Large ganglioneuroma presenting as presacral mass

Ganglioneuromas are benign tumours of the sympathetic nervous system that originate from neural crest cells. They are extremely rare in the presacral region. Here, we report a case of a presacral mass in a 14-year-old female who presented with complaints of pelvic discomfort, difficulty with micturition and constipation. Ultrasonogram showed a large heteroechoic solid mass in the pelvis with bilateral hydroureteronephrosis. It appeared as a well-circumscribed, hypodense mass lesion on CT scan, measuring 14 x 11 x 10 cm. It appeared isointense to muscle on T(1) and heterogeneously hyperintense on T(2) weighted images with heterogeneous post-contrast enhancement on MRI. The lesion was seen in the presacral region displacing the rectum and bladder anteriorly, and extending posteriorly, causing widening of the sacral foramina. The mass was surgically excised and her symptoms resolved. Histopathological examination of the mass revealed features of ganglioneuroma. We report this case in view of the large size of the mass and its rare location.