JRSM > Volume 98, Number 2 > Pp. 63-64

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Ganglioneuromas in the adult scrotum

S J Hanna MRCS  ¹ A Muneer FRCS  ¹ S B Coghill FRCPath  ²   M A W Miller MD FRCS  ¹

¹ Department of Urology Northampton General Hospital, Northampton NN1 5BD, UK
² Department of Histopathology, Northampton General Hospital, Northampton NN1 5BD, UK

Correspondence to: Stephen Hanna, c/o Mr Miller’s secretary, Integrated Surgery, Northampton General HospitalE-mail: sjhanna{at}doctors.org.uk

Ganglioneuromas are benign tumours of the sympathetic nervous system. The occasional report of a paratesticular ganglioneuroma reflects embryological development.

CASE HISTORY

A man of 22 with insulin-dependent diabetes was referred for treatment of a phimosis secondary to balanitis xerotica obliterans. On routine examination he was found to have a smooth mobile mass in the right hemiscrotum. Scrotal ultrasound revealed several solid paratesticular lesions and a scrotal exploration was undertaken. Five small masses were identified and removed. All were paratesticular; the testicle, epididymis and vas deferens were entirely normal.

On histological examination the lesions proved to be composed of spindle cells resembling those of a nerve sheath tumour, as well as large round cells with abundant amphophilic cytoplasm and a large slightly eccentrically placed nucleus with a prominent nucleolus (Figure 1). There were no immature elements. They were judged to represent benign ganglioneuromata. MRI scanning excluded the presence of any synchronous retroperitoneal tumour.

View larger version (125K): [in this window] [in a new window]   Figure 1. Photomicrograph of ganglion cell-rich area. Arrows point to ganglion cells () and spindle cells ()

 

COMMENT

Ganglioneuromas are the most benign of the neuroblastic group of tumours, which include neuroblastoma and ganglioneuroblastoma.¹ They consist of ganglion cells, Schwann cells and connective tissue.^1,2 The most common locations are the posterior mediastinum, retroperitoneum, adrenal gland and neck.¹ To our knowledge there have only been three previously reported cases of paratesticular ganglioneuromas,^3–5 of which one was actually a composite tumour consisting of a ganglioneuroma and a malignant peripheral nerve sheath tumour.³ Two of these cases were in children, one⁵ in an adult.

The paratesticular region consists of many cell types and neoplasms arising therefrom are histologically heterogeneous.⁶ Tumours in this region present as discrete scrotal masses and may cause diagnostic confusion with testicular tumours. The commonest benign tumours are lipomata, adenomatoid tumours and leiomyomata; the more common malignant neoplasms are sarcomas, mesotheliomas, lymphomas and epididymal adenocarcinomas.⁶ This region may on rare occasions be the site of metastatic spread of other primary tumours, including lung, pleura, stomach, colon, prostate and kidney.⁶ Scrotal involvement by a tumour that commonly affects the retroperitoneum is not surprising in view of their common embryological origin. For this reason a patient with paratesticular ganglioneuromas should undergo imaging of the retroperitoneum and posterior mediastinum.

REFERENCES

1. Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic–pathologic correlation. Radiographics2002; 22:911 –34[Abstract/Free Full Text]

2. Jain M, Subha BS, Sethi S, Banga V, Bagga D. Retroperitoneal ganglioneuroma: report of a case diagnosed by fine-needle aspiration cytology, with review of the literature. Diagnostic Cytopathol1999; 21:194 –6

3. Banks E, Moonahm Y, Brodhecker C, Goheen M. A malignant peripheral nerve sheath tumor in association with a paratesticular ganglioneuroma. Cancer1989; 64:1738 –42[CrossRef][Medline]

4. Ceroni V, Di Lüttichau F. Su una rar osservazione di ganglioneuroma paratesticolare nell’infanzia. Pathologica1975; 67:245 –9[Medline]

5. Pardalidis NP, Grigoriadis K, Papatsoris A, Kosmaoglou EV, Horti M. Primary paratesticular adult ganglioneuroma. Urology2004; 63:584

6. Khoubehi B, Mishra V, Ali M, Motiwala H, Karim O. Adult paratesticular tumours. BJU Int2002; 90:707 –15[CrossRef][Medline]

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This Article Figures Only Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hanna, S J Articles by Miller, M A W Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?