Adrenal ganglioneuroma: a rare incidental finding

Abstract

The widespread use of imaging technology as a diagnostic tool has resulted in the identification of many previously unknown, clinically benign lesions. The current era of easy access to imaging studies places physicians in a difficult position, since many lesions are not precisely diagnosed by imaging. For example, the accurate diagnosis of non-functioning adrenal lesions remains a clinical challenge. This report describes a patient with the incidental CT finding of an uncommon adrenal ganglioneuroma. Clinical and radiological findings can guide suspicion towards this rare lesion; however, the actual diagnosis is based on histological findings. Specific characteristics of adrenal ganglioneuromas that would allow their diagnosis without invasive procedures have not been established. This case report is an attempt to add more data that will help to establish diagnostic criteria for this rare disease.

Figure 1

Angio CT: nodular lesion of the right adrenal gland with 4.3×2.9 cm, heterogeneous with coarse calcifications and non-enhanced attenuation (less than 40 Hounsfield units).

Figure 2

Adrenal ganglioneuroma. Microscopic aspects: Schwan elongated cells, with regular nuclei without atypia or mitotic activity visible, scattered. Mature ganglion cells, arranged in an isolated or forming small aggregates.

Figure 3

Immunohistochemistry. Positivity of the spindle celss (Schwan cells) for S100. Ganglion cells are positive for synaptophysin, neuron specific enolase and chromogranin.