article · Georgian Medical Journal
Cervico-mediastinal ganglioneuromas are rare, benign tumours originating from sympathetic nervous tissue. Preoperative identification is difficult because their radiological appearances often resemble other neck and chest masses. The documented case involves a twelve-year-old girl with an asymptomatic, enlarging neck mass that extended into the superior mediastinum and displaced the airway and oesophagus. Although initial scans suggested a cystic lymphangioma, complete excision was achieved using an anterior combined cervico-transsternal surgical technique. Histopathological analysis confirmed the diagnosis of ganglioneuroma. The patient experienced temporary drooping of the eyelid following the operation, which resolved spontaneously without long-term consequences. At a three-year follow-up, there were no signs of tumour recurrence. The findings highlight that planned surgical access allows complete removal while preserving vital nerves and vessels.
Large tumours situated between the neck and chest pose significant risks to critical blood vessels and airways. Demonstrating that a carefully planned surgical strategy can safely extract such extensive growths provides valuable guidance for paediatric clinical teams managing complex benign masses, helping patients achieve disease-free survival without permanent nerve damage.
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Background: Cervico-mediastinal ganglioneuroma (GN) is a rare benign neurogenic neoplasm arising from neural crest-derived sympathetic tissue. The tumour may be asymptomatic or may produce symptoms attributable to compression of adjacent cervical and mediastinal structures, including Horner's syndrome. Preoperative diagnosis is challenging owing to overlapping radiological features with other cervicothoracic masses. Complete surgical resection remains the definitive treatment and is associated with an excellent long-term prognosis. Case presentation: We report the case of a 12-year-old girl presenting with a six-year history of a progressively enlarging, painless left laterocervical mass without compressive symptoms. Thoracic CT demonstrated a well-defined, oval, lobulated, predominantly cystic lesion measuring 85 × 55 × 122 mm, extending from the left laterocervical region through the thoracic inlet into the superior mediastinum, with rightward displacement of the tracheooesophageal axis. Preoperative imaging suggested cystic lymphangioma. Under general anaesthesia, complete surgical resection was achieved via an anterior cervico-transsternal approach. The postoperative course was marked by transient unilateral ptosis, which resolved spontaneously. Final histopathological examination confirmed the diagnosis of ganglioneuroma. At three-year follow-up, the patient remains in good general condition with no evidence of recurrence. Conclusion: This case illustrates the diagnostic challenges of cervico-mediastinal GN in the paediatric population and underscores the importance of an appropriately planned surgical approach — including a combined cervico-transsternal access — for achieving complete resection whilst preserving adjacent vascular and neural structures. Transient Horner's syndrome is an expected operative risk and commonly resolves postoperatively. Keywords: ganglioneuroma; cervico-mediastinal; neurogenic tumour; paediatric thoracic surgery; thoracic inlet; cervicotomy; Horner syndrome; case report
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DOI: 10.66636/gmj.v1.i3.a158
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