bims-netuvo Biomed News
on Nerves in tumours of visceral organs
Issue of 2024–10–06
fourteen papers selected by
Maksym V. Kopanitsa, Charles River Laboratories
  1. What a wonderful world!
  2. Cancer neuroscience at the brain-body interface.
  3. Neuroscience of cancer: Research progress and emerging of the field.
  4. Harnessing brain-body communication to understand cancer.
  5. Comparison between Substance P and Calcitonin Gene-Related Peptide and Their Receptors in Colorectal Adenocarcinoma.
  6. Predictors of brain metastases in patients with oligometastatic solid tumours treated with stereotactic body radiation therapy.
  7. A radiomics model for predicting perineural invasion in stage II-III colon cancer based on computer tomography.
  8. Cold Atmospheric Plasma Induces Growth Arrest and Apoptosis in Neurofibromatosis Type 1-Associated Peripheral Nerve Sheath Tumor Cells.
  9. Excision of large median and ulnar nerve schwannomas: a case series.
  10. Computed tomography-based radiomics nomogram for prediction of lympho-vascular and perineural invasion in esophageal squamous cell cancer patients: a retrospective cohort study.
  11. Primary Aortic Malignant Peripheral Nerve Sheath Tumor.
  12. Malignant peripheral nerve sheath tumor mimicking carotid body tumor, a rare case report and review of literature.
  13. Clinicopathological differences between classical schwannomas and cellular schwannomas in the retroperitoneum.
  14. Case Report: Adrenal schwannoma associated with ganglioneuroma.
  1. Genes Dev. 2024 Oct 03.
    What a wonderful world!
    Claire Magnon.
      The world of cancer science is moving toward a paradigm shift in making connections with neuroscience. After decades of research on genetic instability and mutations or on the tumor microenvironment, emerging evidence suggests that a malignant tumor is able to hijack and use the brain and its network of peripheral and central neurons as disrupters of homeostasis in the body. Whole-body homeostasis requires brain-body circuits to maintain survival and health via the processes of interoception, immunoception, and nociception. It is now likely that cancer disturbs physiological brain-body communication in making bidirectional brain tumor connections.
    Keywords:  brain–body; physiology; symposium
    DOI:  https://doi.org/10.1101/gad.352278.124
  2. Genes Dev. 2024 Oct 03.
    Cancer neuroscience at the brain-body interface.
    Jeremy C Borniger.
      Our approaches toward understanding cancer have evolved beyond cell-intrinsic and local microenvironmental changes within the tumor to encompass how the cancer interfaces with the entire host organism. The nervous system is uniquely situated at the interface between the brain and body, constantly receiving and sending signals back and forth to maintain homeostasis and respond to salient stimuli. It is becoming clear that various cancers disrupt this dialog between the brain and body via both neuronal and humoral routes, leading to aberrant brain activity and accelerated disease. In this outlook, I discuss this view of cancer as a homeostatic challenge, emphasize cutting-edge work, and provide outstanding questions that need to be answered to move the field forward.
    Keywords:  brain–body; physiology; symposium
    DOI:  https://doi.org/10.1101/gad.352288.124
  3. Ibrain. 2024 ;10(3): 305-322
    Neuroscience of cancer: Research progress and emerging of the field.
    Issam AbuQeis, Yu Zou, Ying-Chun Ba, Abeer A Teeti.
      Cancer cells immediately expand and penetrate adjoining tissues, as opposed to metastasis, that is the spread of cancer cells through the circulatory or lymphatic systems to more distant places via the invasion process. We found that a lack of studies discussed tumor development with the nervous system, by the aspects of cancer-tissue invasion (biological) and chemical modulation of growth that cascades by releasing neural-related factors from the nerve endings via chemical substances known as neurotransmitters. In this review, we aimed to carefully demonstrate and describe the cancer invasion and interaction with the nervous system, as well as reveal the research progress and the emerging neuroscience of cancer. An initial set of 160 references underwent systematic review and summarization. Through a meticulous screening process, these data were refined, ultimately leading to the inclusion of 98 studies that adhered to predetermined criteria. The outcomes show that one formidable challenge in the realm of cancer lies in its intrinsic heterogeneity and remarkable capacity for rapid adaptation. Despite advancements in genomics and precision medicine, there is still a need to identify new molecular targets. Considering cancer within its molecular and cellular environment, including neural components, is crucial for addressing this challenge. In conclusion, this review provides good referential data for direct, indirect, biological, and chemical interaction for nerve tissue-tumor interaction, suggesting the establishment of new therapy techniques and mechanisms by controlling and modifying neuron networks that supply signals to tumors.
