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Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
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American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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David Rain
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A Rare Adrenal Incidentaloma: Case Report of a Right Adrenal Ganglioneuroma

Youssef Jakhlal*, Ahmed Jahid, Settaf Abdellatif

Department of Digestive surgery B, Ibn Sina Teaching Hospital, Mohammed V University, Rabat, Morocco

Abstract: Adrenal ganglioneuroma (AGN) is an extremely rare and benign tumor that originates from the neural crest tissue of the sympathetic nervous system. The majority of cases are detected incidentally. It presents a challenging preoperative diagnostic differential with other solid adrenal tumors. However, the assessment and management of AGNs are similar to other adrenal tumors. We present a case of a 40-year-old female referred to our institution for a right solid adrenal mass that was detected incidentally on an abdominal CT scan (4×5×5cm). The patient underwent laparoscopic surgical excision of the tumor. The histopathology examination showed areas of spindle cells and scattered mature ganglionic cells compatible with AGN.

Keywords: adrenal ganglioneuroma, imaging features, laparoscopy

Received June 22, 2020; Revised July 23, 2020; Accepted August 03, 2020

Citation: Youssef Jakhlal, Ahmed Jahid, Settaf Abdellatif, A Rare Adrenal Incidentaloma: Case Report of a Right Adrenal Ganglioneuroma. Global Journal of Surgery, 8 (1). 17-20. January 2020. doi:10.12691/js-8-1-4

1. Introduction

Adrenal Ganglioneuroma (AGN) is a rare and benign tumor that originates from primitive neural crest cells. Histologically, the tumor is composed of Schwann mesenchymal cells and gangliocytes. Commonly, AGNs are hormonally silent and as a result can be asymptomatic even when the lesion is of substantial size. It is difficult to make a precise diagnosis preoperatively. Definitive diagnosis is done by the histopathological examination of the specimen. The assessment and management of these tumors are similar to other adrenal tumors.

2. Presentation of Case

A 40-year-old female, with no previous medical history, consulted for right lumbago evolving for 2 months without any other associated signs. The physical examination was without particularity. An abdominopelvic CT showed a right adrenal incidentaloma measuring 4 × 5 × 5 cm, well limited with lobulated contours, hypodense heterogeneous enhanced after injection and containing central calcifications (Figure 1). Complete preoperative hormonal evaluation was carried out to evaluate functionality and the lesion was considered a non-secreting tumor.

Figure 1. An abdominopelvic scan showed a right adrenal incidentaloma measuring 4 × 5 × 5 cm, well defined with lobulated contours, hypo-dense heterogeneous enhanced after injection with central calcifications: A) axial section; B) coronal section

Figure 2. Tumor proliferation made of spindle cells without atypia; in contact with the adrenal fat. (HEx10)

Figure 3. Spindle cells arranged in bundles containing layers of mature ganglion cells. (HEx40)

The patient underwent laparoscopic right adrenalectomy whose histopathological examinations confirm the diagnosis of AGN (Figure 2 and Figure 3). The postoperative period was uneventful.

3. Discussion

A GN is a rare differentiated benign tumor arising from primordial neural crest cells that form the sympathetic nervous system [1]. On histology studies, it is composed of mature Schwann cells and ganglion cells with a fibrous stroma [2,3]. GNs are a member of a group of neurogenic tumors which include ganglioblastomas and neuroblastomas. It differs from other neurogenic tumors in its benign nature [1]. GNs may arise in any region of the paravertebral sympathetic plexus [4,5], but are typically observed in the posterior mediastinum (39-43%) or the retroperitoneum (3252%). In contrast, neuromas rarely occur in the adrenal glands [6,7]. Although GNs are generally considered to occur more frequently in young people, some recent studies have shown that they may also be seen in patients between the ages 40 and 50 [8,9].

