Open Access

Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature

  • Authors:
    • Shilong Zhang
    • Benli Xiao
    • Yewei Zhang
    • Zihan Zhou
    • Xiangyu Fu
    • Shi Zuo
  • View Affiliations

  • Published online on: May 16, 2022
  • Article Number: 208
  • Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Ganglioneuroblastoma (GNB) is a condition belonging to the neuroblastoma family. It is a transitional tumor consisting of a mixture of mature ganglioneuromas and malignant neuroblastomas. Its biological behavior is intermediate between benign and malignant, with a risk of recurrence and metastasis. It usually occurs in pediatric patients aged <10 years, particularly between the ages of 1 and 2 years, but may also occur in adolescents or adults. The present study reported on the clinical management of a case of postoperative stress ulcer with perforation in a 17‑year‑old female patient with retroperitoneal GNB and provided a review of the literature on retroperitoneal GNB in adolescents and adults.


Ganglioneuroblastoma (GNB) is an embryonal tumor originating from primitive neural crest cells in the neuroectoderm (1). It is a transitional tumor consisting of a mixture of mature ganglioneuromas (GNs) and malignant neuroblastomas (NBs), hence its biological behavior is intermediate between that of GN and NB. Furthermore, GNB is a malignant or potentially malignant tumor (1,2). It usually occurs in pediatric patients aged <10 years, particularly between the ages of 1 and 2 years (3). By contrast, GNB is rare in adolescents and adults, with previous studies reporting <50 cases in adults (4). The most common site of origin for GNB is the adrenal medulla (~35%), followed by the retroperitoneum, brain and mediastinum, with tissues such as the orbit and parotid gland also reportedly involved (513). Although cases of GNB in adolescents or adults have been previously reported, GNB occurring in the retroperitoneum is rare. The present study reported on a case of retroperitoneal GNB in a 17-year-old female who had an abdominal computed tomography (CT) finding of an occupying lesion in the head of the pancreas and underwent retroperitoneal tumor resection, which was confirmed by pathology to be GNB. On the third day after surgery, the patient developed a stress duodenal ulcer perforation and underwent an emergency major distal gastrectomy and duodenal ulcer resection. The present study reviewed the clinical course of this case together with an analysis and discussion of relevant literature.

Case report

A 17-year-old woman was admitted to the Affiliated Hospital of Guizhou Medical University (Guiyang, China) on September 7, 2021, for a whole abdomen CT scan at 9 days post-trauma that revealed a pancreatic head mass. However, the patient had no symptoms of nausea, vomiting, acid reflux or abdominal pain. Furthermore, no mass was palpated on examination and no positive signs such as abdominal tenderness, rebound pain or abdominal muscle tension were present. The patient had a previous gastroscopy diagnosis of a peptic ulcer (no gastroscopy report was available) and a history of prolonged and intermittent non-steroidal drug (NSAID) use for menstrual pain. The patient had a previous artificial abortion but no medical history of hypertension, diabetes mellitus, hepatitis or tuberculosis. However, the patient had a cystic solid occupancy in the posterior pancreatic head with clear borders ~120×64 mm in size as per the color Doppler ultrasound and enhanced CT of the abdomen; furthermore, the nature and origin of the tumor required further examination (Fig. 1). Magnetic resonance cholangiopancreatography (MRCP) revealed a morphologically irregular abnormal mass shadow behind the right posterior pancreatic head in the peritoneal area (~62×52×125 mm) with a non-uniform signal and well-defined borders; the enhancement scan indicated that the mass was not significantly strengthened (Fig. 2). After admission, laboratory tests for routine blood, liver and renal function, as well as coagulation and tumor markers were all unremarkable. The preliminary diagnosis was a retroperitoneal occupancy neurogenic tumor. The patient then underwent exploratory laparotomy and retroperitoneal mass resection under general anesthesia on the 8th day post-admission. The operation went well and the patient returned safely to the ward after surgery and was given basic treatment, such as pantoprazole sodium for acid suppression and gastric protection and fluid supplementation. Based on the intraoperative findings (Fig. 3A-C), the mass was located in the right retroperitoneum of the hepatoduodenal ligament, was ~12 cm in diameter, soft with a complete capsule, movable and well defined. The mass was closely associated with the surrounding nodal tissue, posterior aspect of the head of the pancreas, portal veins, superior mesenteric veins and pancreatic hooks, but no distant metastases or enlarged lymph nodes were observed, as no images other than those of the tumor were acquired. During the surgery, the tumor was completely removed and the abdominal cavity was closed after careful examination and confirmation that no lesions remained and no adjacent organs or blood vessels were damaged. The tumor was irregular in shape, measuring ~13×7×5 cm, was solid, grey-white, soft, and had yellowish-white streaks on the cut surface. Microscopic observation revealed scattered, thread-like and nested tumor cells with sheets of necrosis. Certain cells had abundant cytoplasm and were eosinophilic, various cells had displaced nuclei with clear, vesicular nucleoli; certain cells had a nodular distribution with nests of immature small cells within the nodules and deeply stained heterogeneous nucleoli, and multinucleated cells and nuclear divisions were also observed (Fig. 3D and E). The immunohistochemistry results were as follows: Vimentin(+), S100(+), Sox10(+), CD56(+), CD57(+), specific esterase (SE)(+), neurofilament (NF)(+), synaptophysin (Syn)(+), friend leukemia integration-1(+), glial fibrillary acidic protein (less +), CgA (less +), myogenin (partial +), myogenic differentiation 1 (partial +), CD99 (partial +), smooth muscle actin(−), desmin (−), caldesmon (−) and Ki-67 (average of ~2%; hotspots of ~10% +) (Figs. 3F and G and S1). The pathological results were consistent with the diagnosis of retroperitoneal GNB.