    Keywords:  cancer invasion; neuroscience; paracrine mode; perineural invasion; tumor microenvironment
    DOI:  https://doi.org/10.1002/ibra.12172
  4. Genes Dev. 2024 Oct 03.
    Harnessing brain-body communication to understand cancer.
    Erica K Sloan.
      Solid tumors that arise in the body interact with neurons, which influences cancer progression and treatment response. Here, we discuss key questions in the field, including defining the nature of interactions between tumors and neural circuits and defining how neural signals shape the tumor microenvironment. This information will allow us to optimally target neural signaling to improve outcomes for cancer patients.
    Keywords:  brain–body; physiology; symposium
    DOI:  https://doi.org/10.1101/gad.352292.124
  5. J Clin Med. 2024 Sep 22. pii: 5616. [Epub ahead of print]13(18):
    Comparison between Substance P and Calcitonin Gene-Related Peptide and Their Receptors in Colorectal Adenocarcinoma.
    Robert-Emmanuel Șerban, Mihail Virgil Boldeanu, Dan Nicolae Florescu, Mihaela Ionescu, Mircea-Sebastian Șerbănescu, Lidia Boldeanu, Mirela-Marinela Florescu, Mioara-Desdemona Stepan, Vasile-Cosmin Obleagă, Cristian Constantin, Dragoş-Marian Popescu, Costin Teodor Streba, Cristin Constantin Vere.
      Background: Colorectal cancer is a major health problem that still causes many deaths worldwide. Neuropeptides, such as substance P and calcitonin gene-related peptide, play the neurotransmitter and neurohormone roles that increase tumor invasiveness and metastasis potential. This study aimed to see whether these neuropeptides and their receptors-neurokinin 1 receptor and calcitonin receptor-like receptor-correlate with the diagnosis stage, tumor differentiation grade, and different patient characteristics in colorectal cancer and also to compare them. Methods: We performed serum analyses of substance P and CGRP levels in patients with colorectal cancer and also the immunohistochemical analysis of their receptors in colorectal tumors and then correlated them with the disease stage and with different tumor characteristics. Results: We demonstrated that both substance P and calcitonin gene-related peptide had increased levels in colorectal cancer and that their levels correlated with the stage of the disease and with the tumor differentiation grade. We also demonstrated the correlation of NK-1R and CRLR higher immunohistochemical scores with advanced and poorly differentiated tumors. Conclusions: This study demonstrates that the neuropeptides SP and CGRP and their receptors NK-1R and CRLR could play a role in the pathogenesis of colorectal cancer, and they could be used as diagnostic and prognostic markers and could represent potential therapeutic targets.
    Keywords:  calcitonin gene-related peptide; calcitonin receptor-like receptor; colorectal cancer; neurokinin 1 receptor; neuropeptides; substance P
    DOI:  https://doi.org/10.3390/jcm13185616
  6. J Neurooncol. 2024 Oct 04.
    Predictors of brain metastases in patients with oligometastatic solid tumours treated with stereotactic body radiation therapy.
    Kevin Yijun Fan, Katarzyna Joanna Jerzak, Sudhir Kumar, Veronika Moravan, Badr Id Said, Sunit Das, Alexander V Louie, Hany Soliman, Arjun Sahgal, Hanbo Chen.
       PURPOSE: In patients with oligometastatic disease (OMD) treated with stereotactic body radiation therapy (SBRT), those who develop brain metastases (BrM) may have poor outcomes. We aimed to investigate variables associated with BrM development in this population.
    METHODS: Patients with ≤ 5 extracranial metastases from solid tumors treated with SBRT from 2008 to 2016 at Sunnybrook Odette Cancer Centre were included. We investigated the association between covariates and CIBrM (cumulative incidence of BrM) using Fine-Gray analysis, and progression-free survival (PFS) and overall survival (OS) using Cox regression. We investigated the association between extracranial progression and CIBrM using time-based conditional analysis.