Adrenal GNs are usually silent hormonally and as a result can be asymptomatic; even when the lesion is of substantial size [8,10]. On the other hand, it has been reported that up to 30% of patients with GNs may have elevated plasma and urinary catecholamine levels, but without exhibiting any symptoms of catecholamine hypersecretion [2]. Additionally, it has been noted that ganglion cells can secrete vasoactive intestinal peptide (VIP), While pluripotent precursor cells sometimes produce steroid hormones, such as cortisol and testosterone [11,12].

Most GNs are discovered incidentally on imaging studies [7,13]. Ultrasonography shows a well-defined, homogeneous, hypoechogenic mass [14,15]. CT usually reveals a homogeneous or slightly heterogeneous mass that tends to surround major blood vessels without compression or occlusion. The tumor is well-defined, hypodense, and poorly enhanced by contrast medium [14,16]. Calcifications, typically fine and punctate, are seen in approximately 42-60% of GNs. Early enhancement of linear septae has been reported, and delayed heterogeneous contrast uptake has also been described in some cases. CT allows for an accurate description of the lesion and its relationship with vascular structures [17]. On magnetic resonance imaging, T1-weighted images tend to have homogeneously low or intermediate signal, whereas T2-weighted images have heterogeneously intermediate or high signal [18]. Arguably, the latter is caused by the presence of the myxoid matrix along with a relatively low number of ganglion cells [17]. Furthermore, gadolinium administration can result in delayed and progressive enhancement of the lesion [10,14]. Moreover, MIBG (131-metaiodobenzylguanidine) scintigraphy produces similar results in GNs, ganglioneuroblastomas and neuroblastomas [7,14]. Recently, PET scans have been proclaimed to facilitate the diagnostic process. Particularly, a Standardized Uptake Value (SUV) of 3.0 or higher has been suggested to distinguish malignant adrenal lesions from benign ones with a 100% sensitivity and 98% specificity [19]. However, Adas and al [20] did report an adrenal GN with a SUV of 4.1 that was determined to be histologically benign.

Preoperative diagnosis is difficult because of the lack of specific imaging findings [11,21]. Percutaneous biopsy may help, but the presence of undifferentiated components limits its utility [11,22]. The differential diagnosis of adrenal GN includes other adrenal solid masses such as pheochromocytoma, NB, GNB, adenoma, and carcinoma [2,11,22]. GNB and NB more frequently develop in children.

Ultimately, histopathological examination is required to confirm the diagnosis of GN. In the vast majority of cases, GNs are histologically benign lesions which can be classified into two main categories [2]. Firstly, “mature type” GNs comprise of mature Schwann cells, ganglion cells, and perineural cells within a fibrous stroma While completely lacking neuroblasts and mitotic figures [10]. Secondly, “maturing type” GNs consist of similar cellular populations with miscellaneous maturation degrees, ranging from fully mature cells to neuroblasts. Nevertheless, the detection of neuroblasts is typically indicative of neuroblastomas or ganglioneuroblastomas. These types of neurogenic tumors have the potential to evolve into GNs [14]. Characteristically, GNs exhibit immunohistochemical reactivity for specific markers such as S-100, vimentin, synaptophysin, and neuron-specific enolase [18].

Surgical management remains the gold standard for the treatment of primary adrenal GNs [2,23]. Surgical indications are similar to that of adrenal incidentalomas: if size exceeds 4-6 cm and/or suspicion of malignancy. AGNs are often non-secretory. Nonetheless, malignant GNs remain extremely rare occurrences [24]. Even though laparoscopic adrenalectomy is usually the procedure of choice, a number of variables (e.g., hormonal activity, tumor location, and proximity to adjacent structures) also need to be taken into account when deciding on the best approach to manage these rare tumors [25]. Wide margin resections are usually unnecessary because adrenal GNs rarely metastasize or recur. Postoperatively, there is no need for adjuvant therapy in patients with AGNs and their prognosis is excellent [2,24].

4. Conclusion

AGNs are rare tumors and, despite some peculiarities used for radiologic diagnosis, preoperative diagnosis is difficult. Therefore, complete resection is recommended once malignancy cannot be excluded. The prognosis is excellent with surgical removal.

References

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