On the third day after surgery, the patient presented with abdominal distension, abdominal pain and palpitations. Physical examination revealed significant whole abdominal pressure, rebound pain and abdominal muscle tension. Emergency blood cell analysis revealed a white blood cell count of 22.41×109/l and neutrophil percentage of 90.50%. Abdominal CT indicated pneumoperitoneum, exudate and effusion in the abdominal cavity and pelvis, as well as edema in the gastric sinus and duodenal wall (Fig. 4). Stress ulcers with peptic perforation were considered in the context of the patient's physical signs, laboratory tests and abdominal CT results. An emergency laparotomy was performed on the 4th day after the first surgery, which revealed a thick accumulation of pus in the original surgical area and a perforation in the posterior wall of the duodenal bulb ~3.0×2.0 cm, with intestinal fluid spillage. After obtaining informed consent from the patient's family, the patient underwent major distal gastrectomy and duodenal ulcer resection. The pathological results indicated old duodenal ulcers with inflammatory exudation, granulation and fibrous tissue hyperplasia, scar formation and ulcerative changes in the plasma membrane of the intestinal canal (Fig. 5).

The patient recovered well from the second surgery and was discharged in good condition, with no recurrence or metastatic tendencies noted at the follow-up examination.


In 1947, Stout reported the first case of a tumor consisting of a malignant NB nodule and a mature GN, which was termed a mixed peripheral NB (14). In 1984, Shimada et al (15) summarized 295 cases of NB tumors and first introduced the concept of GNB; GNBs were then classified as nodular or mixed. In 1999, the International Classification of Neuroblastoma Pathology adopted Shimada's classification and revised it in 2003, redefining neuroblastoma and classifying it into NB, mixed GNB, GN and nodular GNB according to histological features (16,17).

As part of the present study, the PubMed database was searched using the subject key terms ‘ganglioneuroblastoma’, ‘GNB’, ‘retroperitoneum’ and ‘retroperitoneal’ (January 27, 2022). A total of 330 papers with titles containing GNB were found, of which only 14 (4.24%) were related to the retroperitoneum (12,13,1829). Among these papers, there were 59 cases involving retroperitoneal GNB, and of these, 53 (89.8%) cases were in children (<12 years), one (1.7%) was in an adolescent (12–20 years) and five (8.5%) were in adults (>20 years). Thus, retroperitoneal GNB in adults or adolescents is rare. The present study reported the clinical course of another case of retroperitoneal GNB in a 17-year-old female and summarized the data on non-pediatric cases (age, >12 years) of GNB as follows (Table I).

