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Definition

Ganglioneuroma is a tumor of the peripheral nervous system.

Causes, incidence, and risk factors

Ganglioneuromas are rare tumors that most frequently start in the autonomic nerve cells, which may be in any part of the body. The tumor are usually noncancerous (benign).

Ganglioneuromas usually occur in people ages 10 to 40. They grow slowly, and may release certain chemicals or hormones.

There are no known risk factors. However, the tumors may be associated with some genetic problems, such as neurofibromatosis type 1.

Symptoms

A ganglioneuroma usually causes no symptoms, and is only discovered when being examined or treated for another condition.

Symptoms depend on the location of the tumor and the type of chemicals released.

If the tumor is in the chest area (mediastinum), symptoms may include:

  • Breathing difficulty
  • Chest pain
  • Compression of the windpipe (trachea)

If the tumor is lower down in the abdomen in the area called the retroperitoneal space, symptoms may include:

  • Abdominal pain
  • Bloating

If the tumor is near the spinal cord, it may cause:

  • Compression of the spinal cord, which leads to pain and loss of strength or feeling in the legs, the arms, or both
  • Spine deformity

These tumors may produce certain hormones, which can cause the following symptoms:

  • Diarrhea
  • Enlarged clitoris (women)
  • High blood pressure
  • Increased body hair
  • Sweating
Signs and tests

The best tools to identify a ganglioneuroma are:

Blood and urine tests may be done to determine if the tumor is producing hormones or other chemicals.

A biopsy or complete removal of the tumor may be needed to confirm the diagnosis.

Treatment

Treatment involves surgery to remove the tumor (if it is causing symptoms).

Expectations (prognosis)

Most ganglioneuromas are noncancerous. The expected outcome is usually good. A ganglioneuroma may, however, become cancerous and spread to other areas, or it may come back after removal.

Complications

If the tumor has been present for a long time and has pressed on the spinal cord or caused other symptoms, surgery to remove the tumor may not necessarily reverse the damage.

Compression of the spinal cord may result in loss of movement (paralysis), especially if the cause is not detected promptly.

Surgery to remove the tumor may also lead to complications in some cases.

Calling your health care provider

Call your health care provider if you or your child has symptoms that may be caused by this type of tumor.

ReferencesSovak MA, Aisner SC, Aisner J. Tumors of the pleura and mediastinum. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds.Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 77.
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Definition

Ganglioneuroma is a tumor of the peripheral nervous system.

Causes, incidence, and risk factors

Ganglioneuromas are rare tumors that most frequently start in the autonomic nerve cells, which may be in any part of the body. The tumor are usually noncancerous (benign).

Ganglioneuromas usually occur in people ages 10 to 40. They grow slowly, and may release certain chemicals or hormones.

There are no known risk factors. However, the tumors may be associated with some genetic problems, such as neurofibromatosis type 1.

Symptoms

A ganglioneuroma usually causes no symptoms, and is only discovered when being examined or treated for another condition.

Symptoms depend on the location of the tumor and the type of chemicals released.

If the tumor is in the chest area (mediastinum), symptoms may include:

  • Breathing difficulty
  • Chest pain
  • Compression of the windpipe (trachea)

If the tumor is lower down in the abdomen in the area called the retroperitoneal space, symptoms may include:

  • Abdominal pain
  • Bloating

If the tumor is near the spinal cord, it may cause:

  • Compression of the spinal cord, which leads to pain and loss of strength or feeling in the legs, the arms, or both
  • Spine deformity

These tumors may produce certain hormones, which can cause the following symptoms:

  • Diarrhea
  • Enlarged clitoris (women)
  • High blood pressure
  • Increased body hair
  • Sweating
Signs and tests

The best tools to identify a ganglioneuroma are:

Blood and urine tests may be done to determine if the tumor is producing hormones or other chemicals.

A biopsy or complete removal of the tumor may be needed to confirm the diagnosis.

Treatment

Treatment involves surgery to remove the tumor (if it is causing symptoms).

Expectations (prognosis)

Most ganglioneuromas are noncancerous. The expected outcome is usually good. A ganglioneuroma may, however, become cancerous and spread to other areas, or it may come back after removal.

Complications

If the tumor has been present for a long time and has pressed on the spinal cord or caused other symptoms, surgery to remove the tumor may not necessarily reverse the damage.

Compression of the spinal cord may result in loss of movement (paralysis), especially if the cause is not detected promptly.

Surgery to remove the tumor may also lead to complications in some cases.

Calling your health care provider

Call your health care provider if you or your child has symptoms that may be caused by this type of tumor.

ReferencesSovak MA, Aisner SC, Aisner J. Tumors of the pleura and mediastinum. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds.Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 77.
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Ganglioneuroma-- A ganglioneuroma is a tumor composed of mature nerve cells.

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Definition

Ganglioneuroblastoma is an intermediate tumor arising from nerve tissue. An intermediate tumor is one that is between benign (slow-growing and unlikely to spread) and malignant (fast-growing, aggressive, and likely to spread).

Causes, incidence, and risk factors

This rare tumor has a yearly occurrence of less than 5 per 1,000,000 children.

Tumors of the nervous system vary in their degree of differentiation. The degree of differentiation determines how the tumors appear under the microscope and whether or not they are likely to spread.

Benign tumors are less likely to spread. Malignant tumors are aggressive, grow quickly, and often spread. A ganglioneuroma is a benign tumor, while a neuroblastoma (occurring in children more than a year old) is generally malignant.

A ganglioneuroblastoma may be localized to one area or it may be widespread, but it is usually less aggressive than a neuroblastoma. The cause is unknown.

Symptoms

Most commonly, a mass can be felt in the abdomen, but this condition may also occur in other parts of the body.

Signs and tests
  • Bone marrow aspiration and biopsy may be necessary.
  • Bone scan may be necessary.
  • CT scan or MRI scan of the affected area
  • MIBG scan may be necessary.
  • Specialized blood and urine tests
  • Surgical biopsy to confirm diagnosis
Treatment

Because these tumors are rare, they should be treated in a specialized center by experts who have experience with them.

Depending on the specific nature of the tumor, treatment can consist of surgery, and possibly chemotherapy and radiation therapy.

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group.

Expectations (prognosis)

The prognosis depends on the extent of the tumor and whether or not some areas of the tumor contain the more aggressive cells of a neuroblastoma.

Complications
  • Invasion of the tumor into surrounding areas (spread of the tumor)
  • Complications of surgery, radiation, or chemotherapy
Calling your health care provider

Call your health care provider if you feel a mass or growth on your child's body. Make sure children receive routine examinations as part of their well child care.

References

Sovak MA, Aisner SC, Aisner J. Tumors of the pleura and mediastinum. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 77.

Kim S, Chung DH. Pediatric solid malignancies: neuroblastoma and Wilms' tumor. Surg Clin North Am. 2006;86(2):469-487.

Park JR, Eggert A, Caron H. Neuroblastoma: biology, prognosis, and treatment. Pediatr Clin North Am. 2008;55(1):97-120.

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Definition

Catecholamines are hormones produced by the adrenal glands, which are found on top of the kidneys. They are released into the blood during times of physical or emotional stress. The major catecholamines are dopamine, norepinephrine, and epinephrine (which used to be called adrenalin).

This article discusses the test to check the level of catecholamines in a sample of blood.

Catecholamines are more often measured with a urine test than with a blood test. See: Catecholamines - urine

Alternative Names

Norepinephrine - blood; Epinephrine - blood; Adrenalin - blood; Dopamine - blood

How the test is performed

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

How to prepare for the test

The accuracy of the test can be affected by certain foods and drugs, as well as physical activity and stress.

Foods that can increase catecholamine levels include:

  • Coffee
  • Tea
  • Bananas
  • Chocolate
  • Cocoa
  • Citrus fruits
  • Vanilla

You should avoid these foods for several days prior to the test, particularly if both blood and urine catecholamines are to be measured.

You should also avoid stressful situations and vigorous exercise, which can both interfere with test results.

