From Big Medical Encyclopedia

GANGLIONEUROMA (ganglioneuroma; lat. ganglion nerve knot + neuroma; synonym: ganglionic neuroma, simpatikotsitoma, ganglioma) — seldom found benign tumor peripheral and the central nervous system from elements sympathetic nervous gangliyev. It is for the first time described by W. Loretz in 1870 sometimes call a ganglioznokletochny tumor.

Fig. 1. Microdrug of a ganglioneuroma: between bunches of fibrous fabric cells of type ganglionic (1) and multinuclear are located (2); x 150, coloring hematoxylin-eosine.

Macroscopically To of a peripheral nervous system it is usually presented by a node of rounded or irregular shape of various sizes of a dense and elastic consistence with indistinctly expressed capsule. On a section fabric of a tumor of whitish-gray color, a fibrous or lobular look, sometimes with the centers of myxomatosis. Microscopically in the differentiated (mature) G. of a peripheral nervous system three structural components are well distinguishable: ganglionic cells, nerve and connective tissue fibrils. Cells of a neurolemma are sometimes visible. Nervous (ganglionic) cells of an ovate-orbicular form have a large kernel with well noticeable kernel and a small amount of the branching shoots. Cytoplasm of ganglionic cells homogeneous, basphilic, sometimes from glybka of a brown pigment. Many cells practically not of an otlichima from normal ganglionic cells, but meet also multihead elements (fig. 1). Ganglionic cells are surrounded with cells satellites and located in a tumor odinochno or small groups among collagenic and nervous (myelin I amyelenic) fibers. In many G. smaller cells like neuroblasts meet. Differ in slow growth and therefore sometimes, without finding clinical symptoms, can reach the big sizes and weight (to 6 kg and more).

It is more often localized at the level of various departments of a backbone — in a postmediastinum, in retroperitoneal space, in a basin, in adrenal glands, in a neck (localization is specified as the decreasing frequency). In exceptional cases G. arises in a wall went. - kish. a path, a bladder and even in bones.

It is observed (more than in half of cases) at persons 20 years are aged younger (more often at women).

G.'s emergence is connected with disturbance of laying of elements of a sympathetic nervous system. Quite often G. is combined with various malformations (a labium leporium, a wolf mouth, etc.).

Clinic disease has no peculiar features and is defined by localization, the sizes of a tumor and its relationship with adjacent bodies and fabrics.

by Fig. 2. The roentgenogram of a thorax of the patient with a mediastinal ganglioneuroma (the arrow specified a ganglioneuroma).

X-ray pattern Depends on its localization. Most often an object rentgenol, researches is G. growing from elements of a boundary sympathetic trunk and getting into juxtaspinal department of a postmediastinum. On the direct roentgenogram of G. of a postmediastinum gives the homogeneous blackout of a semicircular or semi-oval form of various sizes which is closely adjoining a shadow of a backbone. Outlines of a shadow of G. usually accurate and equal (fig. 2). In a side projection the direct proximity to a shadow of the vertebral ends of edges is characteristic of G. At difficulty of definition of localization of G. can be applied pnevmomediastinografiya (see) or artificial pheumothorax (see. Pheumothorax artificial ). At the big sizes can push aside a gullet and a trachea. In certain cases G. moves apart edges or causes emergence uzur from pressure of adjacent departments of vertebrae. G.'s calcification meets seldom. At G.'s malignancy its bystry increase and destruction of edges and vertebras, adjacent to it, is noted. At localization diagnosis is only possible G. in a front mediastinum when rentgenol, the research is supplemented with a puncture biopsy under the screen. The special kind of G. is made by the so-called tumors in the form of hourglasses consisting of 2 nodes — smaller, located in the vertebral channel, and bigger — in a postmediastinum. At the same time in pictures expansion of the corresponding intervertebral foramen usually is defined. At G. of an adrenal gland apply also a tomography (see) in the conditions of artificial pneumoretroperitoneum (see) and the selection angiography (see).

Ganglioneuroma of the central nervous system more often call a gangliocytoma (a synonym of a gangliogliom). Macro - and its microscopic structure is generally similar to G., but the gangliocytoma has no capsule, the sizes of a tumor do not exceed 2 — 4 cm, often contains cysts; microscopically elements of a glia prevail. Gangliocytomas expansive and slowly grow. Can press small outgrowths in brain fabric, in a soft meninx. Malignant options meet (see. Ganglioneyroblastoma , Neuroblastoma ). Also the glial element of a tumor can be exposed to blastomatous transformation (e.g., a ganglioglioblastoma). Primary multiple and rare diffusion gangliocytomas are known.

The gangliocytoma meets in all departments of c. N of page, on frequency prevail gangliocytomas of a bottom of the third ventricle and a hypothalamus, a temporal share, subcrustal kernels, a frontal lobe. Especially allocate the gangliocytoma of a cerebellum which is characterized by diffusion defeat of bark of a cerebellum (dysplastic G., a diffusion hypertrophy of bark of a cerebellum). Gangliocytomas make 0,1 — 0,4% of all intracranial tumors. Meet more often at children and young people up to 30 years. Genesis is identical with G. of a peripheral nervous system.

The clinical symptomatology of gangliocytomas consists of general and brain and focal symptoms according to localization of a tumor (see. Brain , tumors).

G.'s treatment only surgical. Removal of a gangliocytoma usually happens partial as quite often tumors are located in the vital areas of a brain.

Forecast not always favorable. A recurrence is possible.

Bibliography Golbert 3. Century and L and in-nikova G. A. Tumors and cysts of a mediastinum, page 28, M., 1965; Kuznetsov I. D. and Rozenshtraukh L. S. Radiodiagnosis of tumors of a mediastinum, page 187, M., 1970; The Multivolume guide to pathological anatomy, under the editorship of A. I. Strukov, t. 2, page 466, M., 1962; The Guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smol-yannikova, page 355, M., 1971; Arndt J. Indikationen und Grenzen der Strahlen-therapie bosartiger Neubildungen, Jena * 1973; Russell D. S. a. Rubinstein L. J. Pathology of tumors of the nervous system, Baltimore, 1971; Stout A. P. Ganglioneuroma of the sympathetic nervous system, Surg. Gynec. Obstet., v. 84, p. 101, 1947;

Zimmer-m a n H. M, N e t s k at M. of G. a. D a v i-d o f f L. M. Atlas of tumors of the nervous system, p. 32, 169, Philadelphia, 1956

BB. H. Solovyov, V. V. Arkhangelsky; L. S. Rozenshtraukh (rents.).