Ganglioneuroma

Case contributed by Ammar Ashraf
Diagnosis certain

Presentation

Abdominal pain (lumbar region) for 10 days, associated with a few episodes of vomiting. No dysuria or fever.

Patient Data

Age: 30 years
Gender: Male
ultrasound
Longitudinal
Longitudinal
Longitudinal
Longitudinal
Longitudinal
Longitudinal
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Info

Heterogeneous partly calcified mass lesion measuring 5 x 6 cm, in right suprarenal location. No vascularity is seen in it on color Doppler ultrasound examination. 

ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial C+
arterial phase
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal
non-contrast
This study is a stack
Coronal C+
arterial phase
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Sagittal
non-contrast
This study is a stack
Sagittal C+
arterial phase
This study is a stack
Sagittal C+ portal
venous phase
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Info

Right suprarenal mass lesion measuring about 5.7 x 5.4 cm, containing multiple flocculent calcifications, showing enhancement of the soft tissue components in the post-contrast study. Partially thrombosed inferior vena cava. Multiple para-aortic and renal hilar lymph nodes, with the largest one measuring 1.2 cm in short axis. Multiple simple and a few hyperdense (hemorrhagic/complicated) bilateral renal cysts. 

I-123 MIBG

Nuclear medicine
Posterior
planar abdomen
Anterior and posterior planar
image of chest & abdomen
Coronal
SPECT
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Info

Abnormal I-123 MIBG uptake in the right suprarenal region, with no evidence of MIBG-avid disease elsewhere.  

Case Discussion

Procedure: Open right adrenalectomy.

Diagnosis: Ganglioneuroma (schwannian stroma-dominant). 

Immunohistochemistry: S100 (polyclonal) is strongly positive. SMA (Alpha-SM1) is negative.

40 % of ganglioneuromas are seen in patients over the age of 20 years and 20 % are within the adrenal gland. 

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