Table I.

Information on previously reported non-pediatric cases of ganglioneuroblastoma and the present case.

Table I.

Information on previously reported non-pediatric cases of ganglioneuroblastoma and the present case.

First author/s, yearCountryPatient age, yearsSexSymptomsTherapyDiagnostic basisComorbidityOutcome(Refs.)
Marya and Gupta, 1979India14MaleAbdominal distension and painSurgeryH&E-Improvement(25)
Yamanaka et al, 2001Japan60MaleBack painSurgeryH&E+IHC (NSE, S100)-Died(13)
Hayama et al, 2012Japan55FemaleAbdominal painSurgeryH&E+IHC (S100, NF, Syn)Mature cystic teratomaImprovement(21)
Jrebi et al, 2014USA33MaleBack painSurgery + chemotherapyH&E-Died(19)
Chen et al, 2014UK21FemaleBack painSurgeryH&EPregnancyImprovement(20)
Present studyChina17Female-SurgeryH&E+IHC (Vim, S100, CD56, CD57, SE, NF, Syn)Stress ulcersImprovement

[i] H&E, hematoxylin & eosin; IHC, immunohistochemistry; NSE, neuron-specific enolase; NF, neurofilament; Syn, synaptophysin; Vim, vimentin; SE, specific esterase.

The clinical symptoms and signs of GNB and NB are similar; however, the degree of malignancy and prognosis exhibit a great variation. CT and MRI are the most commonly used imaging methods to differentiate GNB from NB. A previous study has also indicated that on CT, NB is mostly located in the adrenal region, with vascular inclusions, local infiltration, organ and lymph node metastases, and clustered or linear dilated vascular shadows around and within the tumor. However, GNB tumors frequently display a regular shape with well-defined margins and are accompanied by pressure displacement of surrounding large vessels (18). Due to the diversity of GNB components and the heterogeneous distribution of the fibrovascular network (which in turn may undergo bleeding and necrosis), the majority of CT enhancements are heterogeneous (18,30). GNB exhibits equal or slightly low signals on MRI T1WI, whereas T2WI is dominated by heterogeneous slightly high signals and the necrotic area exhibits longer T2 signals. The signal level of T2WI reflects the proportion of parenchymal cells and stroma in the tumor to a certain extent and the slightly low signal is dominated by parenchymal cells (31). In the present case, no significant changes were observed on the enhanced CT in the arterial phase, with mild enhancement in the venous and delayed phases, whereas the pancreatic ducts and portal veins were displaced by compression. The MRCP exhibited a predominantly slightly low signal on the T1W1 image and a predominantly slightly high signal on the T2W1 and T2-FS images, with a small amount of plaque-like slightly low signals and separated shadows. Although CT and MRI are useful in the diagnosis of GNB, the diagnosis of the disease is still dependent on pathological examination of the tumor tissue. The diagnosis is usually confirmed by microscopic findings of NB components and mature ganglion cells, frequently with nuclear schwannoma, hemorrhage, necrosis and calcification. In addition, Syn, CD56, SE, NF, CgA and S100 may be considered as GNB-specific markers (32).

Early radical surgery is the best treatment for retroperitoneal GNB and its prognosis is related to the ratio of neuroblasts to ganglion cells. If there are fewer neuroblasts, the patient's prognosis is better; conversely, if there are more neuroblasts, the patient's prognosis is worse as well. In addition, patient age and tumor size are also associated with GNB prognosis. Previous studies have indicated that patient age is inversely related to prognosis of GNB, with older pediatric patients having worse prognoses than younger pediatric patients (3335). Furthermore, adults with GNBs >8 cm in diameter are frequently at risk of distant metastases (36). Compared to other reports of retroperitoneal GNB lesions, the present case had a larger lesion size (13 cm), hence the risk of recurrence may be increased. Therefore, GNB lesions in adolescents or adults should be carefully followed up, even after complete resection.

