SCIENTIFIC
Cervical Ganglioneuroma Presenting as a Neck Mass with Horner ' s Syndrome
AUTHORS : Erica Haught BS 1
Tyler Harper BS 1 Pamela Phillips MD 2 Marcus Shaffer MD 3
1
West Virginia University School of Medicine
2
Department of Radiology , Charleston Area Medical Center
3
Department of Otolaryngology , Charleston Area Medical Center
CASE
An 11-year-old female presented with a slow-growing left neck mass over two years duration . She was asymptomatic except for a history of unilateral Horner ' s syndrome , including left-sided ptosis , miosis , and anhidrosis . When the patient ' s mother first noticed the mass , magnetic resonance imaging ( MRI ) was performed and revealed an ovoid mass measuring 4.7 cm x 1.7 cm x 1.0 cm in the left neck with homogenous low signal on T1 and heterogenous high signal on T2 . Due to the benign-appearing nature of the mass , the patient was advised to follow up in one year or return sooner if growth of the mass occurred .
ABSTRACT
cm posterior to the carotid artery and jugular vein on the left ( Figure 1 ). The inferior extent of the mass reached the level of the superior thyroid lobe while the superior extent reached the level of the oropharynx . There was no change in size in comparison to the MRI obtained 1.5 years prior . Since there were no signs of infection or growth of the mass , the patient initially opted for continued close monitoring as the treatment .
Ganglioneuromas ( GNs ) are benign neoplasms of the autonomic nervous system . They are typically located in the retroperitoneum , posterior mediastinum , and adrenal gland . Rarely , they can arise in the cervical region and present as an enlarging neck mass . However , there have not been any reported cases , to our knowledge , of a GN presenting as Horner ' s syndrome . An 11-year-old female presented with a neck mass and a history of left-sided ptosis , miosis , and anhidrosis . The mass was excised , and pathology revealed a GN . In patients with a neck mass and Horner ' s syndrome , GNs should be considered as well as other nerve sheath tumors .
After six months , the patient sought otolaryngology consultation for possible excision of the mass due to rising concern . On physical examination , the patient had a hard , circumscribed mass posterior to the angle of the mandible . Repeat MRI revealed a 4.7 cm by 2.1 cm x 1.2 cm lesion with heterogenous high signal on T2-weighted imaging deep to carotid sheath structures , consistent with a sympathetic chain lesion ( Figure 2 ).
FIGURE 1 : Sagittal CT of the head and neck showing an ovoid mass with lower attenuation than its surroundings at the level of the angle of the mandible .
At the one-year follow-up with the otolaryngologist , the patient reported a recent change in her left vision that was addressed by ophthalmology , including a non-contrast head computed tomography ( CT ). This study demonstrated a 1.27 cm x 2.21 cm area of homogenous hypodensity posterior to the left mandibular angle . Continued observation of the mass was again recommended . Six months later , the patient returned due to the patient ’ s increasing uncertainty about the significance of the mass . An ultrasound at that time revealed a well-circumscribed 5.6 cm x 2.1 cm homogenous mass with a mild heterogeneity . A C T with contrast was obtained for further evaluation and revealed an ovoid homogenous mass with low attenuation measuring 5 cm x 4.8 cm x 2.4
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