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Impellizzeri P, Peri FM, Arena S, Trimarchi R, Romeo C, Dionigi G. Retroperitoneal approach in a child with ganglioneuroma: points of technique and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background data
Ganglioneuroma is rare in children and often incidentally discovered. The transperitoneal laparoscopic approach is the surgical choice for most of the surgeons because of the familiar anatomy and the wider working spaces. However, a posterior retroperitoneal approach started to be used in pediatric population demonstrating to be safe and effective.
Case presentation
We present a case of a child with radiological finding of a right adrenal mass. Due to the increased risk of having a malignant transformation, a surgical resection was decided using a retroperitoneal approach. The adrenal mass was recognized and completely enucleated. The histopathological examination revealed a GN. Clinical course was uneventful with hospital discharge after 3 days. The outcome was evaluated by ultrasound examination performed 3–6 to 12–24 months and then annually. After 24 months, the patient is completely asymptomatic, and no adrenal masses in both sides have been detected.
Conclusions
The posterior retroperitoneoscopy permits a more direct exposure of the adrenal gland, without violating the peritoneum, and a close vision to the main vessels. We believe that this technique is a valid option for pediatric patients with small adrenal lesions.
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2
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Negahi A, Jahanshahi F, Boozari B, Sadeghipour A. The occurrence of giant mesenteric cyst and adrenal ganglioneuroma in a schizophrenic male patient presenting as pseudocyesis: A case report. Clin Case Rep 2021; 9:193-197. [PMID: 33489158 PMCID: PMC7813079 DOI: 10.1002/ccr3.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/29/2020] [Accepted: 10/20/2020] [Indexed: 11/09/2022] Open
Abstract
In psychological patients like our case, somatically expressed symptoms which can imply another psychological syndrome should be dealt with cautiously.
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Affiliation(s)
- Alireza Negahi
- General Surgery DepartmentRasoul Akram Hospital, Iran University of Medical SciencesTehranIran
| | - Fatemeh Jahanshahi
- Student Research CommitteeFaculty of MedicineIran University of Medical SciencesTehranIran
| | - Behnaz Boozari
- Pathology Department, Firoozgar HospitalIran University of Medical SciencesTehranIran
| | - Alireza Sadeghipour
- Pathology DepartmentRasoul Akram Hospital, Iran University of Medical SciencesTehranIran
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Burns AJ, Sullivan KM, Koh EK, Tretiakova MS, Zern NK. Dopamine secreting adrenal tumor-ganglioneuroma rather than pheochromocytoma: case report. Gland Surg 2020; 9:2204-2210. [PMID: 33447572 DOI: 10.21037/gs-20-475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ganglioneuromas are rare, benign, well-differentiated neural crest tumors arising in the paravertebral sympathetic chain, and are classically non-secretory and clinically asymptomatic. As the diagnosis of ganglioneuroma is based on histopathology, the clinical presentation prior to surgical excision often mirrors that of pheochromocytoma or adrenal cortical adenoma. We describe a case of an incidentally found right sided calcified adrenal mass with evidence of marked dopamine excess, suspicious for pheochromocytoma in a 70-year-old female. The patient endorsed a 6-month history of intermittent right flank pain and a 2-year history of weight loss and fatigue. She reported mild symptoms of hypomania but denied other symptoms of dopamine excess including agitation, anxiety, nausea, and vomiting. Exam revealed isolated mild hypertension. The imaging features of this mass were concerning for malignancy including the presence of macrocalcification and irregular borders. After preoperative alpha blockade, the patient underwent open right adrenalectomy and the final pathology was consistent with ganglioneuroma rather than pheochromocytoma. Following resection, the dopamine level normalized, confirming the resected right adrenal ganglioneuroma as the source of dopamine excess. This case represents a rare presentation of dopamine-secreting adrenal ganglioneuroma. This illustrates that although rare, ganglioneuroma should be included on the differential diagnosis for functional adrenal tumors.
