Ganglioneuroblastoma: a rare cause of adrenal mass in adults
Gulsah Elbuken1, Zuleyha Karaca1, Ilkay Cakir1, Fatih Tanriverdi1, Mustafa Gulec2, Alper Akcan3, Hulya Akgun1, Kursad Unluhizarci1 & Fahrettin Kelestimur1
Introduction: Neurogenic tumors in abdomen arise from ganglion cell origin and usually seen in the distribution of the sympathetic ganglia along paraspinal areas or adrenal medulla or the organ of Zuckerkandl.
Ganglioneuroblastomas are the tumors of sympathetic cell origin which have the features of both malignant and benign neuroblastoma. The presence of immature tissue indicates potentially a malignant behavior. Ganglioneuroblastomas are most often seen in the earlier ages of childhood, especially 2 to 4 years with similar frequency in boys and girls. It is extremely rare in adults. Because of this, the radiographic and pathological features of the tumor have not been clearly understood.
Case: A 29-year-old man with adrenal mass is presented. Laboratory evaluation was compatible with a non-functioning adenoma. The computed tomography revealed a well-circumscribed tumor with central hypodens area which was 3.5× 4.5 cm in size and had 38 Hounsfield unit (HU). Based on the non-benign radiological features of adrenal mass, it was removed laparoscopically. The lesion was diagnosed as ganglioneuroblastoma with adrenal gland and surrounding fatty tissue invasion.
Conclusion: The predictive value of CT and MRI characteristics of adrenal incidentalomas is quite consistent with histopathologic findings. To exclude malignancy, adrenal masses with suspicious imaging should be removed. Ganglioneuroblastoma should be kept in mind in differential diagnosis of adrenal masses with increased HU on adrenal CT.