Retropharyngeal ganglioneuroma presenting with neck stiffness: report of a case and review of the literature.

OBJECTIVE: Ganglioneuromas rarely occur in the retropharynx with only three cases reported in the current literature. The most common symptom associated with retropharyngeal ganglioneuromas is dysphagia. We report a retropharyngeal ganglioneuroma with an unusual clinical presentation of neck stiffness and pain. STUDY DESIGN: Case report and review of literature. METHODS: A 42 year old woman presented with incapacitating neck pain and neck stiffness as well as dysphagia. Neurological work up was normal. Imaging revealed a hyper-dense, ill-defined, diffuse right retropharyngeal mass suggestive of a possible nerve sheath tumor with no communication with the cervical spine. Surgical removal was uneventful and associated with a post-operative Horner's syndrome. In follow-up, dysphagia and neck symptoms improved. CONCLUSION: Retropharyngeal ganglioneuromas can occur in a wide age range of patients. Surgical excision via a cervical approach offers definitive therapy but maybe associated with an iatrogenic Horner's syndrome for which the patients should be counseled prior to operative intervention. Neck pain is an atypical symptom that needs to be worked up to rule out a communication with the spinal column prior to surgical removal. Patients must be counseled that atypical symptoms may not completely resolve with surgical treatment.