Drugs that can increase catecholamine measurements include:

  • Aminophylline
  • Caffeine
  • Chloral hydrate
  • Clonidine
  • Disulfiram
  • Erythromycin
  • Insulin
  • Levodopa
  • Lithium
  • Methenamine
  • Methyldopa
  • Nicotinic acid(large doses)
  • Nitroglycerin
  • Quinidine
  • Tetracycline

Drugs that can decrease catecholamine measurements include:

  • Clonidine
  • Disulfiram
  • Guanethidine
  • Imipramine
  • MAO inhibitors
  • Phenothiazines
  • Reserpine
  • Salicylates

Never stop taking any medication without first talking to your doctor.

How the test will feel

Some people feel discomfort when the needle is inserted. Others may notice only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

This test is used to diagnose or rule out a pheochromocytoma or neuroblastoma. It may also be done in patients with those conditions to determine if treatment is working.

Normal Values

Epinephrine: 0-900 picograms/milliliter (pg/ml)

Norepinephrine: 0-600 pg/ml

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Higher-than-normal levels of blood catecholamines may suggest:

Additional conditions under which the test may be performed include Shy-Drager syndrome.

What the risks are

There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

  • Excessive bleeding
  • Fainting or feeling light-headed
  • Hematoma (blood accumulating under the skin)
  • Infection (a slight risk any time the skin is broken)
References

Young WF Jr. Adrenal medulla, catecholamines, and pheochromocytoma. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 246.

Ferri FF. Laboratory tests and interpretation of results. In: Ferri FF, ed. Ferri's Clinical Advisor 2008: Instant Diagnosis and Treatment. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:section IV.

