title: Adrenal ganglioneuromas: incidentalomas with misleading clinical and imaging features.
abstract: BACKGROUND
  Ganglioneuromas are benign neoplasms of the neural crest, occurring rarely in the adrenal glands. This study presents our experience regarding diagnostic and therapeutic management of these neoplasms and a review of the relevant literature.
  
  
  METHODS
  Among 150 patients with of incidentalomas, we had 7 primary ganglioneuromas. Their clinical, imaging, and operative data were collected retrospectively, and the literature was reviewed using MEDLINE. There were 4 females and 3 males, with mean age of 50 years (range, 39-64). All neoplasms were discovered incidentally with ultrasonography and were evaluated subsequently with computed tomography (CT). One patient was studied further with (131)I-MIBG due to asymptomatic increased in urine vanillylmandelic acid, and 1 patient with history of breast cancer underwent additional FDG-PET/CT.
  
  
  RESULTS
  All but 2 patients were asymptomatic. Two patients complained of epigastric pain and hypertension, respectively. The preoperative mean size on CT was 6.8 cm, whereas the postoperative true mean histologic size was 7.7 cm. Both patients who were evaluated with radionuclide studies had false positive results, suggestive of pheochromocytoma and adrenal metastasis, respectively. Three patients underwent open adrenalectomy due to preoperative suspicion of carcinoma, and the remaining 4 underwent laparoscopic anterior adrenalectomy. Histologically, all 7 neoplasms were completely differentiated, mature ganglioneuromas. We had no mortality or significant morbidity. No recurrence occurred during a mean follow-up of 6 years (range, 1-18).
  
  
  CONCLUSIONS
  Adrenal ganglioneuromas are rare incidentalomas that can mimic primary or secondary adrenal malignancies as well as pheochromocytomas. Despite their usually large size, resection via laparoscopic approach is safe and effective.
authors.affiliation: 1st Surgical Clinic, Diagnostic and Therapeutic Center of Athens Hygeia, Athens, Greece. dlinos@hms.harvard.edu
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Linos
authors.forename: Theodoros
authors.initials: T
authors.lastname: Tsirlis
authors.forename: Athina
authors.initials: A
authors.lastname: Kapralou
authors.forename: Andreas
authors.initials: A
authors.lastname: Kiriakopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsakayannis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papaioannou
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods; D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005729:Ganglioneuroma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome