A RARE CASE OF PAEDIATRIC THORACIC INLET GANGLIONEUROMA PRESENTING AS A CERVICOTHORACIC MASS

Abstract

Posterior mediastinal tumours in children represent a unique subgroup of thoracic neoplasms, with the majority being of neurogenic origin. These lesions arise from sympathetic chain elements, peripheral nerve sheaths, or paravertebral ganglia. Although neuroblastomas account for most posterior mediastinal tumours in early childhood, the ganglioneuromas are considerably less common and typically present in adolescents. ^[1]

Ganglioneuromas grow slowly and may extend through anatomical conduits such as the thoracic inlet or intervertebral foramina because of their indolent behaviour. As a result, they often reach considerable size before detection. Their location adjacent to the airway, great vessels, vertebral column, and cervical neurovascular bundle makes surgical management challenging despite their benign nature. ^[2]

Cross-sectional imaging is essential to delineate the tumour’s relationship to critical mediastinal structures and to evaluate potential intraspinal extension. Although complete excision is the preferred treatment, the approach must be individualised based on the cranio-caudal extent, proximity to the arch vessels, and degree of displacement of the airway and oesophagus. Large tumours involving the cervicothoracic junction may require combined cervical and intrathoracic exposures to achieve complete resection while avoiding damage to neurovascular structures.

This report describes a rare paediatric ganglioneuroma extending from the posterior mediastinum through the thoracic inlet into the neck and highlights the value of an extended median sternotomy approach for safe and complete resection.