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- Title
A Case of Retroperitoneal Ganglioneuroma: Masquerader of Pancreatic Head Mass.
- Authors
Jimin Han; Dong Wook Lee; Ho Gak Kim
- Abstract
Background/Aims Differential diagnoses of a pancreatic head mass include both pancreatic and extrapancreatic lesions. Methods We report a case of retroperitoneal ganglioneuroma that was difficult to differentiate from pancreatic head mass. Results A 22-year-old female presented with incidental finding of pancreatic head mass. The patient had no symptoms. Past medical history and family history were noncontributory. She was a 0.3 pack-year smoker and drank a bottle of Soju three times a week. Physical examination showed soft and flat abdomen. No mass was palpable. Complete blood count, biochemical panel were all within normal. CA19-9 was less than 2 U/mL. Transabdominal ultrasonography showed a hypoechoic lesion in pancreatic head. Abdominal computed tomography demonstrated a 6.2-cm-low density mass in pancreatic head with delayed enhancement and encasement of superior mesenteric vessels. Magnetic resonance imaging of the pancreas revealed a 5.6-cm mass between pancreatic head and inferior vena cava. Superior mesenteric artery was traversing the mass. The patient underwent complete surgical excision. The mass was dissected easily from the superior mesenteric vessels. Gross appearance of the resected specimen showed an 8.0x7.0x4.5-cm well encapsulated round solid mass (Fig. 1A). Cross-section showed yellow to whitish glittering surface and no necrosis or hemorrhage. Microscopic examination showed mature neural tissue with scattered large ganglion cells (Fig. 1B). There was no pancreatic tissue. There was no atypical mitosis or necrotic area. The patient recovered uneventfully and was discharged. Final diagnosis was retroperitoneal ganglioneuroma. Conclusions Ganglioneuroma is a rare tumor derived from primordial neural crest cells in the sympathetic nervous system and composed entirely of mature ganglion cells and Schwannian stroma. Most cases had been reported from pediatric population. Treatment of choice is complete resection. Because local recurrence has been reported, periodic surveillance with cross-sectional imaging is necessary. Although it is a rare tumor, ganglioneuroma should be included in differential diagnoses of pancreatic head mass.
- Subjects
VENA cava inferior; SYMPATHETIC nervous system; BLOOD cell count; SURGICAL excision; NEURAL crest
- Publication
Gut & Liver, 2019, Vol 13, Issue 6(suppl. 1), p202
- ISSN
1976-2283
- Publication type
Article