Felföldi Tamás, Varga Zsolt, Kolozsi Péter, Kovács Dávid Ágoston, Tóth Dezső
University of Debrecen Clinical Center Surgical Department, 4032 Debrecen, Móricz Zsigmond krt. 22, Hungary.
Int J Surg Case Rep. 2023 Nov;112:108914. doi: 10.1016/j.ijscr.2023.108914. Epub 2023 Oct 5.
Ganglioneuromas are extremely rare, slow-growing, benign tumors that arising from Schwann cells, ganglion cells, and neuronal or fibrous tissue. Their malignant degeneration occurs very rarely, complete surgical removal is recommended to eliminate possible symptoms or to prevent possible malignant transformation. Reviewing the literature, there is currently insufficient data available on laparoscopic resection of retroperitoneal ganglioneuromas.
20-year-old young woman with no previous medical history or regular medication use complaints of abdominal pain. Abdominal CT scan found a cystic mass measuring up to 50 mm in diameter with a thick fluid density and no contrast accumulation, was identified in the porta hepatis region extrahepatically. Ultrasound-guided biopsy was performed, histopathological finding revealed mature benign neurogenic tumor tissue consisting of mature ganglion cells, mature Schwann cells, and branching stroma.
A laparoscopic surgery was performed, the 5 cm large tumor was excised from the hepatoduodenal ligament. The tumor was removed from the region of the inferior caval vein, portal vein, and the common and proper hepatic arteries. Final histological diagnosis is ganglioneuroma of the hepatoduodenal ligament. After uneventful postoperative period, the patient was discharged home on the 6th day.
Retroperitoneal tumors were previously excised during laparotomy. However, in recent decades, with the development of laparoscopic surgical techniques and tools, laparoscopic removal of some retroperitoneal tumors seems to be the ideal approach. The use of laparoscopy improves visibility of the relationship of the tumor to the surrounding, often vital, structures. Based on a review of the international literature and our own experience, laparoscopic ganglioneuroma resection is the recommended procedure with careful patient selection, as well as appropriate preoperative imaging and diagnostics, and with adequate expertise.
神经节神经瘤极为罕见，生长缓慢，是起源于施万细胞、神经节细胞以及神经元或纤维组织的良性肿瘤。其恶性变极为罕见，建议完整手术切除以消除可能的症状或预防可能的恶性转化。查阅文献发现，目前关于腹腔镜切除腹膜后神经节神经瘤的可用数据不足。
一名20岁年轻女性，既往无病史且未规律用药，主诉腹痛。腹部CT扫描发现肝门区肝外有一个直径达50毫米的囊性肿块，密度较高且无造影剂积聚。进行了超声引导下活检，组织病理学检查发现成熟的良性神经源性肿瘤组织，由成熟的神经节细胞、成熟的施万细胞和分支间质组成。
实施了腹腔镜手术，从肝十二指肠韧带切除了一个5厘米大的肿瘤。该肿瘤从下腔静脉、门静脉以及肝总动脉和肝固有动脉区域切除。最终组织学诊断为肝十二指肠韧带神经节神经瘤。术后恢复顺利，患者于第6天出院。
腹膜后肿瘤以前是在剖腹手术中切除的。然而，近几十年来，随着腹腔镜手术技术和工具的发展，腹腔镜切除一些腹膜后肿瘤似乎是理想的方法。腹腔镜的使用提高了肿瘤与周围通常为重要结构关系的可视性。基于对国际文献的回顾和我们自己的经验，在仔细选择患者、进行适当的术前影像学检查和诊断以及具备足够专业知识的情况下，腹腔镜神经节神经瘤切除术是推荐的手术方式。
