Ganglioneuroma presenting as a paraesophageal mass lesion diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology: a case report.
BACKGROUND
Endoscopic ultrasound-guided fine needle aspiration is a well-established modality in detection and diagnosis of mediastinal lesions. Ganglioneuroma is a benign, rare, soft tissue neoplasm arising from sympathetic ganglion cells, and complete surgical resection is considered to be curative. Ganglioneuroma in a surgical specimen is a straightforward diagnosis; however, due to the infrequent occurrence of this entity, diagnosis by fine needle aspiration is more challenging.


METHODS
A case of paraesophageal ganglioneuroma was diagnosed by endoscopic ultrasound-guided fine needle aspiration. A 75-year-old man with a history of adenocarcinoma of the lung was noted to have a mediastinal mass on chest computed tomography. Upper endosonography identified a 40x17-mm mass extrinsic to the thoracic esophagus. An endoscopic ultrasound-guided fine needle aspiration of the mass revealed intermingled fragments of spindle cells and ganglion cells admixed within a fibromyxoid stroma. Immunohistochemistry showed that both the spindle and ganglion cell components were positive for S-100 protein and negative for pancytokeratin. This immunohistochemical profile established both the neurogenic origin of the spindle and ganglion cells.


CONCLUSIONS
Our case represents 1 of the few reported cases of ganglioneuroma diagnosed by fine needle aspiration cytology and the second case diagnosed under endoscopic ultrasound guidance.
Department of Anatomic Pathology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
Daniel C
DC
Dim
Summer L
SL
Nugent
Hong Q
HQ
Peng
D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D019160:Endosonography; D004947:Esophagus / Q000473:pathology; D005729:Ganglioneuroma / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000378:metabolism / Q000473:pathology*; D009418:S100 Proteins / Q000378:metabolism; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000378:metabolism
D014408:Biomarkers, Tumor; D009418:S100 Proteins