    RESULTS: Among 404 patients, the most common primary sites were lung, colorectal, prostate, breast and kidney. Median follow-up was 49 months. Median PFS was 25 months. Median OS was 70 months. 58 patients developed BrM, and 5-year CIBrM was 16%. On multivariable analysis, number of extracranial metastases, location of metastases, total planning target volume (PTV), and time from primary diagnosis to OMD were not associated with CIBrM, although several of these variables were associated with extracranial PFS and OS. Primary site was associated with CIBrM, with colorectal and prostate cancer associated with lower CIBrM compared to lung cancer. Widespread extracranial progression (≥ 5 sites) within 24, 36, 48 and 60 months of OMD diagnosis was independently associated with higher CIBrM.
    CONCLUSION: In patients with OMD treated with SBRT, baseline variables related to extracranial disease burden and distribution were not associated with BrM development, while primary site and widespread extracranial progression were associated with BrM development.
    Keywords:  Brain metastasis; Extracranial disease; Oligometastatic disease; Predictors; Solid tumor; Stereotactic body radiation therapy
    DOI:  https://doi.org/10.1007/s11060-024-04834-9
  7. BMC Cancer. 2024 Oct 04. 24(1): 1226
    A radiomics model for predicting perineural invasion in stage II-III colon cancer based on computer tomography.
    Tairan Guo, Bing Cheng, Yunlong Li, Yaqing Li, Shaojie Chen, Guoda Lian, Jiajia Li, Ming Gao, Kaihong Huang, Yuzhou Huang.
       BACKGROUND: Colon cancer, a frequently encountered malignancy, exhibits a comparatively poor survival prognosis. Perineural invasion (PNI), highly correlated with tumor progression and metastasis, is a substantial effective predictor of stage II-III colon cancer. Nonetheless, the lack of effective and facile predictive methodologies for detecting PNI prior operation in colon cancer remains a persistent challenge.
    METHOD: Pre-operative computer tomography (CT) images and clinical data of patients diagnosed with stage II-III colon cancer between January 2015 and December 2023 were obtained from two sub-districts of Sun Yat-sen Memorial Hospital (SYSUMH). The LASSO/RF/PCA filters were used to screen radiomics features and LR/SVM models were utilized to construct radiomics model. A comprehensive model, shown as nomogram finally, combining with radiomics score and significant clinical features were developed and validated by area under the curve (AUC) and decision curve analysis (DCA).
    RESULT: The total cohort, comprising 426 individuals, was randomly divided into a development cohort and a validation cohort as a 7:3 ratio. Radiomics scores were extracted from LASSO-SVM models with AUC of 0.898/0.726 in the development and validation cohorts, respectively. Significant clinical features (CA199, CA125, T-stage, and N-stage) were used to establish combining model with radiomics scores. The combined model exhibited superior reliability compared to single radiomics model in AUC value (0.792 vs. 0.726, p = 0.003) in validation cohorts. The radiomics-clinical model demonstrated an AUC of 0.918/0.792, a sensitivity of 0.907/0.813 and a specificity of 0.804/0.716 in the development and validation cohorts, respectively.
    CONCLUSION: The study developed and validated a predictive nomogram model combining radiomics scores and clinical features, and showed good performance in predicting PNI pre-operation in stage II-III colon cancer patients.
    Keywords:  Colon cancer; PNI; Predictive model; Radiomics
    DOI:  https://doi.org/10.1186/s12885-024-12951-x
  8. Biomedicines. 2024 Sep 02. pii: 1986. [Epub ahead of print]12(9):
    Cold Atmospheric Plasma Induces Growth Arrest and Apoptosis in Neurofibromatosis Type 1-Associated Peripheral Nerve Sheath Tumor Cells.
    Brian Na, Blake Haist, Shilp R Shah, Graeme Sabiston, Steven J Jonas, Jeremie Vitte, Richard E Wirz, Marco Giovannini.
      Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder resulting from mutations in the NF1 gene. Patients harboring these mutations are predisposed to a spectrum of peripheral nerve sheath tumors (PNSTs) originating from Schwann cells, of which malignant peripheral nerve sheath tumors (MPNSTs) are the deadliest, with limited treatment options. Therefore, an unmet need still exists for more effective therapies directed at these aggressive malignancies. Cold atmospheric plasma (CAP) is a reactive oxygen species (ROS) and reactive nitrogen species (RNS) generating ionized gas that has been proposed to be a potential therapeutic modality for cancer. In this study, we sought to determine the effects of CAP on NF1-associated PNSTs. Utilizing established mouse and human cell lines to interrogate the effects of CAP in both in vitro and in vivo settings, we found that NF1-associated PNSTs were highly sensitive to CAP exposure, resulting in cell death. To our knowledge, this is the first application of CAP to NF1-associated PNSTs and provides a unique opportunity to study the complex biology of NF1-associated tumors.