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Affiliation(s)
- Alicia J Burns
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin M Sullivan
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Eun K Koh
- Multicare Endocrinology, Tacoma, WA, USA
| | | | - Nicole K Zern
- Department of Surgery, University of Washington, Seattle, WA, USA
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Shao M, Zhang W, Niu Z, Chen S, Jia Y, An Y, Zhu F, Wang J. Computed tomography characteristics of adrenal ganglioneuroma: a retrospective analysis of 30 pathologically-confirmed cases. J Int Med Res 2020; 48:300060520945510. [PMID: 33176508 PMCID: PMC7673062 DOI: 10.1177/0300060520945510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the computed tomography (CT) characteristics of adrenal ganglioneuromas (AGNs) and to determine the ability of CT scanning to distinguish between large (>3 cm) and small (≤3 cm) AGNs. Methods This retrospective study searched the electronic medical record system of a hospital between January 2008 and July 2019 in order to identify patients with pathologically-confirmed AGNs that underwent three phases of CT scanning. The CT features were compared between large and small AGNs. Results A total of 30 patients with pathologically-confirmed AGNs were included in the study. The majority of patients (76.7%; 23 of 30) were asymptomatic and there were nonspecific symptoms in seven patients. The ‘pointed peach’ sign appeared in more than half of the patients (53.3%; 16 of 30). The CT value of the arterial phase, progressive enhancement, morphology and calcification in the CT images were found to be significantly different between large and small AGNs. Progressive enhancement was more likely to occur in small AGNs. Most large AGNs had irregular shapes, while small AGNs were likely to be round or oval with a smooth border. Calcifications were noted in large AGNs (42.9%; six of 14). Conclusion CT scanning can show many of the key imaging characteristics of AGNs used to distinguish between large and small AGNs.
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Affiliation(s)
- Meihua Shao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Wenming Zhang
- Department of Radiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China
| | - Zhongfeng Niu
- Department of Radiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China
| | - Songkuan Chen
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Yuzhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Yongyu An
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fangmei Zhu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
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Nardi WS, Quildrian SD. Left adrenal ganglioneuroma: Report of a new case. Int J Surg Case Rep 2018; 45:143-145. [PMID: 29631229 PMCID: PMC6000988 DOI: 10.1016/j.ijscr.2018.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/10/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adrenal ganglioneuroma (AGN) represents about 20% of the reported cases. PRESENTATION OF CASE We present a 37-year-old man referred to our institution for a history of abdominal discomfort and a left adrenal solid mass incidentally discovered in CT abdominal scan (24 × 20 mm). Patient underwent laparoscopic surgical excision of the tumor. CONCLUSION The histopathology examination showed areas of spindle cells and scattered mature ganglionic cells compatible with AGN.
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Affiliation(s)
- Walter Sebastián Nardi
- Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Perdriel 74, CABA, 1280AEB, Argentina.
| | - Sergio Damián Quildrian
- Soft Tissue Tumors Unit, Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Perdriel 74, CABA, 1280AEB, Argentina.
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Lee JH, Chai YJ, Kim TH, Choi JY, Lee KE, Kim HY, Yoon YS, Kim HH. Clinicopathological Features of Ganglioneuroma Originating From the Adrenal Glands. World J Surg 2017; 40:2970-2975. [PMID: 27431319 DOI: 10.1007/s00268-016-3630-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ganglioneuromas are benign tumors that rarely develop from adrenal glands. In this study, we present our clinical experience of patients with adrenal ganglioneuroma (AGN). METHODS Demographic, diagnostic, surgical, and pathologic findings of patients who were adrenalectomized as a result of AGN were retrospectively reviewed from the database of a tertiary referral hospital. RESULTS Among 1784 patients who underwent an adrenalectomy between 2002 and 2015, 35 (1.9 %; 14 males, 21 females) were diagnosed with AGN. Mean age was 33.4 ± 18.7 years (0-84). Twenty-nine (82.9 %) were asymptomatic, four (11.4 %) complained of abdominal discomfort, and two (5.7 %) had abdominal distension. Preoperative computed tomography (CT) reported AGN in 22 (62.9 %) cases. Precontrast Hounsfield units, increased postcontrast phase attenuation, and well-defined borders were characteristic CT features of AGN. Mean tumor size was 6.3 ± 3.3 cm (range, 1.5-16.0). No recurrence occurred during a median follow-up period of 19 months (range, 1-120). CONCLUSION AGN was asymptomatic in most cases and diagnosis may be challenging. Adrenalectomy is a safe treatment modality for AGN and ensures favorable outcomes when diagnosed.
