Adrenal Ganglioneuroma: A Rare Incidentaloma

Adrenal ganglioneuroma is a very rare tumour of sympathetic nervous system that originate from neural crest sympathogonia which are completely undifferentiated cells of the sympathetic nervous system, constituting 20 to 30% of all Ganglioneuromas (GNs). GNs are generally asymptomatic and usually do not secrete hormones and most often detected incidentally on routine imaging tests during work up. The tumour could cause some complications, if it becomes large enough to press against the adjacent organs. Ganglioneuroma generally present as solitary mass which are painless and grow slowly. The common sites of GN are posterior mediastinum (41%), retroperitoneum (37%), adrenal gland (21%) and neck (8%). Histopathologically, ganglioneuroma is entirely composed of ganglion cells and schwannian stroma and does not contain neuroblasts, intermediate cells or mitotic figures. Preoperative diagnosis of GNs is difficult and cannot be made on radiological findings alone, thus histopathological examination is required in order to confirm the diagnosis of GN. Adrenal ganglioneuroma is a rare sympathetic tumour which originated from adrenal medulla. Prognosis is good after removal of the tumour, adjuvent therapy is not required and there is no recurrence. This report is of a rare case of adrenal ganglioneuroma in a 66-year- old male from Bihar came with complaints of bipedal oedema for seven days, white coloured urine and burning pain during micturition for three months. The patient was evaluated for chyluria, routine investigations were normal but ultrasound and Computed Tomography (CT) scan of abdomen revealed non-specific solitary right adrenal mass measuring 44.8×38.2 mm. Biochemical investigations showed increased catecholamines and metanephrines in plasma. The excised mass was sent for histopathological examination which showed features of adrenal ganglioneuroma and same was confirmed by immunohistochemistry.