Stress ulcers are acute mucosal erosions and ulcers of the gastrointestinal tract that occur in stressful conditions such as shock, trauma, critical illness or surgery (37). The incidence of stress ulcers has significantly decreased with the widespread use of proton pump inhibitors (3840). In the case of the present study, the patient developed abdominal pain and elevated body temperature on the third postoperative day, and laboratory tests and imaging data confirmed a peptic ulcer with perforation. Review of the surgical procedure did not indicate any injury to adjacent organs or blood vessels. Combined with the patient's previous history of peptic ulcer and history of NSAID use, the possibility of stress ulcer with perforation was considered. As the patient's pathological examination results indicated GNB with malignant tendency and the ulcer perforation area was large (3.0×2.0 cm), it was difficult to achieve the ideal treatment result with the conventional ulcer repair surgery and the final decision was made to perform ‘major distal gastrectomy and duodenal ulcer resection’. Therefore, active and effective prevention of stress ulcers has an important role in saving the patient's life as well as improving the patient's quality of life.

Controversy still exists as to whether patients with GNB should be treated with chemotherapy after surgery. The main chemotherapeutic agents used in pediatric patients include cyclophosphamide, vincristine, adriamycin and etoposide. Raina et al (41) reported a case wherein complete remission was achieved with a combination of cyclophosphamide, vincristine, adriamycin, cisplatin, etoposide and ifosfamide. In addition, certain studies have demonstrated that neoadjuvant chemotherapy is effective in patients with GNB (33,4144), but its prognostic impact remains uncertain due to the low incidence of GNB. The pathological results of the patient of the present study suggested a high proportion of NB and a poorly located tumor with a close relationship to the surrounding tissues. After multi-disciplinary treatment discussion, chemotherapy or classical meta-iodobenzylguanidine treatment was recommended, but the patient and her family decided not to proceed with chemotherapy for the time being.

Recurrence of the disease mainly occurs 2 years after surgery. Patients should therefore be followed up for a long period and reviewed every 6 months, which should include a full blood count and imaging of the primary tumor site (45).

In conclusion, GNB is a transitional tumor frequently occurring in children. It consists of a mature GN and malignant NB and is therefore malignant or potentially malignant. to date, <50 adult or adolescent cases have been previously reported and there are only five cases of retroperitoneal GNB in adults or adolescents in the PubMed database.

Although the diagnosis of GNB depends on histopathological analysis, imaging with CT and MRI may still aid in GNB diagnosis. When an abdominal mass is found in an adult or adolescent, clinicians should consider the possibility of GNB and its malignancy and proactively prevent the development of complications.

Supplementary Material

Supporting Data


Not applicable.


The present study was supported by the Special Fund for Outstanding Young Scientific and Technological Talents of Guizhou Province [grant no. (2019)5647] and the Science and Technology Fund Project of Guizhou Health and Family Planning Commission (grant no. gzwjkj2020-1-101).

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Authors' contributions

SLZ and BLX examined the patient, analyzed the clinical, radiological and laboratory results, and wrote the manuscript. YWZ assisted with data analysis. XYF and ZHZ were involved in the surgical treatment. SZ designed the study, including proofreading of the manuscript and revising it critically. SLZ, BLX, YWZ, XYF, ZHZ and SZ confirm the authenticity of all the raw data. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Written informed consent was obtained from the patient and their family for the publication of this case.

Competing interests

The authors declare that they have no competing interests.



Badiu Tișa I, Samașca G, Aldea C, Lupan I, Farcau D and Makovicky P: Ganglioneuroblastoma in children. Neurol Sci. 40:1985–1989. 2019. View Article : Google Scholar


He WG, Yan Y, Tang W, Cai R and Ren G: Clinical and biological features of neuroblastic tumors: A comparison of neuroblastoma and ganglioneuroblastoma. Oncotarget. 8:37730–37739. 2017. View Article : Google Scholar


Akin M, Ergen SA, Oz B, Atkovar G and Sahinler I: Ventricular ganglioneuroblastoma in an adult and successful treatment with radiotherapy. Balkan Med J. 31:173–176. 2014. View Article : Google Scholar : PubMed/NCBI


Vassallo L, Fasciano M, Baralis I, Pellegrino L, Fortunato M, Orcioni GF and Sorrentino S: A rare case of adrenal ganglioneuroblastoma-intermixed in an adult and a review of literature. Radiol Case Rep. 16:2351–2356. 2021. View Article : Google Scholar : PubMed/NCBI