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Affiliation(s)
- Joon-Hyop Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Young Jun Chai
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, 101 Daeak-ro, Jongno-gu, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital and College of Medicine, 101 Daeak-ro, Jongno-gu, Seoul, Korea
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Maciel CA, Tang YZ, Coniglio G, Sahdev A. Imaging of rare medullary adrenal tumours in adults. Clin Radiol 2016; 71:484-94. [PMID: 26944698 DOI: 10.1016/j.crad.2016.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/14/2015] [Accepted: 01/26/2016] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- C A Maciel
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK.
| | - Y Z Tang
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - G Coniglio
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - A Sahdev
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
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Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review. J Endocrinol Invest 2015; 38:547-54. [PMID: 25501841 DOI: 10.1007/s40618-014-0226-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Ganglioneuromas are benign tumors which originate from the neural crest. This tumor affects mainly young patients rather than adult ones, and its most frequent localizations are mediastinum, retroperitoneum, adrenal glands and cervical region. Usually, ganglioneuromas are discovered as incidentalomas since they are often asymptomatic, even if they could present sympathetic or mass-related symptoms. To obtain a definitive diagnosis, histological exam is necessary since CT scan and MRI are not capable of distinguishing ganglioneuromas from other tumors, such as neuroblastomas or pheocromocytomas. The surgical excision is the chosen treatment and it offers an excellent prognosis. METHODS We conducted a retrospective analysis of our cases of ganglioneuroma from 2004 to 2014; this study aims to compare our experience with literature review (2000-2014). Data about patients' features, tumor localization, symptoms, treatment and follow-up were analyzed and reported in detailed tables. RESULTS Between 2004 and 2014 we treated 14 patients affected by ganglioneuroma. For all of them the diagnosis was incidental; 9 out of 12 (64.3 %) patients presented an adrenal mass; in 2 patients (14.3 %) the tumor was localized in cervical region; in other 2 patients (14.3 %) the tumor was in the retroperitoneum and one patient (7.1 %) presented a ganglioneuroma in the costo-vertebral space. All our patients underwent surgical removal and none of them present surgery-related complications or recurrences to date. CONCLUSIONS Our data widen the knowledge about ganglioneuroma and confirm that the surgical approach has an excellent prognosis with very low incidence of surgery-related complications and recurrences.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A Barbetta
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - C Ugolini
- Department of Laboratory Medicine and Integrated Diagnostics, Section of Experimental Pathology, University of Pisa, Pisa, Italy.
