have calcifications or fatty densities . Classic MRI findings on T1-weighted images are homogenous hypointense signals , and T2-weighted images are heterogenous with hyperintense signals . 10 MRI findings in our patient were consistent with these aforementioned descriptions .
The first line and definitive treatment of cervical GNs is total excision , which may , as this case demonstrates , lead to Horner ' s syndrome . A literature review reported 27 cases of cervical GNs in children and adults . 7 Effective treatment of all of these were excision of the GN with no recurrence on follow-up . Cervical GNs can be excised transorally or transcervically . 12 In the reported case of a parapharyngeal GN by Albonico and colleagues , aspiration of the lesion was attempted but was inadequate and therefore excision was successfully performed . 13
The excision of GNs can be accompanied by complications . Reported complications include vocal cord palsy and Horner ' s syndrome . 6 Sánchez-Galán and colleagues ’ retrospective review of children who had undergone GN excision ( N = 24 ) reported three patients experienced post-operative Horner ’ s syndrome , one had mild scoliosis , one experienced adhesive bowel obstruction , and one experienced acute urinary retention . 14 While 20 of those children had complete excision , four of them had gross residual tumor that had no regrowth ormalignancy within an 84-month follow-up . The authors concluded that while excision of GNs are necessary for definitive diagnosis , it may be safe to leave residual tumor to preserve function of surrounding structures . 14
CONCLUSION
GNs are benign neoplasms of the autonomic nervous system that can rarely arise in the cervical region and present as an enlarging neck mass . We report a case of a cervical GN that presented with an enlarging neck mass and left-sided ptosis , miosis , and anhidrosis . The patient was successfully treated with surgical excision . In patients presenting with a neck mass and Horner ' s syndrome , GN should be in the differential diagnosis , classic radiologic findings should be reviewed , and surgical excision should be considered for definitive diagnosis .
REFERENCES
1 . Folkert KN , de Beaufort H , Bauman NM . Horner Syndrome from a Pediatric Otolaryngology Perspective . Annals of Otology , Rhinology & Laryngology . 2020 ; 129 ( 2 ): 191-194 . doi : 10.1177 / 0003489419877428 .
2 . Leeson MC , Hite M . Ganglioneuroma of the sacrum . Clin Orthop Relat Res . 1989 ;( 246 ): 102 – 105 .
3 . Cannon TC , Brown HH , Hughes BM , Wenger AN , Flynn SB , Westfall CT . Orbital ganglioneuroma in a patient with chronic progressive proptosis . Arch Ophthalmol . 2004 ; 122 ( 11 ): 1712-1714 .
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