Sekiguchi N, Noguchi T, Fukushima T, Kobayashi T, Ozawa T, Sato Y, Takeda T, Yoshida K and Koizumi T: Posterior mediastinal ganglioneuroblastoma in an adolescent: A case report and review. Thorac Cancer. 11:451–455. 2020. View Article : Google Scholar : PubMed/NCBI


Mousa AM, Shokouh-Amiri MH, Shah LM, Garzon S and Xie KL: Adult-onset ganglioneuroblastoma of the posterior mediastinum with osseous metastasis. Radiol Case Rep. 15:1676–1682. 2020. View Article : Google Scholar : PubMed/NCBI


Heidari Z, Kaykhaei MA, Jahantigh M and Sheikhi V: Adrenal ganglioneuroblastoma in an adult: A rare case report. Int J Endocrinol Metab. 16:e630552018. View Article : Google Scholar : PubMed/NCBI


Yao PS, Chen GR, Shang-Guan HC, Lin QS, Wang XF, Zheng SF and Kang DZ: Adult hippocampal ganglioneuroblastoma: Case report and literature review. Medicine (Baltimore). 96:e88942017. View Article : Google Scholar : PubMed/NCBI


Ramaswamy B, Bhandarkar AM, Menon SS, Agarwal AC and Nair SS: Ganglioneuroblastoma of skull base. J Clin Diagn Res. 9:MD01–MD03. 2015.PubMed/NCBI


Bolzacchini E, Martinelli B and Pinotti G: Adult onset of ganglioneuroblastoma of the adrenal gland: Case report and review of the literature. Surg Case Rep. 1:792015. View Article : Google Scholar : PubMed/NCBI


Patnaik A, Mishra SS, Mishra S, Das S and Deo RC: Primary extradural spinal ganglioneuroblastoma: A case report. Turk Neurosurg. 24:253–255. 2014.PubMed/NCBI


Nakaoka T, Uemura S, Nakagawa Y, Yano T and Oda M: Retroperitoneal ganglioneuroblastoma resected 8 years after mass screening: A case report. J Pediatr Surg. 42:E29–E32. 2007. View Article : Google Scholar : PubMed/NCBI


Yamanaka M, Saitoh F, Saitoh H, Nisimura S, Sawada Y, Tsukui A, Kaimori M and Takahashi N: Primary retroperitoneal ganglioneuroblastoma in an adult. Int J Urol. 8:130–132. 2001. View Article : Google Scholar


Stout AP: Ganglioneuroma of the sympathetic nervous system. Surg Gynecol Obstet. 84:101–110. 1947.


Shimada H, Chatten J, Newton WA Jr, Sachs N, Hamoudi AB, Chiba T, Marsden HB and Misugi K: Histopathologic prognostic factors in neuroblastic tumors: Definition of subtypes of ganglioneuroblastoma and an age-linked classification of neuroblastomas. J Natl Cancer Inst. 73:405–416. 1984. View Article : Google Scholar


Munchar MJ, Sharifah NA, Jamal R and Looi LM: CD44s expression correlated with the international neuroblastoma pathology classification (Shimada system) for neuroblastic tumours. Pathology. 35:125–129. 2003. View Article : Google Scholar : PubMed/NCBI


Shimada H, Ambros IM, Dehner LP, Hata J, Joshi VV, Roald B, Stram DO, Gerbing RB, Lukens JN, Matthay KK and Castleberry RP: The international neuroblastoma pathology classification (the Shimada system). Cancer. 86:364–372. 1999. View Article : Google Scholar : PubMed/NCBI


Wang H, Chen X, Liu H, Yu C and He L: Computed tomography-based radiomics for differential of retroperitoneal neuroblastoma and ganglioneuroblastoma in children. Nan Fang Yi Ke Da Xue Xue Bao. 41:1569–1576. 2021.(In Chinese). PubMed/NCBI


Jrebi NY, Iqbal CW, Joliat GR, Sebo TJ and Farley DR: Review of our experience with neuroblastoma and ganglioneuroblastoma in adults. World J Surg. 38:2871–2874. 2014. View Article : Google Scholar : PubMed/NCBI