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Zhou Y, Liang Q, Ou WT, Li ZY, Liu QL. Laparoscopic resection of primary adrenal ganglioneuroma: A case report and review of the literature. Oncol Lett 2015; 9:2167-2170. [PMID: 26137033 DOI: 10.3892/ol.2015.3021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/10/2015] [Indexed: 01/06/2023] Open
Abstract
Adrenal ganglioneuroma (AGN) is an extremely rare, benign tumor that originates from the neural crest tissue of the sympathetic nervous system. The majority of cases are detected incidentally, since the disease often lacks clear clinical manifestations or is asymptomatic. In addition, AGN is often misdiagnosed as being an adrenal adenoma or adrenal pheochromocytoma. The present study describes a 58-year-old female who visited the outpatient clinic of the Affiliated Hospital of Guangdong Medical College (Zhanjiang, Guangdong, China) with symptoms of face and lower extremity dropsy. Color Doppler ultrasonography revealed a solid tumor in the right kidney, and abdominal computed tomography identified an irregular, solid tumor measuring ~6×4.5×7 cm3 and arising from the right adrenal gland, with a clear boundary. Magnetic resonance imaging was not performed. An initial diagnosis of adrenal adenoma was established. The patient was treated by laparoscopy in order to remove the tumor. However, following surgery, a pathological examination suggested that the tumor was a GN originating from the adrenal medulla. The formation of a correct diagnosis can be extremely challenging, as AGNs do not exhibit any specific clinical manifestations. Therefore, detection often depends entirely upon imaging studies, and the final diagnosis can be only by confirmed following a histopathological evaluation.
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Affiliation(s)
- Yuan Zhou
- Department of Oncology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524001, P.R. China
| | - Qilian Liang
- Department of Oncology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524001, P.R. China
| | - Wen-Ting Ou
- Department of Oncology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524001, P.R. China
| | - Zhou-Yu Li
- Department of Radiotherapy, Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Qiu-Long Liu
- Department of Oncology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524001, P.R. China
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10
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Incidentally detected ganglioneuroma during pregnancy: A case report. Obstet Gynecol Sci 2014; 57:228-31. [PMID: 24883295 PMCID: PMC4038690 DOI: 10.5468/ogs.2014.57.3.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/04/2013] [Accepted: 10/11/2013] [Indexed: 11/08/2022] Open
Abstract
Retroperitoneal ganglioneuroma is a rare benign tumor, which is included in the neuroblastomas group. It can occur anywhere along the peripheral autonomic ganglion sites, and the tumor is often incidentally detected in asymptomatic patients or may produce symptoms related to the slow growing tumor. Surgical excision is the treatment of choice and the prognosis is good. We report a case of retroperitoneal ganglioneuroma, which was incidentally detected in the first trimester of pregnancy in a 29-year-old woman. Surgical resection of the ganglioneuroma was done at the time of cesarean section at full term without complications.
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Adas M, Koc B, Adas G, Ozulker F, Aydin T. Ganglioneuroma presenting as an adrenal incidentaloma: a case report. J Med Case Rep 2014; 8:131. [PMID: 24779851 PMCID: PMC4031973 DOI: 10.1186/1752-1947-8-131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/17/2014] [Indexed: 12/12/2022] Open
Abstract
Introduction Ganglioneuromas are rare benign tumors arising from the neural crest tissue and are most commonly located in the posterior mediastinum and retroperitoneum; they are rarely found in the adrenal gland. This tumor is usually asymptomatic and in the majority of cases is detected incidentally. Although the characteristics of adrenal ganglioneuroma on computerized tomography and magnetic resonance imaging have been well described, the exact diagnosis is difficult. Histopathological examination is currently the mainstay of diagnosis. Ganglioneuromas have a very good prognosis with surgical removal. We report the case of a male patient with an incidentally identified adrenal ganglioneuroma with high standardized uptake values in a positron emission tomography scan. Case presentation An 18-year-old Turkish male patient with no previous comorbidities was admitted to our hospital with lower-quadrant pain. He had no significant past medical or surgical history. A physical examination did not reveal any signs and the results of routine laboratory tests were all within the normal ranges. Our patient underwent computed tomography of his abdomen, which showed a relatively homogenous left adrenal tumor measuring 5.2×4.3×7.1cm. On a positron emission tomography scan, the left adrenal gland disclosed a standardized uptake value of 4.1. Our patient underwent an exploratory laparotomy with left adrenalectomy without any related complications. Conclusion Ganglioneuroma may sometimes be similar to other adrenal malignancies. Careful evaluation with endocrine tests and imaging procedures is necessary to provide an accurate diagnosis. Definitive diagnosis can be made by histological examination. The prognosis is very good with surgical removal.
