Conus medullaris ganglioneuroma with syringomyelia radiologically mimicking ependymoma: A case report

Abstract

Abstract. Ganglioneuromas are rare, benign, well-differentiated tumors of the conus medullaris. Approximately 20 cases of spinal cord ganglioneuroma, and only 1 case of mixed chemodectoma-ganglioneuroma of the conus medullaris have been previously reported. The present study presents the case of a 38-year-old man with a histopathological diagnosis of conus medullaris ganglioneuroma. The patient presented with hypoesthesia in the lower limbs, muscle atrophy of the right lower limb and dysuria. Magnetic resonance imaging analysis led to a diagnosis of ependymoma. Histopathological analysis of the excised mass revealed typical, well-differentiated ganglion cells, consistent with a ganglioneuroma. The mass was associated with a neighboring syringomyelia. At an 18 month follow-up the patient had recovered, although some remaining difficulty in walking and urinating remained. The aim of the present report was to raise awareness that when ganglioneuromas present in unusual locations, analogous radiological findings may mislead investigators to consider more common pathologies and thus result in misdiagnosis. The present case demonstrates the importance of considering the potential differential diagnoses for neural tissue neoplasms.

Intradural Extramedullary Epidermoid Cyst at the Conus Medullaris Level with Thoracic Syringomyelia: A Case Report

“…Ependymomas are the most common space-occupying lesions at the conus medullaris-cauda equina level. Lymphomas, astrocytomas, gangliogliomas, and ganglioneuromas can be considered during differential diagnosis (7,10,11). They can be frequently identified and distinguished by MRI studies.…”

“…Astrocytomas, gangliogliomas, and ganglioneuromas have heterogeneous contrast patterns. Ependymomas have homogenous contrast enhancement, and epidermoid cysts have peripheral contrast enhancement (7,9,11). Nevertheless, radiological differentiation is sometimes difficult for these spinal lesions, but they can be histopathologically diagnosed.…”