presentation can be due to a degeneration of a well-known solid form while maintaining a benign character: the distinguishing malignity character is the revelation of immature cells on histological examination.

Keywords: CT; MRI; backpain; cystic mass; ganglioneuroma; retroperitoneal mass.

Figure 1

The axial T2-weighted sequence shows a cystic retroperitoneal paravertebral left mass as an occasional finding.

Figure 2

The T2-weighted fat-saturated sequence shows a hyperintense signal of the lesion with a medial hypointense dishomogeneity.

Figure 3

Ganglioneuroma in a coronal-T2 image.

Figure 4

On coronal T1-spir image the ganglioneuroma shows a delayed phase enhancement.

Figure 5

(a) patient with cystic ganglioneuroma (arrow); (b) a different patient without any retroperitoneal mass.