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Affiliation(s)
| | - Bora Koc
- Department of Surgery, Okmeydani Training and Research Hospital, 34200 Şişli, İstanbul, Turkey.
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12
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Erem C, Fidan M, Civan N, Cobanoglu U, Kangul F, Nuhoglu I, Alhan E. Hormone-secreting large adrenal ganglioneuroma in an adult patient: a case report and review of literature. Blood Press 2013; 23:64-9. [PMID: 23705630 DOI: 10.3109/08037051.2013.796103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND. Ganglioneuromas (GNs) are neural crest cell-derived tumors and rarely occur in the adrenal gland. They are usually asymptomatic and hormonally silent. The majority of cases are detected incidentally during work-up for unrelated conditions. Hormone-secreting pure adrenal GNs in adults are extremely rare. To date, only four cases have been reported in the English literature. CASE REPORT. We describe an adult case of endocrinologically active adrenal GN incidentally diagnosed in a 64-year-old male patient with history of uncontrolled hypertension. On physical examination, he had a blood pressure (BP) of 160/100 mmHg. Abdominal computed tomography and magnetic resonance imaging showed a large solid tumor (8.5 × 7.5 × 7 cm) in the right adrenal gland. Urinary levels of norepinephrine, normetanephrine, vanillylmandelic acid and dopamin were elevated, although urinary level of epinephrine was suppressed. Right adrenalectomy was performed for treatment purposes. The histological diagnosis of the resected tumor was adrenal GN. CONCLUSIONS. Hormone-secreting pure adrenal GN occurs very rarely in adults and preoperative diagnosis is difficult. Adrenal GN may present with hormonal activity such as increased secretion of catecholamines and their metabolites. There are no specific diagnostic signs and symptoms discriminating GN and pheochromocytoma. Therefore, histopathological examination need for a definitive diagnosis of adrenal GN. The prognosis after completed surgical resection without further therapy seems to be excellent. To our knowledge, the present case is the second report that describes hormone-secreting pure adrenal GN in an adult from Turkey in the English literature. We discuss this case and review the literature on this unusual entity.
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Affiliation(s)
- Cihangir Erem
- Division of Endocrinology and Metabolism,Department of Internal Medicine
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13
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Alramadan M, López Martínez S, Cerezo Arillo AM, Martín Ordoñez F. Adrenal ganglioneuroma: a diagnostic challenge. ACTA ACUST UNITED AC 2012; 60:272-3. [PMID: 23141899 DOI: 10.1016/j.endonu.2012.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/19/2012] [Accepted: 04/20/2012] [Indexed: 11/29/2022]
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14
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Sucandy I, Akmal YM, Sheldon DG. Ganglioneuroma of the adrenal gland and retroperitoneum: A case report. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:336-8. [PMID: 22540109 PMCID: PMC3336884 DOI: 10.4297/najms.2011.3336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Context: Ganglioneuromas are benign tumors of the sympathetic nervous system that rarely arise in the adrenal gland. Majority of cases are detected incidentally since they are usually asymptomatic. Up to the current era of laparoscopic adrenal mass excision, this unusual entity has not been adequately reported in the surgical literature. Case Report: A 51 year old male with history of hypertension was found to have abdominal bruit during a regular physical examination. A 4 cm right adrenal mass with upper pole calcification and a 6 cm retro-pancreatic mass were subsequently found on a computed tomography scan. Endoscopic ultrasound-guided needle biopsy was indeterminate. Preoperative endocrine evaluation showed mildly elevated vanillyl mandelic acid with normal 24-hour cathecolamine, metanephrine and cortisol levels. Histopathologic examination after an uneventful laparoscopic excision was consistent with ganglioneuroma. Conclusions: Ganglioneuroma occurs rarely in adrenal gland and preoperative diagnosis is difficult since symptoms are usually nonspecific. Due to widespread utilization of abdominal imaging, however, it should be included in differential diagnosis of adrenal or retroperitoneal mass. Histopathologic examination is currently the mainstay of diagnosis.
