Adolescent thoracic scoliosis due to giant ganglioneuroma: a two-case report and literature review

Abstract

Ganglioneuromas are rare benign tumors that arise from the sympathetic nervous system. The presentation of tumors is variable and associated with adolescent thoracic scoliosis. Herein, we present two case reports and a review of literature. The two cases involved 10 and 13-year-old patients who were asymptomatic for muscle pain or weakness, and ganglioneuromas were incidentally detected through imaging screening. Both patients underwent a two-stage surgery. The first stage involved detachment of the tumor from the spinal cord and simultaneously performing deformity correction surgery from the posterior aspect. The second stage was resection of the ganglioneuroma through the anterior approach without neurological problems. A two-stage surgery was necessary to excise the tumor and correct the deformity, thereby avoiding neurological problems and concurrently establish a pathological diagnosis. Commencing with the posterior approach proved to be safe and was more effective.

Keywords: adolescent thoracic scoliosis; corrective fusion; ganglioneuroma; tumor resection; two-stage surgery.

Fig. 1

Radiographic evaluation of spinal surgery outcome (Case 1) Fig. 1A: Whole-spine posterior-anterior radiograph showed a 71-degree scoliosis deformity at T7-T11. Fig. 1B: Chest radiograph anterior-posterior showed a huge shadow in the right thoracic cavity. Fig. 1C: Whole-spine posterior-anterior radiograph after surgery 8 years.

Fig. 2

Multimodal imaging evaluation of tumor characteristics, spinal involvement (Case 1) Fig. 2A: MRI revealed a soft tissue mass located on the convex apex side of the vertebral body and the tumor measured 9.0x7.5x3.0 cm, showing hypodense on T1W. Fig. 2B: MRI in T2W heterogeneous hyperdense on coronal view. Fig. 2C: MRI in T1W with Gadolinium on coronal view with mild heterogeneous enhancement effect. Fig. 2D: MRI in T2W revealed that tumor developed into spinal canal via intervertebral foramen of T8/9 on axial view (white arrow). Fig. 2E: CT scan revealed bone proliferation at the corner of vertebral body of T9. MRI: magnetic resonance imaging CT: computed tomography

Fig. 3

Long-term radiographic follow-up of spinal surgery outcome (Case 2) Fig. 3A: Whole-spine posterior-anterior radiograph showed 69-degree of scoliosis at T7-T11. Fig. 3B: Chest radiograph anterior-posterior showed a large shadow overlapping the thoracic spine. Fig. 3C: Whole-spine posterior-anterior radiograph after surgery 4 years 8 months.

Fig. 4

MRI evaluation of tumor characteristics (Case 2) Fig. 4A: MRI revealed a soft tissue mass located on the convex apex side of the vertebral body and the tumor measured 9.0x6.6x2.4 cm, showing hyperdense on T2W. Fig. 4B: MRI in T2W revealed that tumor developed into spinal canal via right intervertebral foramen of T9/10 on axial view (white arrow). MRI: magnetic resonance imaging