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. A 42-year-old woman presented with incapacitating
neck pain, neck stiffness, right upper extremity weakness, as well as
dysphagia. Neurological workup was normal. Imaging revealed a hyperdense, 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 postoperative
Horner's syndrome. In follow-up,
dysphagia and neck symptoms improved. Retropharyngeal
ganglioneuromas can occur in a wide age range of patients. Surgical excision via a cervical approach offers definitive
therapy but may be 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.