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Affiliation(s)
- Iswanto Sucandy
- Department of Surgery, Abington Memorial Hospital, Abington, PA., USA
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15
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Camelo M, Aponte LF, Lugo-Vicente H. Dopamine-secreting adrenal ganglioneuroma in a child: beware of intraoperative rebound hypertension. J Pediatr Surg 2012; 47:E29-32. [PMID: 22974632 DOI: 10.1016/j.jpedsurg.2012.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 04/20/2012] [Accepted: 04/28/2012] [Indexed: 10/27/2022]
Abstract
Ganglioneuromas are benign tumors originating from the neural crest and are composed of mature ganglion cells. We describe a 15-year-old normotensive adolescent girl with a 2-month history of left flank pain. Imaging revealed a left suprarenal mass with elevated urinary dopamine level. During laparoscopic adrenalectomy, intraoperative rebound hypertension occurred. After resection, dopamine levels normalized. The pathologic diagnosis revealed an adrenal ganglioneuroma.
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Affiliation(s)
- Monica Camelo
- Universidad Central del Caribe, School of Medicine, Bayamón, PR 00912
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16
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Kanthan R, Senger JL, Kanthan S. Three uncommon adrenal incidentalomas: a 13-year surgical pathology review. World J Surg Oncol 2012; 10:64. [PMID: 22540324 PMCID: PMC3407001 DOI: 10.1186/1477-7819-10-64] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 04/27/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The discovery of adrenal incidentalomas due to the widespread use of sophisticated abdominal imaging techniques has resulted in an increasing trend of adrenal gland specimens being received in the pathology laboratory. In this context, we encountered three uncommon adrenal incidentalomas.The aim of this manuscript is to report in detail the three index cases of adrenal incidentalomas in the context of a 13-year retrospective surgical pathology review. METHODS The three index cases were investigated and analyzed in detail with relevant review of the English literature as available in PubMed and Medline. A 13-year retrospective computer-based histopathological surgical review was conducted in our laboratory and the results were analyzed in the context of evidence-based literature on adrenal incidentalomas. RESULTS A total of 94 adrenal specimens from incidentalomas were identified, accounting for 0.025% of all surgical pathology cases. In all 76.6% were benign and 23.4% were malignant. A total of 53 females (56.4%) and 41 males (43.6%) aged 4 to 85 years were identified. The benign lesions included cortical adenoma (43.1%), pheochromocytoma (29.3%) and inflammation/fibrosis/hemorrhage (8.3%). Metastatic neoplasms were the most common malignant lesions (50%) followed by primary adrenocortical carcinomas (31.8%) and neuroblastoma (13.6%). These cases were discovered as adrenal incidentalomas that led to surgical exploration.The three index cases of adrenal incidentalomas with unusual pathologies were encountered that included (a) adrenal ganglioneuroma, (b) periadrenal schwannoma and (c) primary adrenal pleomorphic leiomyosarcoma. These cases are discussed, with a literature and clinicopathological review. CONCLUSIONS Adrenal lesions are uncommon surgical specimens in the pathology laboratory. However, higher detection rates of adrenal incidentalomas aided by the ease of laparoscopic adrenalectomy has resulted in increased adrenal surgical specimens leading to unsuspected diagnostic and management dilemmas. Accurate pathological identification of common and uncommon adrenal incidentalomas is essential for optimal patient management.
