Adult-onset adrenal ganglioneuroblastoma - Bone metastasis two years after surgery: report of a case

Adrenal ganglioneuroblastoma with metastasis near the renal hilum in an adult female: A case report and review of the literature

Ganglioneuroblastoma (GNB), predominantly observed in children, is an uncommon malignant tumor in adults, with established treatment protocols notably lacking. The present study details the case of a 20-year-old woman who presented with a left adrenal gland mass, identified during a physical examination. Additionally, an unidentified mass was noted near the renal hilum in the preoperative evaluation. Following thorough preoperative preparation, both the primary adrenal gland mass and the renal hilar mass were surgically removed. The procedure concluded successfully. Pathological analysis confirmed that the left adrenal mass was a GNB and identified the renal hilar mass as a metastatic extension. Postoperative examination revealed a new formation at the original surgical site, later verified as a postoperative scar. Through the publication of a case report and extensive literature review, the present study aims to enhance our understanding of this condition, providing valuable diagnostic, therapeutic and post-recovery references for this rare adult disease.

Adrenal Ganglioneuroblastoma of Adult Onset: A Literature Review

Ganglioneuroblastomas (GNBs) are a rare subtype of neoplastic tumors that arise from the autonomic nervous system and contain both mature gangliocytes and immature neuroblasts. The primary age group affected by GNBs is the pediatric population, with less than 50 cases of adult GNBs existing in the literature. To the authors' best knowledge, only 21 cases of GNBs arising in the adrenal glands of adults have been reported. Herein we present a literature review examining the symptoms, treatment type, age, and sex of adults, and the presence of tumor metastases and calcification from the 21 cases reported in the literature.

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

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.

A rare case of adrenal ganglioneuroblastoma-intermixed in an adult and a review of literature

Peripheral neuroblastic tumors are extremely rare in the adult with less just over 20 cases involving adrenal gland described in the literature. We reported herewith the case of a 22-year-old young male who presented with epigastric pain and diarrhea. Imaging studies documented a 3.5cm x 3cm x 4cm solid well-circumscribed right adrenal mass, of heterogeneous structure and with fine calcifications. The lesion turned negative at MIBG scintigraphy. A right robotic-assisted adrenalectomy was performed leading to complete excision of the lesion without complications. Histology was consistent with intermixed stroma-rich ganglioneuroblastoma. A wait-and-see strategy was considered adequate. Two years after diagnosis patient is alive disease-free. Although the definitive diagnosis of a peripheral neuroblastic tumor is obtained after histopathological analysis, CT, and MRI are helpful to further characterize masses and useful in pretreatment risk stratification. Clinicians should be aware of the possibility of GNB development in adult population and its malignant potential.

Adult-onset ganglioneuroblastoma of the posterior mediastinum with osseous metastasis

Ganglioneuroblastomas are a member of the neuroblastic family of tumors most commonly seen in children but they may also occur in adults. Ganglioneuroblastomas have metastatic potential and, like other neuroblastic tumors, osseous metastasis is possible. Imaging features of ganglioneuroblastomas tend to be variable. We describe a case of an adult female who developed a ganglioneuroblastoma of the posterior mediastinum that metastasized to the thoracolumbar spine, highlighting rarely documented osseous metastasis.

Posterior mediastinal ganglioneuroblastoma in an adolescent: A case report and review

Ganglioneuroblastoma is an uncommon malignant tumor of the sympathetic nervous system, which is considered a disease of children with the majority of cases in patients less than four years old and it rarely occurs in adults. We encountered a very unusual case of a posterior mediastinal ganglioneuroblastoma that developed in a 17-year-old male adolescent who underwent successful excision of the mediastinal mass and remained stable postoperatively. However, he developed lumbago one year after the surgery. Radiographic findings revealed osteolytic lesions in the lumbar vertebra and histological analysis confirmed bone metastasis of ganglioneuroblastoma. Here, we report the clinical course and present a review of the literature regarding adolescent and adult onset mediastinal ganglioneuroblastoma.