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Oncogenomics WAVE3, an actin-polymerization gene, is truncated and inactivated as a result of a constitutional t(1;13)(q21;q12) chromosome translocation in a patient with ganglioneuroblastoma Khalid Sossey-Alaoui1, Guanfang Su1, Eda Malaj2, Bruce Roe2 and John K Cowell1 1Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, New York, USA2Department of Chemistry, University of Oklahoma, Norman, Oklahoma, USA Correspondence to: J K Cowell, Department of Cancer Genetics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA; E-mail: John.Cowell@RoswellPark.org Abstract Neuroblastoma (Nb) is a malignancy of the sympathetic nervous system which affects children in their first decade. It is the most common extra-cranial solid tumor in children with an incidence of approximately 1 in 8-10 000 live births annually and accounts for approximately 10% of all children's cancers. Ganglioneuroblastoma is a relatively benign form of Nb and consists of a mixture of fibrils, mature and maturing ganglion cells, as well as undifferentiated neuroblasts. During routine cytogenetic analysis of patients with different manifestations of neuroblastoma we have identified one patient with ganglioneuroblastoma that carries an apparently balanced t(1:13)(q21:q12) reciprocal translocation. Positional cloning of the translocation breakpoint on chromosome 13 resulted in the mapping of the breakpoint between coding exon 2 and exon 3 of WAVE3, a member of WASP gene family. Although the breakpoint region on chromosome 1 was localized to within 2 kb of genomic sequence, no gene was found to be interrupted on this chromosome. The WAVE3 transcript is mainly expressed in the nervous system and, like all the members of the WASP gene family, WAVE3 is a key element in actin polymerization and cytoskeleton organization. WAVE3, therefore, is important for cell differentiation and motility and its expression is lost in a number of low grade and stage 4S tumors. From analysis of its expression pattern and function, WAVE3 is a candidate tumor suppressor gene, at least in some forms of neuroblastoma. Oncogene(2002) 21, 5967-5974. doi:10.1038/sj.onc.1205734 Keywords WAVE3; neuroblastoma; actin polymerization Introduction Neuroblastoma (Nb) is the most common extracranial solid tumor in childhood, accounting for 8% of all pediatric malignancy. Family studies (Kushner et al., 1986) and epidemiological analyses (Knudson and Strong, 1972) suggests that the Nb tumor phenotype segregates as an autosomal dominant trait with reduced (63%) penetrance. This led to the proposal that tumorigenesis was a consequence of a loss of function of a critical gene(s) in embryonic tumor cells in a way similar to that proposed for retinoblastoma (Knudson, 1971). However, because Nb families are rare (Kushner et al., 1986), it has not yet been possible to assign any Nb predisposition gene to a particular chromosome region using conventional linkage studies. This analysis may be further complicated by the possibility that Nb may, in fact, represent several different clinical entities. Thus, ganglioneuroblastoma, which is considered a relatively benign tumor, consists of both immature neuroblasts as well as fully differentiated neuronal cells. Ganglioneuroma, on the other hand, consists entirely of differentiated cells. What is not known is whether these two variants represent distinct diseases or whether ganglioneuroma arises as a result of differentiation of cells from a ganglioneuroblastoma. The most aggressive forms of Nb within the disease spectrum consist of undifferentiated neuroblasts. It has been consistently demonstrated that undifferentiated Nb cells can differentiate in vitro when exposed to a variety of inducing agents (Ponzoni et al., 1991; Lanciotti et al., 1992), indicating that differentiation signals in these cells can overcome the malignant phenotype. Thus, whether neuroblastoma represents the end point or a continuous progression from the more benign forms, or whether they are different diseases, is not clear. The indication that Nb in fact probably represents several different diseases has been suggested from survival studies (Castleberry et al., 1999). The final conundrum comes from the special form of the disease called 'stage 4S'. This tumor presents as a low-grade primary tumor in children under the age of 12 months, but is associated with distant metastases primarily to the liver and bone marrow. The feature that makes this form of Nb stand out is the fact that these tumors can spontaneously resolve themselves (D'Angio et al., 1971). Clearly, in this sub-type, there has been a massive expansion of primitive neuroblasts, although these cells can still respond to differentiation or apoptotic signals. Again whether this represents a distinct form of the disease or arises through a completely different pathway has not been determined. Analysis of constitutional chromosome abnormalities in individuals who develop particular tumor types has frequently indicated the site of predisposition gene. This has been the case for retinoblastoma (Yunis and Ramsay, 1978), Wilms' tumor (Riccardi et al., 1978), neurofibromatosis (Fountain et al., 1989; O'Connell et al., 1989), and familial adenomatous polyposis (Varesco et al., 1989). These structural abnormalities are predominantly deletions, but where translocations are identified, the breakpoints usually interrupt the predisposition gene (reviewed in Mitchell, 1991). A few cases of Nb with constitutional chromosome abnormalities have been described (Anderson et al., 2001; Fryns, 1996; Laureys et al., 1990, Nagano et al., 1980; Sanger et al., 1984). In particular, two patients with stage 3 and 4 tumors were shown to carry constitutional chromosome changes involving 1p35-36. Laureys et al. (1990) reported a patient with a constitutional reciprocal translocation which was later defined (van Roy et al., 1997) although no genes have been reported to be involved in this rearrangement to date. We (Mead and Cowell, 1995) described a patient with stage 4S disease, and a constitutional t(1;10)(p22;q21) translocation. The chromosome 1 translocation breakpoint does not lie within the consensus LOH region seen in advanced stage tumors but does lie in the LOH region reported for stage 4S tumors (Mora et al., 2000). Cloning the breakpoint from this translocation identified an in-frame fusion of two genes resulting in the truncation and inactivation of the NB4S/EVI5 gene (Roberts et al., 1998a,b). The association of different chromosome rearrangements with different subtypes of the disease was further demonstrated in the report by Michalski et al. (1992) who described a patient with ganglioneuroblastoma and a constitutional t(1;13)(q23;q12) reciprocal chromosome translocation. The breakpoint on chromosome 1 was in a different position compared with the patients with stage 3, 4 and 4S. Recent reports suggest that amplification of this region is frequently seen in low-grade tumors and so may represent a subtype-specific gene locus for Nb (Hirai et al., 1999). We have now cloned the breakpoints associated with this 1;13 translocation and shown that WAVE3 on 13q12, which is though to be involved in actin-polymerization (Suetsugu et al., 1999) is physically interrupted and inactivated as a result of this translocation event. We have shown that the WAVE3 transcript is down regulated in three sporadic neuroblastoma tumors. No known or predicted gene is associated with the 1q23 breakpoint. Results Mapping the breakpoint on chromosome 1 To study the de novo constitutional t(1;13)(q22;q12) translocation in patient DG a somatic cell hybrid, DGF27 (Michalski and Cowell, 1993), was isolated which retained the derivative chromosome 1, (1pter-q21;13q12-qter).

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