    Keywords:  apoptosis; cancer therapy; cold atmospheric plasma; neurofibromatosis type 1; reactive nitrogen species; reactive oxygen species
    DOI:  https://doi.org/10.3390/biomedicines12091986
  9. BMC Surg. 2024 Oct 03. 24(1): 284
    Excision of large median and ulnar nerve schwannomas: a case series.
    Chih-Hsun Chang, Jung-Pan Wang, Yi-Chao Huang, Cheng-Yu Yin, Kuang-Hung Chen, Hui-Kuang Huang.
       OBJECTIVE: Schwannomas are benign, slow-growing tumors originating from Schwann cells in peripheral nerves, commonly affecting the median and ulnar nerves in the forearm and wrist. Surgical excision is the gold standard treatment. This study presents our treatment strategies and outcomes for large-sized ulnar and median nerve schwannomas at the forearm and wrist level.
    METHODS: From 2012 to 2023, we enrolled 15 patients with schwannomas over 2 cm in size in the median or ulnar nerve at the forearm and wrist. The study included 12 patients with median nerve schwannomas (mean age: 61 years) and 3 with ulnar nerve schwannomas (mean age: 68 years), with a mean follow-up of 26.9 months.
    RESULTS: After surgery, all patients with median nerve schwannomas experienced mild, transient numbness affecting fewer than two digits, resolving within six months without motor deficits. Ulnar nerve schwannoma excision caused mild numbness in two patients, also resolving within six months, but all three developed ulnar claw hand deformity, which persisted but improved at the last follow-up. Despite this, patients were satisfied with the surgery due to relief from severe tingling pain.
    CONCLUSIONS: Schwannomas of the median, ulnar, and other peripheral nerves should be removed by carefully dissecting the connecting nerve fascicles to avoid injury to healthy ones. Sensory deficits may occur but are unlikely to significantly impact quality of life. However, in motor-dominant nerves like the ulnar nerve, there is a risk of significant motor deficits that could affect hand function, though not completely. Therefore, thorough preoperative discussion and consideration of interfascicular nerve grafting are essential.
    Keywords:  Median nerve; Neurilemmoma; Schwannoma; Surgical technique; Unar nerve
    DOI:  https://doi.org/10.1186/s12893-024-02583-0
  10. Cancer Imaging. 2024 Oct 04. 24(1): 131
    Computed tomography-based radiomics nomogram for prediction of lympho-vascular and perineural invasion in esophageal squamous cell cancer patients: a retrospective cohort study.
    Bin Tang, Fan Wu, Lin Peng, Xuefeng Leng, Yongtao Han, Qifeng Wang, Junxiang Wu, Lucia Clara Orlandini.
       PURPOSE: Lympho-vascular invasion (LVI) and perineural invasion (PNI) have been established as prognostic factors in various types of cancers. The preoperative prediction of LVI and PNI has the potential to guide personalized medicine strategies for patients with esophageal squamous cell cancer (ESCC). This study investigates whether radiomics features derived from preoperative contrast-enhanced CT could predict LVI and PNI in ESCC patients.
    METHODS AND MATERIALS: A retrospective cohort of 544 ESCC patients who underwent esophagectomy were included in this study. Preoperative contrast-enhanced CT images, pathological results of PNI and LVI, and clinical characteristics were collected. For each patient, the gross tumor volume (GTV-T) and lymph nodes volume (GTV-N) were delineated and four categories of radiomics features (first-order, shape, textural and wavelet) were extracted from GTV-T and GTV-N. The Mann-Whitney U test was used to select significant features associated with LVI and PNI in turn. Subsequently, radiomics signatures for LVI and PNI were constructed using LASSO regression with ten-fold cross-validation. Significant clinical characteristics were combined with radiomics signature to develop two nomogram models for predicting LVI and PNI, respectively. The area under the curve (AUC) and calibration curve were used to evaluate the predictive performance of the models.
