[Hourglass retroperitoneal ganglioneuroma]

Ganglioneuromas are neuroblastic tumours with a higher degree of histological differentiation and clinical benignity. They are well defined, encapsulated tumours that are made up of mature ganglionar cells. They are located mainly in the sympathetic ganglia of the mediastinum and the retroperitoneum. In this latter place they can be very large and even penetrate through the intervertebral foramen in the spinal canal in the shape of an hourglass and produce medullar compression. They are tumours that are produced in childhood or infancy.

In the course of the diagnosis of an acute digestive haemorrhage in a 29 year old female patient, an abdominal computerised axial tomography (CAT) scan revealed, by chance, an abdominal retroperitoneal tumour that had introduced itself into the spinal canal in the shape of an hourglass. The patient had had lumbar pain that irradiated to the anterior side of the abdomen although up to that moment it was not considered very important. From the CAT scan and magnetic resonance imaging of the lumbar region a large, solid tumour was detected which protruded out in the shape of an hourglass from the vertebral canal at the point between L2 and L3. The patient was submitted to a surgical intervention in two stages and the tumour was removed. Because it was highly vascularised, hours before the intervention an arterial embolization of the tumour was performed in order to limit surgical bleeding.

Due to the unspecific and late symptomatology of ganglioneuromas, we maintained the therapeutical criterion of carrying out a biopsy puncture, as well as a follow up and control if the histological study did not show up any kind of malignity. Because of the possibility of this kind of tumour becoming malign and the fact that there is little chance of guaranteeing a correct diagnosis by means of biopsy puncture, extirpation should be carried out as completely and early as possible