Giant Ganglioneuroma of the Lumbar Spine: A Rare Cause of Radiculopathy

Abstract

Background: Ganglioneuroma (GN) is a rare, benign tumor that originates from neural crest cells and can potentially affect any anatomical site within the sympathetic nervous system. Typically, GNs are more frequently reported in children and young adults, with a slightly higher prevalence in females. We are reporting a rare case of a giant lumbar spine ganglioneuroma by outlining the clinical presentation, radiological finding, management, and outcome. Case Description. A 37-year-old female presented with low back pain radiating to the right lower limb for few years. Neurological examination revealed bilateral lower limb hyperreflexia (+3). Lumbar spine CT and MRI revealed a right paravertebral soft tissue lesion with heterogeneous signal intensity and enhancement at L1 to L3. The patient underwent complete resection of the lesion via a retroperitoneal approach. The surgery was uneventful. The histopathological sections were suggestive of mature ganglioneuroma. She was discharged in stable condition with follow-up at neurosurgery clinic.

Conclusion: Giant ganglioneuromas are rare, benign tumors of sympathetic neurons. Complete surgical resection is the most effective therapeutic option for ganglioneuroma to avoid recurrence. Given the benign nature of ganglioneuroma, chemotherapy and radiotherapy tend to have a limited role following surgical resection.

Figure 1

(a, b) Coronal and sagittal lumbar CT (bone window) demonstrating an eccentric, expansile lytic lesion at the posterior aspect of the right L2 vertebral body extending along the right psoas muscle. It is causing mass effect on the right neural foramen. (c, d) Axial and coronal lumbar MRI with contrast showing a right paravertebral soft tissue lesion with heterogeneous signal intensity and enhancement at L1 to L3. There is spinal canal component at L2-L3 right neural foramen and epidural space involving the exiting nerve. It invaginates into the right psoas muscle and causes scalloping of the right vertebral body of L2 and L3. It measures about 9 × 6 × 4 cm in maximum diameters. (e) Hematoxylin and eosin stain (high power; magnification ×200). Ganglioneuroma, mature: admixture of few mature ganglion cells and abundant atypical Schwann cells.