A Rare Case of Right Adrenal Ganglioneuroma: A Case Report.

Gunjot Singh Ghai; Ravikumar BR; Suhas U Umakanth

doi:10.51168/t4j9xj59

Authors

Gunjot Singh Ghai Urology, JSS Academy of Higher Education and Research, Mysuru
Ravikumar BR Urology, JSS Academy of Higher Education and Research, Mysuru
Suhas Umakanth Urology, JSS Academy of Higher Education and Research, Mysuru

DOI:

https://doi.org/10.51168/t4j9xj59

Keywords:

Adrenal, ganglioneuroma, adrenalectomy, spindle cells, Schwann cells

Abstract

Background:

Adrenal ganglioneuromas are rare benign neuroectodermal tumors. Preoperative diagnosis is often challenging, with most cases being diagnosed after adrenalectomy. The incidence of adrenal ganglioneuromas is approximately 0.3%-2% of all adrenal incidentalomas.

Case presentation:

A case of a 29-year-old female who presented with mild right flank pain. A contrast-enhanced computed tomography (CECT) scan of the abdomen and pelvis identified a well-defined soft tissue density lesion of 6 x 5.4 x 7.7 cm in the right suprarenal region with few calcifications. Post-contrast images showed minimal enhancement of 7 HU (pre-contrast at 35 HU, post-contrast venous phase at 42 HU, and delayed images at 15 minutes showing 60 HU). The absolute washout was 19%, and the relative washout was 7%. Hormonal workup (serum aldosterone, plasma free metanephrines, plasma free normetanephrines, plasma 3-methoxytyramine, and serum cortisol) was normal. The patient was clinically diagnosed with a large non-functioning right adrenal tumor with a suspicion of malignancy. The patient underwent laparoscopic right adrenalectomy. Intraoperative and postoperative periods were uneventful. Histopathological examination confirmed the diagnosis of adrenal ganglioneuroma (a spindle cell tumor composed of cells arranged in sheets with spindle to wavy normochromic nuclei, moderate eosinophilic cytoplasm, fibrous stroma, scattered ganglion cells, and areas of calcification, but absence of neuroblasts). Postoperatively, the patient is doing well and has completed 6 months of follow-up. Although adrenal ganglioneuromas are benign with mostly normal hormonal evaluation, they can mimic malignancies due to their large size.

Conclusion:

This case underscores the importance of considering adrenal ganglioneuroma in the evaluation of adrenal masses.

Author Biographies

Gunjot Singh Ghai, Urology, JSS Academy of Higher Education and Research, Mysuru
Suhas Umakanth, Urology, JSS Academy of Higher Education and Research, Mysuru

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