Surgical strategy for an adult patient with a catecholamine-producing ganglioneuroblastoma and a cerebral aneurysm: a case report

Background

Ganglioneuroblastomas, particularly those that produce catecholamine, are extremely rare in adults. Here, we report an interesting surgical case of an adult patient with a catecholamine-producing ganglioneuroblastomas in her adrenal gland, suspected to be a pheochromocytoma, and with a cerebral aneurysm.

Case presentation

The patient was a 73-year-old woman under treatment for hypertension. During a health check-up, a cystic retroperitoneal tumor was incidentally found in the superior pole of her right kidney. Her blood adrenaline level was slightly elevated, and her urinary adrenaline, noradrenaline, and dopamine levels were above the upper reference limits. In addition, 24-h urinary excretion of metanephrine, normetanephrine, and vanillylmandelic acid were all increased. 123I-Meta-iodobenzylguanidine scintigraphy showed an abnormal accumulation of the marker in the cyst wall. She was, therefore, diagnosed with a pheochromocytoma and scheduled for tumor resection. However, preoperatively, 8-mm-diameter cerebral aneurysm was incidentally found in her basilar artery. This required careful preoperative discussion. The aneurysm was difficult to approach and treat, and based on its position, shape, and size, the risk of rupture was low. Because hypertension is a major risk factor for aneurysmal rupture, we decided to proceed with the tumor resection. A lumbar catheter was placed to monitor the cerebral aneurysm for intraoperative rupture, and her transcranial motor-evoked potential and somatosensory-evoked potentials were monitored to track her intraoperative neurological function. During surgery, we carefully monitored fluctuations in blood pressure and resected the tumor with minimal mobilization. Postoperatively, head computed tomography confirmed that there was no sign of rupture. Histopathologically, the tumor was diagnosed as a catecholamine-producing ganglioneuroblastoma. The postoperative course was good, and the patient’s blood pressure improved.

Conclusions

Careful perioperative management is needed for a patient with both a catecholamine-producing tumor and cerebral aneurysm.

Adrenal Ganglioneuroblastoma in an Adult: A Rare Case Report

Ganglioneuroblastoma is a primary malignant tumor of the sympathetic nervous system. It usually occurs in children and is extremely rare in adults. Here, we report a case of an adrenal ganglioneuroblastoma in a 38-year-old man. The adrenal incidentaloma was surgically removed and pathologically diagnosed as a ganglioneuroblastoma. The characteristics were described, because it is an unusual tumor based on the published reports in adults. To the best of our knowledge, fewer than 50 cases of ganglioneuroblastoma and 19 cases of adrenal ganglioneuroblastoma, including this case, are reported in the literature.

Imaging of rare medullary adrenal tumours in adults

Although adrenal medullary tumours are rare, they have important clinical implications. They form a heterogeneous group of tumours, ranging from benign, non-secretory, incidental masses to hormonally active tumours presenting acutely, or malignant tumours with disseminated disease and a poor prognosis. Increasingly, benign masses are incidentally detected due to the widespread use of imaging and routine medical check-ups. This review aims to illustrate the multimodality imaging appearances of rare adrenal medullary tumours, excluding the more common phaeochromocytomas, with clues to the diagnosis and to summarise relevant epidemiological and clinical data. Careful correlation of clinical presentation, hormone profile, and various imaging techniques narrow the differential diagnosis. Image-guided percutaneous adrenal biopsy can provide a definitive diagnosis, allowing for conservative management in selected cases. A close collaboration between the radiologist, endocrinologist, and surgeon is of the utmost importance in the management of these tumours.

Adult onset of ganglioneuroblastoma of the adrenal gland: case report and review of the literature

Ganglioneuroblastoma (GBN) is a malignant neoplasm of the autonomic nervous system. Adult onset of ganglioneuroblastoma is extremely rare. Only 16 cases have been reported in English literature, to date. Surgery represents the first-line therapy for the treatment of ganglioneuroblastoma. Radiation therapy is indicated in patients with localized unresectable disease. Chemotherapy is reserved for metastatic disease.

We present the case of a 63-year-old man affected by ganglioneuroblastoma of the adrenal gland. The diagnosis was made incidentally. The tumor, measuring 5 × 3 cm, was successfully surgically removed.

