Skip to main content
Log in

Superior cervical ganglion mimicking retropharyngeal adenopathy in head and neck cancer patients: MRI features with anatomic, histologic, and surgical correlation

  • Head and Neck Radiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

To describe the unique MRI findings of superior cervical ganglia (SCG) that may help differentiate them from retropharyngeal lymph nodes (RPLNs).

Methods

A retrospective review of post-treatment NPC patients from 1999 to 2012 identified three patients previously irradiated for NPC that were suspected of having recurrent nodal disease in retropharyngeal lymph nodes during surveillance MRI. Subsequent surgical exploration revealed enlarged SCG only; no retropharyngeal nodal disease was found.

A cadaveric head specimen was also imaged with a 3T MRI before and after dissection. In addition, SCG were also harvested from three cadaveric specimens and subjected to histologic analysis.

Results

The SCG were found at the level of the C2 vertebral body, medial to the ICA. They were ovoid on axial images and fusiform and elongated with tapered margins in the coronal plane. T2-weighted (T2W) signal was hyperintense. No central elevated T1-weighted (T1W) signal was seen within the ganglia in non-fat-saturated sequences to suggest the presence of a fatty hilum. Enhancement after gadolinium was present. A central “black dot” was seen on axial T2W and post-contrast images in two of the three SCG demonstrated. Histology showed the central black line was comprised of venules and interlacing neurites within the central portion of the ganglion.

Conclusions

The SCG can be mistaken for enlarged RPLNs in post-treatment NPC patients. However, there are features which can help differentiate them from RPLNs, preventing unnecessary therapy. These imaging findings have not been previously described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

RPLN:

Retropharyngeal lymph node

SCG:

Superior cervical ganglion/ganglia

NPC:

Nasopharyngeal cancer

ICA:

Internal carotid artery

References

  1. Forastiere A, Koch W, Trotti A, Sidransky D (2001) Head and neck cancer. N Engl J Med 345:1890–1900

    Article  CAS  PubMed  Google Scholar 

  2. Kuriakose MA, Trivedi NP (2009) Sentinel node biopsy in head and neck squamous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg 17:100–110

    Article  PubMed  Google Scholar 

  3. Leemans CR, Tiwari R, Nauta JJ, van der Waal I, Snow GB (1994) Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor. Cancer 73:187–190

    Article  CAS  PubMed  Google Scholar 

  4. Anil G, Tan TY (2010) Imaging characteristics of schwannoma of the cervical sympathetic chain. A review of 12 cases. AJNR Am J Neuroradiol 31:1408–1412

    Article  CAS  PubMed  Google Scholar 

  5. Harnsberger HR, Osborn A et al. Diagnostic and surgical imaging anatomy—brain, head & neck, spine. International 1st Edition. Suprahyoid and infrahyoid neck. 180–181

  6. King AD, Ahuja AT et al (2000) Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease. Head Neck 22(3):275–281

    Article  CAS  PubMed  Google Scholar 

  7. Yuen HW, Goh CH, Tan TY (2006) Enlarged cervical sympathetic ganglion: an unusual parapharyngeal space tumor. Singap Med J 47(4):321–323

    CAS  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge Dr. Mark Khoo (Mount Elizabeth Hospital Novena, Singapore) for his kind assistance in the cadaveric dissection.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. P. N. Goh.

Ethics declarations

We declare that all human and animal studies have been approved by the National Healthcare Group Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that the Institutional Review Board waived consent for this study.

Conflict of interest

We declare that we have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Loke, S.C., Karandikar, A., Ravanelli, M. et al. Superior cervical ganglion mimicking retropharyngeal adenopathy in head and neck cancer patients: MRI features with anatomic, histologic, and surgical correlation. Neuroradiology 58, 45–50 (2016). https://doi.org/10.1007/s00234-015-1598-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-015-1598-1

Keywords

Navigation