Laparoscopic resection of primary adrenal ganglioneuroma: A case report and review of the literature

Zhou,Yuan; Liang,Qilian; Ou,Wen‑Ting; Li,Zhou‑Yu; Liu,Qiu‑Long

doi:10.3892/ol.2015.3021

Laparoscopic resection of primary adrenal ganglioneuroma: A case report and review of the literature

Authors:
- Yuan Zhou
- Qilian Liang
- Wen‑Ting Ou
- Zhou‑Yu Li
- Qiu‑Long Liu
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Affiliations: Department of Oncology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524001, P.R. China, Department of Radiotherapy, Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
Published online on: March 9, 2015 https://doi.org/10.3892/ol.2015.3021
Pages: 2167-2170

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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 ~6x4.5x7 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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1	Zografos GN, Kothonidis K, Ageli C, et al: Laparoscopic resection of large adrenal ganglioneuroma. JSLS. 11:487–492. 2007.PubMed/NCBI
2	Radin R, David CL, Goldfarb H and Francis IR: Adrenal and extra-adrenal retroperitoneal ganglioneuroma: imaging findings in 13 adults. Radiology. 202:703–707. 1997. View Article : Google Scholar : PubMed/NCBI
3	Chang CY, Hsieh YL, Hung GY, et al: Ganglioneuroma presenting as an asymptomatic huge posterior mediastinal and retroperitoneal tumor. J Chin Med Assoc. 66:370–374. 2003.PubMed/NCBI
4	Kouriefs C, Leris AC, Mokbel K, et al: Abdominal ganglioneuromas in adults. Urol Int. 71:110–113. 2003. View Article : Google Scholar : PubMed/NCBI
5	Ichikawa T, Koyama A, Fujimoto H, et al: Retroperitoneal ganglioneuroma extending across the midline: MR features. Clin Imaging. 17:19–21. 1993. View Article : Google Scholar : PubMed/NCBI
6	Rha SE, Byun JY, Jung SE, et al: Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 23:29–43. 2003. View Article : Google Scholar : PubMed/NCBI
7	Lonergan GJ, Schwab CM, Suarez ES and Carlson CL: Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics. 22:911–934. 2002. View Article : Google Scholar : PubMed/NCBI
8	Li L, Shao J, Gu J, et al: Adrenal ganglioneuromas: experience from a retrospective study in a Chinese population. Urol J. 11:1485–1490. 2014.PubMed/NCBI
9	Erem C, Ucuncu O, Nuhoglu I, et al: Adrenal ganglioneuroma: report of a new case. Endocrine. 35:293–296. 2009. View Article : Google Scholar : PubMed/NCBI
10	Ambros IM, Zellner A, Roald B, et al: Role of ploidy, chromosome 1p, and Schwann cells in the maturation of neuroblastoma. N Engl J Med. 334:1505–1511. 1996. View Article : Google Scholar : PubMed/NCBI
11	Domanski HA: Fine needle aspiration of ganglioneuroma. Diagn Cytopathol. 32:363–366. 2005. View Article : Google Scholar : PubMed/NCBI
12	Pillinger SH, Bambach CP and Sidhu S: Laparoscopic adrenalectomy: a 6-year experience of 59 cases. ANZ J Surg. 72:467–470. 2002. View Article : Google Scholar : PubMed/NCBI
13	Tischler AS: Divergent differentiation in neuroendocrine tumors of the adrenal gland. Semin Diagn Pathol. 17:120–126. 2000.PubMed/NCBI
14	Juarez D, Brown RW, Ostrowski M, et al: Pheochromocytoma associated with neuroendocrine carcinoma. A new type of composite pheochromocytoma. Arch Pathol Lab Med. 123:1274–1279. 1999.PubMed/NCBI
15	Chen CL, Huang ST, Chang PL and Ng KF: Adrenal ganglioneuroma: report of five cases. Chang Gung Med J. 23:550–554. 2000.PubMed/NCBI
16	Geoerger B, Hero B, Harms D, et al: Metabolic activity and clinical features of primary ganglioneuromas. Cancer. 91:1905–1013. 2001. View Article : Google Scholar : PubMed/NCBI
17	Watanabe T, Noshiro T, Kusakari T, et al: Two cases of pheochromocytoma diagnosed histopathologically as mixed neuroendocrine-neural tumour. Intern Med. 34:683–687. 1995. View Article : Google Scholar : PubMed/NCBI
18	Yamaguchi K, Hara I, Takeda M, et al: Two cases of ganglioneuroma. Urology. 67:e1–e4. 2006. View Article : Google Scholar : PubMed/NCBI
19	Joshi VV and Silverman JF: Pathology of neuroblastic tumors. Semin Diagn Pathol. 11:107–117. 1994.PubMed/NCBI
20	Rao RN, Singla N and Yadav K: Composite pheochromocytoma-ganglioneuroma of the adrenal gland: A case report with immunohistochemical study. Urol Ann. 5:115–118. 2013. View Article : Google Scholar : PubMed/NCBI
21	Dubois C, Jankowski A, Gay-Jeune C, et al: Imaging of adrenal ganglioneuroma: a case report. J Radiol. 86:659–662. 2005.[In French]. View Article : Google Scholar : PubMed/NCBI
22	Shi BB, Li HZ, Chen C, et al: Differential diagnosis and laparoscopic treatment of adrenal pheochromocytoma and ganglioneuroma. Chin Med J (Engl). 122:1790–1793. 2009.PubMed/NCBI
23	Elder EE, Edler G and Larsson C: Pheochromocytoma and functional paraganglioma syndrome: no longer the 10% tumor. J Surg Oncol. 89:193–201. 2005. View Article : Google Scholar : PubMed/NCBI
24	Manger WM and Eisenhofer G: Pheochromocytoma: diagnosis and management update. Curr Hypertens Rep. 6:477–484. 2004. View Article : Google Scholar : PubMed/NCBI
25	Kasperlik-Zaluska AA, Roslonowska E, Slowinska-Srzednicka J, et al: 1,111 patients with adrenal incidentalomas observed at a single endocrinological center: incidence of chromaffin tumors. Ann N Y Acad Sci. 1073:38–46. 2006. View Article : Google Scholar : PubMed/NCBI
26	Maweja S, Materne R, Detrembleur N, et al: Adrenal ganglioneuroma. A neoplasia to exclude in patients with adrenal incidentaloma. Acta Chir Belg. 107:670–674. 2007.PubMed/NCBI
27	Zografos GN, Markou A, Ageli C, et al: Laparoscopic surgery for adrenal tumors. A retrospective analysis. Hormones (Athens). 5:52–56. 2006. View Article : Google Scholar : PubMed/NCBI
28	Tsuru N, Ushiyama T and Suzuki K: Laparoscopic adrenalectomy for primary and secondary malignant adrenal tumors. J Endourol. 19:702–709. 2005. View Article : Google Scholar : PubMed/NCBI
29	Srinivasan R, Koliyadan KS, Krishnand G and Bhat SS: Retroperitoneal ganglioneuroma with lymph node metastasis: a case report. Indian J Pathol Microbiol. 50:32–35. 2007.PubMed/NCBI