Adult adrenal ganglioneuroblastoma: A rare case report

Ganglioneuroblastoma is an uncommon malignant tumour, and it is extremely rare in adults. A 27-year-old woman was admitted to hospital complaining of commitment left loin pain for 7 months accompanied with fever for 1 day. Computed tomography (CT) scan shows a huge cystic solid mass among the rear of the pancreatic body and tail, inside of the spleen, and the top of the left kidney. Hormone examinations showed that the serum levels of glucocorticoid, aldosterone, norepinephrine, and epinephrine were normal. However, neuron-specific enolase (NSE) was significantly higher (289.46 ng/mL, normal level <16.3 ng/mL). Adrenal mass resection was scheduled. However, intraoperative separation was very difficult and adrenal tumour resection, resection of the pancreatic body and tail, left nephrectomy, and splenectomy were carried out. Pathological diagnosis was ganglioneuroblastoma.

Laparoscopic resection of retroperitoneal neural tumors

PURPOSE

Retroperitoneal neural tumor (RNT) is rarely excised laparoscopically, and the laparoscopic management of RNT remains controversial. We herein report 4 cases of laparoscopic excision of RNT that resulted in diverse clinical outcomes.

PATIENTS AND METHODS

Between August 2005 and January 2011, we performed laparoscopic excision of RNT in 4 patients. The mean tumor size was 4.5 cm. The mean operative time was 297 minutes and the mean amount of blood loss was 55 ml. The surgeries were uneventful, with no operative complications or evidence of intra-abdominal bleeding. However, 2 patients required reoperation for delayed hemorrhage and urinoma formation, respectively.

RESULTS

The postoperative pathological diagnoses were schwannoma in 3 patients and ganglioneuroblastoma in 1 patient. All patients were well with no signs of peripheral neuropathy or radiculopathy, and CT and/or (18)F-FDG PET/CT performed during follow-up indicated no evidence of disease.

CONCLUSIONS

Obtaining extensive preoperative knowledge of the source neural and vascular anatomy of the tumor is important for the surgical planning of laparoscopic resection of RNT. When a great deal of care is taken to divide the tumor and the source nerves and vital vessels, safe execution of RNT can be achieved for minimal postoperative mortality and morbidity.

Efficacy of DynaCT for surgical navigation during complex laparoscopic surgery: an initial experience

BACKGROUND

Precise understanding of surgical anatomy is required during complex laparoscopic surgery (CLS). The purpose of this study was to present our initial operative experience with CLS facilitated by surgical navigation through DynaCT technology.

METHODS

Intraoperative computed tomography (CT) images of two CLS cases were obtained by a C-arm DynaCT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed on a workstation to define particular anatomical structures of the target tumor. The reconstructed CT images were repeatedly displayed on a submonitor. The surgeon then compared the CT images with a laparoscopic image of the surgical field, thus providing a virtual map to the surgeon.

RESULTS

Using the near-real-time surgical navigation system, the surgeon could visualize the surgical anatomy and easily perform the CLS. All procedures were performed successfully with a satisfactory diagnostic yield.

CONCLUSION

This novel technology has great potential for application in CLS because it enables generation of accurate depictions of small target tumors and increases the surgeon's confidence during the procedure.

Ganglioneuroblastoma of the thoracic spinal cord: a very rare case report

An eight-month-old male child was admitted with weakness and swelling in the feet. Paraparesis and bilateral lower extremity edema were present in the neurological examination. Thoracic MRI showed an intradural intramedullary mass 61 x 11 mm in size in the T5-T10 levels. Laminotomy between the T5-T10 vertebrae was performed. A mass with smooth borders was separated from most of the neural tissue. In the postoperative MRI, we observed a contrast enhancing area, considered a residual fragment, only 5 x 4 mm in size. Histopathological properties were compatible with the intermixed subtype of ganglioneuroblastoma. Only a limited number of thoracic cord Ganglioneuroblastoma reports have been previously published. Although very rare in children and young adults, ganglioneuroblastoma should be included in the differential diagnosis of thoracic cord tumors. It is difficult to obtain a preoperative diagnosis with clinical features and radiological investigations. Diagnosis depends on histopathological examinations. Curative treatment should be in the form of a complete resection of the tumor. In partially resected cases, adjuvant radiotherapy may become necessary, along with close follow-up.