Ganglioneuroma

Ganglioneuroma
Ganglioneuroma is a benign neoplasm developing from nerve ganglia that affects the central and peripheral nervous system. This tumor is rare. A macroscopic examination of the ganglioneuroma visualizes a nodule, it can have a different shape and size, a dense, elastic consistency, as well as an indistinctly expressed capsule. Ganglioneuromic nodules can be single or multiple.

The content of the article:
Causes of ganglioneuroma
Classification of ganglioneuroma
Symptoms of ganglioneuroma
Diagnosis of ganglioneuroma
Treatment of ganglioneuroma
Prognosis of ganglioneuroma
Ganglioneuroma
This type of benign tumors is most often diagnosed in different parts of the spine and brain, less often they are detected in the gastrointestinal tract, adrenal glands, bladder walls, skin. The symptoms of pathology depend on the localization of the neoplasm and have no specific features.

The diagnosis is based on the results of a comprehensive examination of the patient, the key methods in which will be CT and histological examination of the tumor fragment. The tactics of ganglioneuroma treatment implies its removal by surgical intervention. This disease is most often detected in women under 20 years of age, but it is also diagnosed in men.

Causes of ganglioneuroma
As with the bulk of neoplasms, the exact etiology of benign nodular tumors of the nerve ganglia is not known. Most pathology researchers tend to believe that the appearance of ganglioneuroma is promoted by dysfunction during the development of the sympathetic nervous system. According to statistics, the risk of developing these neoplasms increases significantly in the presence of concomitant pathologies, in particular genetic (cleft lip, cleft palate, congenital basilar impression, etc.). Based on the above, the following list of harmful effects on the fetus in the period of intrauterine development is distinguished, which can trigger the mechanism of ganglioneuroma development:

bacterial infections of the genitourinary system (syphilis, gonorrhea, chlamydia, etc.);
viral infections (rubella, measles);
chronic diseases of the mother (chronic heart failure, anemia);
alcohol intoxication;
exposure to chemicals and radiation.
Classification of ganglioneuroma
This pathology is classified based on the location of the pathological process. Based on this, there are such types of ganglioneuromas:

ganglioneuroma of the brain;
spinal cord ganglioneuroma;
retroperitoneal ganglioneuroma;
gastric ganglioneuroma, etc.
Symptoms of ganglioneuroma
The clinical manifestations of this tumor depend on the localization of the pathological process, the size of the neoplasm, as well as compression of nearby organs and tissues. The main symptoms indicating the presence of the disease include:

vertigo;
deterioration of memory and concentration;
the phenomenon of headaches in combination with nausea and vomiting;
personality disorders;
unmotivated irritability.
Most often ganglioneuromas affect the spine area, while the tumor is represented by two nodes, one of them is usually embedded in the spinal canal, and the second has a paravertebral localization. With this placement of ganglioneuroma, neurological symptoms are noted in patients, in the case of tumor germination directly into the spinal cord, the clinical picture may be nonspecific.

Slow tumor growth and the absence of symptoms often cause the development of large tumors and late diagnosis of the disease, in particular, ganglioneuromas in the retroperitoneal space.

When the neoplasm is localized in the brain, the pathological process is represented by a gangliocytoma of the brain. Gangliocytomas occupy about 0.4% of all neoplasms localized inside the skull. Ganglioneuromas can affect any part of the brain, but in clinical practice they are most often found in the hypothalamus, the bottom of the III ventricle, the frontal and temporal lobes, the cerebellar cortex and subcortical structures.

As a rule, a gangliocytoma does not have a capsule and its diameter does not exceed 3-4 centimeters. This tumor is characterized by invasive growth in the membranes and tissues of the brain. Gangliocytoma has nonspecific clinical manifestations. The presence of such a tumor may be indicated by focal and cerebral symptoms. The tumor is prone to the phenomena of malignancy, as a result of its blastomatous changes, ganglioneuroblastoma may develop.

In some rare cases, ganglioneuromas can develop in parenchymal or hollow organs, while there are clinical manifestations characteristic of neoplasms of this localization.

Diagnosis of ganglioneuroma
The absence of clinical manifestations of ganglioneuroma prevents timely diagnosis of pathology. Sometimes a tumor is detected randomly during the diagnosis of other diseases or routine examination. Often, during an X-ray examination of the chest or spine organs, a rounded homogeneous darkening is found in the images, connecting with the spine. With large neoplasms, there may be indentation of the ribs or the so-called “spreading of the ribs” syndrome, the cause of which is the constant compression effect of the tumor. In the case of malignancy of this neoplasm, the destruction of the ribs and vertebrae that are located next to the tumor can be visualized on X-ray images.

Localization features force the use of a large number of specialists for diagnostics, therefore, in addition to a vertebrologist and a neurologist, the help of an endocrinologist, a urologist, a gastroenterologist, etc. is often required. Suspicion of ganglioneuroma may occur in a neurologist during a standard neurological examination, after which the patient is prescribed an additional examination to clarify the diagnosis. For this purpose, CT and MRI are used in those areas where, according to the neurologist, the tumor may be located. The final diagnosis is established on the basis of a histological examination of a sample of tumor tissue, which is taken by biopsy.

Treatment of ganglioneuroma
The most productive method of treating ganglioneuroma will be surgery to remove the neoplasm in combination with radiation therapy. The specifics and concretization of therapeutic measures depend on many factors, in particular on the localization, the size of the tumor, as well as on the age and general health of the patient.

As a result of untimely diagnosis of pathology, the tumor reaches large sizes, it is often located near vital organs and has a negative impact on them. The large size of ganglioneuroma can provoke complications. To minimize them and increase the effectiveness of treatment, minimally invasive techniques are used during surgery.

In clinical practice, there are cases when the operation must be performed in several stages, most often one of the stages will be laminectomy or laparotomy (depending on the localization of the pathological process). Sometimes it is not possible to completely remove the tumor, since such an operation may have too high risks for the health and life of the patient. In such cases, it is advisable to partially remove the neoplasm performed during palliative surgery, the purpose of which will be to restore vital body processes that were lost as a result of tumor growth (cerebrospinal fluid dynamics, etc.). Most often, palliative surgery is used for ganglioneuroma affecting the brain. The tumor tissues obtained during surgery are necessarily subject to histological examination to exclude the risk of ganglioneuroma malignancy and its transformation into ganglioneuroblastoma.

Along with surgical methods of treatment, radiation therapy is prescribed. Dosed radiation of the tumor allows you to slow down the gradation of the tumor process, and in some cases there is a positive trend in the form of regression of the disease, which manifests itself in a decrease in the size of the tumor.

Prognosis of ganglioneuroma
With timely diagnosis and removal of ganglioneuromas of small size, in most cases the prognosis is favorable. But even after a successful operation, relapses may occur. A less favorable prognosis for large ganglioneuroma sizes, but still, with proper treatment, good results can be achieved. The most unfavorable form of this pathology is ganglioneuroma, prone to malignant changes, so it is extremely important to diagnose it in time.

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