Chen BF, Rathi M, Al-Samarrai S and Rajeswary J: First reported case of ganglioneuroblastoma in pregnancy and a review of the literature. Obstet Med. 7:128–130. 2014. View Article : Google Scholar : PubMed/NCBI


Hayama S, Ohmi M, Yonemori A, Yamabuki T, Inomata H, Nihei K and Hirano S: Ganglioneuroblastoma arising within a retroperitoneal mature cystic teratoma. World J Clin Oncol. 3:155–158. 2012. View Article : Google Scholar


Perego P, Bovo G, Cappellini A and Bratina G: Adenocarcinoma of the large intestine associated with retroperitoneal ganglioneuroblastoma. Report of a case. Pathologica. 86:316–318. 1994.(In Italian).


Otal-Salaverri C, González-Cámpora R, Hevia-Vazquez A, Lerma-Puertas E and Galera-Davidson H: Retroperitoneal ganglioneuroblastoma. Report of a case diagnosed by fine needle aspiration cytology and electron microscopy. Acta Cytol. 33:80–84. 1989.


Ochoa Urdangarain O, Chávez Olivera R and Molero Denes G: Retroperitoneal ganglioneuroblastoma. Presentation of a case. Arch Esp Urol. 42:703–704. 1989.(In Spanish).


Marya SK and Gupta SP: Ganglioneuroblastoma: A case report. Indian J Pediatr. 46:143–144. 1979. View Article : Google Scholar : PubMed/NCBI


Powers JM, Balentine JD, Wisniewski HM and Terry RD: Retroperitoneal ganglioneuroblastoma: A kaleidoscope of neuronal degeneration. A light and electron microscopic study. J Neuropathol Exp Neurol. 35:14–25. 1976. View Article : Google Scholar


Nyãrãdi A, Kelle L and Klabuzai Z: High catecholamine producing retroperitoneal ganglioneuroblastoma in an adult. Orv Hetil. 112:2162–2164. 1971.(In Hungarian).


Likhachev AA: Retroperitoneal ganglioneuroblastoma in a 14-month-old girl. Vopr Okhr Materin Det. 16:84–85. 1971.(In Russian).


Paulino F and Torres E: Retroperitoneal ganglioneuroblastoma. Hospital (Rio J). 45:139–142. 1954.(In Portuguese). PubMed/NCBI


Takeda Y, Sano H, Kawano A, Mochizuki K, Takahashi N, Kobayashi S, Ohara Y, Tasaki K, Hosoya M and Kikuta A: Usefulness of fluorodeoxyglucose positron emission tomography/computed tomography for detection of a neuroblastic nodule in a ganglioneuroblastoma: A case report. J Med Case Rep. 12:1192018. View Article : Google Scholar : PubMed/NCBI


Gahr N, Darge K, Hahn G, Kreher BW, von Buiren M and Uhl M: Diffusion-weighted MRI for differentiation of neuroblastoma and ganglioneuroblastoma/ganglioneuroma. Eur J Radiol. 79:443–446. 2011. View Article : Google Scholar


Koike K, Iihara M, Kanbe M, Omi Y, Aiba M and Obara T: Adult-type ganglioneuroblastoma in the adrenal gland treated by a laparoscopic resection: Report of a case. Surg Today. 33:785–790. 2003. View Article : Google Scholar : PubMed/NCBI


Decarolis B, Simon T, Krug B, Leuschner I, Vokuhl C, Kaatsch P, von Schweinitz D, Klingebiel T, Mueller I, Schweigerer L, et al: Treatment and outcome of ganglioneuroma and ganglioneuroblastoma intermixed. BMC Cancer. 16:5422016. View Article : Google Scholar : PubMed/NCBI


Mossé YP, Deyell RJ, Berthold F, Nagakawara A, Ambros PF, Monclair T, Cohn SL, Pearson AD, London WB and Matthay KK: Neuroblastoma in older children, adolescents and young adults: A report from the international neuroblastoma risk group project. Pediatr Blood Cancer. 61:627–635. 2014. View Article : Google Scholar


