Journal of Cytology
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Year : 2014  |  Volume : 31  |  Issue : 1  |  Page : 57-58
Aspiration cytology in the preoperative diagnosis of ganglioneuroma presenting as a neck mass


Department of Pathology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

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Date of Web Publication15-Apr-2014
 

How to cite this article:
Bhadarge PS, Poflee SV. Aspiration cytology in the preoperative diagnosis of ganglioneuroma presenting as a neck mass. J Cytol 2014;31:57-8

How to cite this URL:
Bhadarge PS, Poflee SV. Aspiration cytology in the preoperative diagnosis of ganglioneuroma presenting as a neck mass. J Cytol [serial online] 2014 [cited 2020 Aug 15];31:57-8. Available from: http://www.jcytol.org/text.asp?2014/31/1/57/130712


Sir,

Ganglioneuroma (GN) is a rare, fully differentiated, embryonal neural tumor of the sympathetic chain. GN presenting as a neck mass is uncommon and diagnosis on cytology is rarely described. [1] We present a case of ganglioneuroma in an eleven-year-old, prepubertal, female child, who presented with a slowly growing neck mass (for seven years). On account of the large neck mass present since early childhood, cystic hygroma was suspected clinically. However, the patient was referred for preoperative cytology. The mass was diffuse, about 10 × 6 cm, and occupying the entire left side of the neck [[Figure 1], inset]. It was firm, non-fluctuant, nontender, and not moving with deglutition or protrusion of the tongue.
Figure 1: Microphotograph showing clusters of ganglion cells admixed with neurofi brillary stroma (H and E, ×400). Inset-Diffuse mass on the left lateral side of the neck

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Fine needle aspiration cytology (FNAC) was performed from multiple sites and the smears were stained with hematoxylin and eosin stain. The cytology smears yielded good cellularity and showed a biphasic pattern of large polyhedral cells in the fibrillary stroma and a few spindle-shaped cells, with cigar-shaped nuclei. The large cells had abundant, dense, eosinophilic cytoplasm, and single or multiple nuclei with prominent nucleoli [[Figure 2] upper and lower inset]. They were identified as ganglion cells. The spindle cells were mature schwann cells. None of the smears showed presence of primitive round cells. With the characteristic bimodal cell population, a cytological diagnosis of ganglioneuroma was made.
Figure 2: Microphotograph of the cytology smears showing fi brillary stroma with schwann cells (H and E, ×400). Upper left inset-cluster of ganglion cells (H and E, ×400). Lower right inset-multinucleate ganglion cell (H and E, ×400)

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Computed tomography (CT) performed before excision revealed that the swelling was extending from the C2 cervical vertebra to the lateral neck, posterior to the sternocleidomastoid muscle. On gross examination, a single, well-circumscribed mass of 10 × 5.5 × 4 cm, with a yellowish-white cut surface, was obtained. Microscopic examination of the excised mass showed variably sized, mature, ganglion cells and neurofibrillary stroma. Ganglion cells having voluminous eosinophilic cytoplasm, eccentric one-to-three nuclei, and prominent nucleoli were seen in clusters. A neuroblastic component was absent in the multiple sections studied [Figure 1]. Thus, the cytological diagnosis was confirmed on histopathological examination.

Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma are rare tumors that represent three maturational manifestations of a common neoplasm derived from primordial neural crest cells. Other than common locations of the posterior mediastinum, retroperitoneum, and the adrenal gland, ganglioneuromas rarely occur in the cervical and parapharyngeal regions. [2] The average age at diagnosis of GN is seven years. The female to male ratio is 3:1. [3] In our case, a CT of the neck confirmed the precise location of the tumor and showed that the tumor had no relation to the posterior mediastinum. The tumor showed the characteristic cytological features of GN. There was absence of mitosis, atypia, and necrosis. The presence of a significant number of ganglion cells in the smears helped us to differentiate this tumor from benign peripheral nerve sheath tumors that are more common at this site. Absence of the primitive, round-cell component ruled out the possibility of ganglioneuroblastoma and other childhood round-cell tumors. Excision is the only treatment modality for GN. [4] In rare cases, excision of the cervical GN could lead to postoperative Horner's syndrome. [5] Our patient had no postoperative complications.

In conclusion, a cytologist may encounter GN at uncommon locations and in varied age groups, but most of the times cytological features are distinctive enough to suggest an accurate preoperative diagnosis on FNAC, which helps in the proper management of the patient.


   Acknowledgements Top


Dr. A C Shrivastava, Associate Professor, Dept. of Pathology IGGMC, Nagpur and Dr. A V Shrikhande, Professor and Head, Dept. of Pathology, IGGMC, Nagpur.

 
   References Top

1.Kolte SS. Ganglioneuroma presenting as a neck mass diagnosed by fine needle aspiration cytology. Cytopathology 2011;22:205-6.  Back to cited text no. 1
[PUBMED]    
2.Ewings sarcoma/PNET tumor family and related lesions. In: Weiss SW,Goldblum JR editors. Enzinger and Weiss′s soft tissue tumors, 5 th ed. USA: Mosby Elsevier; 2008. p. 945-87.  Back to cited text no. 2
    
3.Ponce-Camacho MA, Diaz de Leon-Medina R, Miranda-Maldonado I, Garza-Guajardo R, Hernandez-Salazar J, Barboza-Quintana O. A 5-year-old girl with a congenital ganglioneuroma diagnosed by fine needle aspiration biopsy: A case report. Cytojournal 2008;5:5.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: Radiologic-pathologic correlation. Radiographics 2002;22:911-34.  Back to cited text no. 4
    
5.Cannady SB, Chung BJ, Hirose K, Garabedian N, Van Den Abbeele T, Koltai PJ. Surgical management of cervical ganglioneuromas in children. Int J Pediatr Otorhinolaryngol 2006;70:287-94.  Back to cited text no. 5
    

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Correspondence Address:
Pradnya S Bhadarge
Department of Pathology, Indira Gandhi Government Medical College, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.130712

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