    RESULTS: The radiomics signature for LVI prediction consisted of 28 features, while the PNI radiomics signature comprised 14 features. The AUCs of the LVI radiomics signature were 0.77 and 0.74 in the training and validation groups, respectively, while the AUCs of the PNI radiomics signature were 0.69 and 0.68 in the training and validation groups. The nomograms incorporating radiomics signatures and significant clinical characteristics such as age, gender, thrombin time and D-Dimer showed improved predictive performance for both LVI (AUC: 0.82 and 0.80 in the training and validation group) and PNI (AUC: 0.75 and 0.72 in the training and validation groups) compared to the radiomics signature alone.
    CONCLUSION: The radiomics features extracted from preoperative contrast-enhanced CT of gross tumor and lymph nodes have demonstrated their potential in predicting LVI and PNI in ESCC patients. Furthermore, the incorporation of clinical characteristics has shown additional value, resulting in improved predictive performance.
    Keywords:  Contrast-enhanced CT; Esophageal squamous cell cancer; LASSO; Lympho-vascular invasion; Perineural invasion; Radiomic
    DOI:  https://doi.org/10.1186/s40644-024-00781-w
  11. Vasc Endovascular Surg. 2024 Sep 30. 15385744241290014
    Primary Aortic Malignant Peripheral Nerve Sheath Tumor.
    Hisaya Mori, Hisato Takagi.
      A 74 year-old woman suffering 1 month persisting lumbago was referred with diagnosis of thoracic aortic aneurysm. Blood examinations indicated slightly or moderately elevated noradrenaline, dopamine, and homovanillic acid with normal-range vanillylmandelic acid. Contrast-enhanced CT scans revealed a tumor, protruding both intra- and extra-luminally, in the wall of the distal descending thoracic aorta without any primary focuses in the whole body. Primary aortic sarcoma or periaortic catecholamine-producing paraganglioma infiltrating the aorta was suspected. The tumor with the normal proximal and distal aorta 2-3 cm apart from it was completely resected under femoro-femoral partial cardiopulmonary bypass. Macroscopically, the tumor was originated from the aortic wall and protruded both intra- and extra-luminally. Immunohistochemically, positive S-100 and vimentin; Ki67 levels of 40%; and negative CD34, CK AE1/AE3, and SMA were identified. The aforementioned findings definitively diagnosed primary aortic malignant peripheral nerve sheath tumor, which has been never reported in the literature.
    Keywords:  malignant peripheral nerve sheath tumor; primary aortic malignancy; primary aortic neoplasm
    DOI:  https://doi.org/10.1177/15385744241290014
  12. Int J Surg Case Rep. 2024 Oct 02. pii: S2210-2612(24)01187-8. [Epub ahead of print]124 110406
    Malignant peripheral nerve sheath tumor mimicking carotid body tumor, a rare case report and review of literature.
    Pezhman Kharazm, Soheil Noruzi, Alireza Aghili, Ali Zarbakhsh, Ramin Azarhoosh, Fereshteh Maghsudloo.
       INTRODUCTION AND IMPORTANCE: Malignant Peripheral Nerve Sheath Tumor (MPNST) is a rare type of soft tissue sarcoma. It is an aggressive tumor with high rates of local recurrence and distant metastasis. MPNST rarely occurs in the neck. We present a case of cervical MPNST manifesting as Carotid Body Tumor (CBT).
    CASE PRESENTATION: A 67-year-old man presented with a neck mass. The mass was rapidly enlarging and imaging studies favored CBT. A previous attempt at surgical resection failed, and the compressive symptoms were progressive during recent weeks. After multidisciplinary discussion, the tumor was resected and pathological evaluation confirmed the diagnosis of MPNST. Post-operative metastatic work-up showed lung metastasis, and the patient died approximately one year after surgery.
    CLINICAL DISCUSSION: Cervical MPNST is rare, and surgery is the mainstay of its treatment. Pre-operative tissue diagnosis is recommended when possible, and immunohistochemical staining is necessary for prompt diagnosis. Adjuvant therapy may be helpful in metastatic cases or incomplete resection. Nevertheless, local recurrence and distant metastasis especially to the lungs are common, as in our case.