Brossard J, Bernstein ML and Lemieux B: Neuroblastoma: An enigmatic disease. Br Med Bull. 52:787–801. 1996. View Article : Google Scholar


Mizuno S, Iida T and Fujita S: Adult-onset adrenal ganglioneuroblastoma-bone metastasis two years after surgery: Report of a case. Surg Today. 40:482–486. 2010. View Article : Google Scholar : PubMed/NCBI


Kasper P, Janssens U and Michels G: How important are proton pump inhibitors in the prevention of stress ulcers and stress-associated gastrointestinal bleeding in ICU patients? Med Klin Intensivmed Notfmed. 114:350–354. 2019.(In German). View Article : Google Scholar : PubMed/NCBI


Eun CS: Does proton pump inhibitor increase the clostridium difficile infection risk in the treatment and prophylaxis of stress ulcers than histanime-2 receptor antagonist? Gut Liver. 11:739–740. 2017. View Article : Google Scholar : PubMed/NCBI


Cohen ME, Hathway JM, Salmasian H, Liu J, Terry M, Abrams JA and Freedberg DE: Prophylaxis for stress ulcers with proton pump inhibitors is not associated with increased risk of bloodstream infections in the intensive care unit. Clin Gastroenterol Hepatol. 15:1030–1036.e1. 2017. View Article : Google Scholar


Azab M, Doo L, Doo DH, Elmofti Y, Ahmed M, Cadavona JJ, Liu XB, Shafi A, Joo MK and Yoo JW: Comparison of the hospital-acquired clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers: A systematic review and meta-analysis. Gut Liver. 11:781–788. 2017. View Article : Google Scholar : PubMed/NCBI


Raina V, Kamble R, Tanwar R, Singh SP and Sharma S: Spinal ganglioneuroblastoma-complete response to chemotherapy alone. Postgrad Med J. 69:746–748. 1993. View Article : Google Scholar : PubMed/NCBI


Irtan S, Brisse HJ, Minard-Colin V, Schleiermacher G, Galmiche-Rolland L, Le Cossec C, Elie C, Canale S, Michon J, Valteau-Couanet D and Sarnacki S: Image-defined risk factor assessment of neurogenic tumors after neoadjuvant chemotherapy is useful for predicting intra-operative risk factors and the completeness of resection. Pediatr Blood Cancer. 62:1543–1549. 2015. View Article : Google Scholar : PubMed/NCBI


Sawaguchi S, Kaneko M, Uchino J, Takeda T, Iwafuchi M, Matsuyama S, Takahashi H, Nakajo T, Hoshi Y, Okabe I, et al: Treatment of advanced neuroblastoma with emphasis on intensive induction chemotherapy. A report from the study group of Japan. Cancer. 66:1879–1887. 1990. View Article : Google Scholar : PubMed/NCBI


Kilton LJ, Aschenbrener C and Burns CP: Ganglioneuroblastoma in adults. Cancer. 37:974–983. 1976. View Article : Google Scholar : PubMed/NCBI


Murphy JM and La Quaglia MP: Advances in the surgical treatment of neuroblastoma: A review. Eur J Pediatr Surg. 24:450–456. 2014. View Article : Google Scholar : PubMed/NCBI

Related Articles

Journal Cover

Volume 24 Issue 1

Print ISSN: 1792-1074
Online ISSN:1792-1082

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
Spandidos Publications style
Zhang S, Xiao B, Zhang Y, Zhou Z, Fu X and Zuo S: Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature. Oncol Lett 24: 208, 2022
Zhang, S., Xiao, B., Zhang, Y., Zhou, Z., Fu, X., & Zuo, S. (2022). Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature. Oncology Letters, 24, 208.
Zhang, S., Xiao, B., Zhang, Y., Zhou, Z., Fu, X., Zuo, S."Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature". Oncology Letters 24.1 (2022): 208.
Zhang, S., Xiao, B., Zhang, Y., Zhou, Z., Fu, X., Zuo, S."Retroperitoneal ganglioneuroblastoma with postoperative stress ulcer perforation in an adolescent: A case report and review of the literature". Oncology Letters 24, no. 1 (2022): 208.