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Affiliation(s)
- Rani Kanthan
- Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada
- Room 2868 G-Wing, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0 W8, Canada
| | - Jenna-Lynn Senger
- Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada
| | - Selliah Kanthan
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Martínez-Quiñones J, Consolini F, Aso-Escario J, Arregui R, Domínguez-Páez M. Ganglioneuroma coincidente con una extrusión discal lumbar. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rondeau G, Nolet S, Latour M, Braschi S, Gaboury L, Lacroix A, Panzini B, Arjane P, Cohade C, Bourdeau I. Clinical and biochemical features of seven adult adrenal ganglioneuromas. J Clin Endocrinol Metab 2010; 95:3118-25. [PMID: 20427489 DOI: 10.1210/jc.2009-2775] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adrenal ganglioneuroma (GN) is seldom considered in the differential diagnosis of adrenal lesions, and its clinical presentation is not well known. OBJECTIVE Our aim was to describe the clinical, biochemical, and radiological features of adrenal GNs in adults. METHODS Seven adults underwent endocrine investigation for adrenal lesions that were confirmed to be adrenal GNs. RESULTS Mean age of the seven patients was 49 yr (range, 23 to 71 yr). Average tumor diameter was 5.0 cm (range, 1.5 to 10.4 cm). In five patients, the adrenal lesions were found incidentally. A 49-yr-old female carried a germline mutation in MSH2 gene. A 57-yr-old female presented with mild virilization and increased testosterone levels. Bilateral adrenal venous sampling revealed testosterone production from her right adrenal lesion. All tumors showed nonenhanced attenuation between 25 and 40 Hounsfield units on computed tomography scan. Magnetic resonance imaging revealed low- to iso-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging. [(18)F]-2-Fluoro-deoxy-d-glucose-positron emission tomography scan (n = 5) disclosed a mean standard uptake value of 2.4. Three tumors were composite pheochromocytoma-GN. Microsatellite instability study and immunohistochemical analysis of MSH2 protein in a patient carrying a MSH2 mutation showed normal MSH2 protein expression and low microsatellite instability, indicating that the adrenal GN was not related to the patient's MSH2 germline defect. CONCLUSIONS We describe one of the largest series of adult adrenal GNs. Adrenal GNs may secrete testosterone or be part of a composite tumor with pheochromocytoma. The association of adrenal GN with MSH2 mutation seems to be a coincidental finding.
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Affiliation(s)
- G Rondeau
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l'Université de Montréal-Hôtel-Dieu, 3850, Saint Urbain Street, Montréal, Québec, Canada H2W 1T7
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Qing Y, Bin X, Jian W, Li G, Linhui W, Bing L, Huiqing W, Yinghao S. Adrenal ganglioneuromas: a 10-year experience in a Chinese population. Surgery 2010; 147:854-60. [PMID: 20060552 DOI: 10.1016/j.surg.2009.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 11/20/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adrenal ganglioneuroma (GN) is extremely rare. The present study is to describe the largest series of this adrenal tumor treated in a single medical center to our knowledge. METHODS Clinical details, radiologic, laboratory, and pathologic findings as well as follow-up data were analyzed retrospectively in 17 patients with incidentally discovered adrenal GN who received operative resection at a tertiary referral hospital in eastern China between June 1999 and June 2009. RESULTS The mean age of the 17 GN patients was 39.2 years (range, 7-72; male:female ratio, 1:2.4), of whom 13 patients had unilateral GN on the right side, and the remaining 4 on the left side. None of the 17 tumors was hormonally active. Only 6 of the 17 GN cases were diagnosed as benign nerve cell tumors by computed tomography or magnetic resonance imaging before operation. Treatment consisted of open unilateral adrenalectomy in 9 patients and laparoscopy in 8 patients. The mean pathologic size of the adrenal GNs was 6.3 +/- 3.1 cm (range, 1.0-13.0). Ultrastructural examination provided additional support for confirming the diagnosis. CONCLUSION Although there have been some clues for radiologic diagnosis of adrenal GN, pre-operative mis- and maldiagnosis are not infrequent. We recommend that complete operative resection should be considered once malignancy cannot be excluded by pre-operative evaluation. Laparoscopic adrenalectomy is a reasonable option at least for tumors < or =7 cm.
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Affiliation(s)
- Yang Qing
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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