    CONCLUSION: MPNST is one of the potential causes of cervical masses and considering its invasive behavior, surgical resection is recommended as soon as the diagnosis is made.
    Keywords:  Carotid body tumor; Case report; Malignant peripheral nerve sheath tumor; Neck mass
    DOI:  https://doi.org/10.1016/j.ijscr.2024.110406
  13. J Neuropathol Exp Neurol. 2024 Sep 28. pii: nlae104. [Epub ahead of print]
    Clinicopathological differences between classical schwannomas and cellular schwannomas in the retroperitoneum.
    Xiaoying Zhang, Haining Zheng, Guilan Li, Ting Li.
      This study aimed to compare clinical and pathological features of retroperitoneal classical schwannomas and cellular schwannomas. A total of 64 cases of retroperitoneal classical schwannoma and 48 cases of cellular schwannoma were studied. Histopathological analysis was performed using hematoxylin and eosin staining and immunohistochemistry. Retroperitoneal cellular schwannomas exhibited 100% (48/48) and 75% (36/48) positive expression for glial fibrillary acidic protein (GFAP) and cytokeratins (CK), respectively. Classical schwannomas showed rates of 6.25% (4/64) and 15.63% (10/64), respectively (P < .05). In classic schwannomas, 85.9% (55/64) showed a reticular pattern of positive anti-CD34 staining around tumor margins and subcapsular areas vs 52.1% (25/48) in cellular schwannomas (P < .05). Cellular schwannomas exhibited more mitotic figures than classical schwannoma (P < .05). The recurrence rate of cellular schwannomas was 10.42% (5/48), while that of classical schwannomas was 1.56% (1/64) (P < .05). Retroperitoneal cellular schwannomas commonly express GFAP and CK compared to classical schwannomas, suggesting that cellular schwannoma may originate from unmyelinated Schwann cells, while classical schwannoma may originate from myelinated Schwann cells. Anti-CD34 staining patterns may be used to distinguish between the 2 types. Retroperitoneal cellular schwannomas also show higher mitotic activity and are more prone to recurrence.
    Keywords:  GFAP; cellular schwannoma; classical schwannoma; immunohistochemistry; retroperitoneum
    DOI:  https://doi.org/10.1093/jnen/nlae104
  14. Front Surg. 2024 ;11 1416801
    Case Report: Adrenal schwannoma associated with ganglioneuroma.
    Dong-Lin He, Run-Lin Feng, Jia-Gui Chai, Xin Guo, Chang-Xing Ke.
       Background: An adrenal collision tumor (ACT) denotes the presence of distinct tumors with diverse behavioral, genetic, and histological features independently co-existing within the adrenal tissue without intermingling, and occurrences of such cases are infrequent. The concurrent occurrence of adrenal schwannoma and adrenal ganglioneuroma is exceedingly rare, and the diagnosis of these ACTs has been notably challenging due to their atypical clinical manifestations and imaging characteristics.
    Case summary: A 37-year-old man presented to the hospital 3 weeks after a computed tomography (CT) examination that revealed a left adrenal mass. Physical examination findings were unremarkable. Both CT and magnetic resonance imaging scans indicated the presence of a left adrenal mass. Plasma cortisol, adrenocorticotropic hormone, and renin-angiotensin-aldosterone system tests yielded normal results. Preoperative imaging confirmed the diagnosis of left adrenal pheochromocytoma. After thorough surgical preparation, a laparoscopic partial left adrenalectomy was performed. Subsequent postoperative pathological analysis identified adrenal schwannoma in conjunction with adrenal ganglioneuroma. The patient recovered well and was discharged on postoperative day 4. A routine urology clinic visit was included in his postoperative care plan. During follow-up assessments, CT scans of the left adrenal gland revealed no abnormalities.
    Conclusion: Adrenal schwannoma combined with ganglioneuroma represents an exceptionally rare collision tumor characterized by the absence of typical clinical or imaging features, leading to potential misdiagnosis. Adrenal incidentalomas present as multifaceted conditions, and this case serves to heighten awareness of their intricate nature. Due to the challenges in preoperative differentiation of various adrenal mass types, postoperative pathological analysis is imperative for guiding the subsequent treatment course for the patient.
    Keywords:  adrenal gland; adrenal tumors; collision tumors; ganglioneuroma; schwannoma
    DOI:  https://doi.org/10.3389/fsurg.2024.1416801
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