Ganglioneuroma, una entidad a considerar en las masas adrenales incidentales. Revisión de la literatura y reporte del primer caso de extracción completamente laparoscópica en México
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v79i2.405Keywords:
Adrenal ganglioneuroma, adrenal incidentaloma, adrenal tumor, laparoscopic adrenalectomyAbstract
INTRODUCTION
Ganglioneuromas are rare tumors that arise from the neural crest tissue, characterized by benign behavior and slow growth, located most frequently in the posterior mediastinum and rarely in the adrenal gland. Its diagnosis is generally incidental and asymptomatic.
CASE REPORT
A 56-year-old male, asymptomatic, who comes to assessment due to the finding of incidental adrenal mass in simple tomography, requested due to microscopic hematuria. Contrast tomography was performed, finding a left adrenal tumor of 4 cm diameter, with enhanced attenuation less than 20 HU. Metabolites of catecholamines in urine and blood within normal parameters. A laparoscopic adrenalectomy was performed. The histopathological study corresponds to adrenal Ganglioneuroma.
DISCUSSION
The diagnosis of adrenal ganglioneuroma represents a diagnostic challenge, due to its silent clinical presentation, some authors suggest that the findings in contrast-enhanced tomography of a metabolically nonfunctioning adrenal mass with unenhanced attenuation less than 40 HU, and the presence of punctiform calcifications should suggest ganglioneuroma, however the differentiation between neural crest tumors is histopathological.
In the presence of an adrenal mass bigger than 4 cm, regardless of its behavior and clinical characteristics, surgical management is indicated, as it corresponds to the most appropriate diagnostic and treatment method.
References
Alramadan M, López Martínez S, Cerezo Arillo AM, Martín Ordoñez F. Ganglioneuroma suprarrenal: un reto diagnóstico. Endocrinología y Nutrición. 2013;60(5):272–3. [accessed 11 Jun 2019] Available from: http://www.sciencedirect.com/science/article/pii/S1575092212001799
Adas M, Koc B, Adas G, Ozulker F, Aydin T. Ganglioneuroma presenting as an adrenal incidentaloma: a case report. J Med Case Rep. 2014;8:131. [accessed 11 Jun 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031973/
Kerkhofs TM, Roumen RM, Demeyere TB, van der Linden AN, Haak HR. Adrenal Tumors with Unexpected Outcome: A Review of the Literature. Int J Endocrinol. 2015;2015. [accessed 11 Jun 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389822/
Titos García A, Pablo Ramírez Plaza C, Ruiz Diéguez P, Marín Camero N, Santoyo Santoyo J. Ganglioneuroma como causa infrecuente de tumor suprarrenal. Endocrinol Nutr. 2011;58(8):443–5. [accessed 11 Jun 2019] Available from: http://www.sciencedirect.com/science/article/pii/S157509221100115X
Zhou Y, Liang Q, Ou W-T, Li Z-Y, Liu Q-L. Laparoscopic resection of primary adrenal ganglioneuroma: A case report and review of the literature. Oncol Lett. 2015;9(5):2167–70. doi: https://doi.org/10.3892/ol.2015.3021
Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review. J Endocrinol Invest. 2015;38(5):547–54. doi: https://doi.org/10.1007/s40618-014-0226-y
Olivar J, Fernández A, Aguilera A, Diaz P, Martín V, Lahera M. Ganglioneuroma adrenal: dilema clínico-quirúrgico acerca de un hallazgo fortuito. Endocrinología y Nutrición. 2013;60(10):e37–40. [accessed 11 Jun 2019] Available from: http://www.sciencedirect.com/science/article/pii/S1575092213001277
Kacagan C, Basaran E, Erdem H, Tekin A, Kayikci A, Cam K. Case report: Large adrenal ganglioneuroma. Int J Surg Case Rep. 2014;5(5):253–5. [accessed 11 Jun 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008857/
Guo Y-K, Yang Z-G, Li Y, Deng Y-P, Ma E-S, Min P-Q, et al. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol. 2007;62(3):359–70. doi: https://doi.org/10.1016/j.ejrad.2006.12.011
Xie J, Dai J, Zhou W-L, Sun F-K. Adrenal Ganglioneuroma: Features and Outcomes of 42 Cases in a Chinese Population. World J Surg. 2018;42(8):2469–75. doi: https://doi.org/10.1007/s00268-018-4499-8
Shawa H, Elsayes KM, Javadi S, Morani A, Williams MD, Lee JE, et al. Adrenal ganglioneuroma: features and outcomes of 27 cases at a referral cancer centre. Clin Endocrinol (Oxf). 2014;80(3):342–7. doi: https://doi.org/10.1111/cen.12320.1111/cen.12320
Radin R, David CL, Goldfarb H, Francis IR. Adrenal and extra-adrenal retroperitoneal ganglioneuroma: imaging findings in 13 adults. Radiology. 1997;202(3):703–7. doi: https://doi.org/10.1148/radiology.202.3.9051020
Perrino C. Ganglioneuroma. 2014. [accessed 11 Jun 2019] Available from: http://www.pathologyoutlines.com/topic/adrenalganglioneuroma.html
Bin X, Qing Y, Linhui W, Li G, Yinghao S. Adrenal incidentalomas: experience from a retrospective study in a Chinese population. Urol Oncol. 2011;29(3):270–4. doi: https://doi.org/10.1016/j.urolonc.2009.03.027
Dinnes J, Bancos I, Ferrante di Ruffano L, Chortis V, Davenport C, Bayliss S, et al. Management of endocrine desease: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis. Eur J Endocrinol. 2016;175(2):R51-64. doi: https://doi.org/10.1530/EJE-16-0461
Agrusa A, Romano G, Frazzetta G, Chianetta D, Sorce V, Di Buono G, et al. Laparoscopic adrenalectomy for large adrenal masses: single team experience. Int J Surg. 2014;12 Suppl 1:S72-74. doi: https://doi.org/10.1016/j.ijsu.2014.05.050
Young WF. The Incidentally Discovered Adrenal Mass. N Engl J Med. 2007;356(6):601–10. [accessed 11 Jun 2019] Available from: https://doi.org/10.1056/NEJMcp065470
Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1–34. doi: https://doi.org/10.1530/EJE-16-0467
Ari A, Buyukasik K, Tatar C, Segmen O, Ersoz F, Arikan S, et al. Laparoscopic Treatment of Adrenal Tumors: A Single-Center Experience with 58 Patients. Surg Res Pract. 2016;2016. [accessed 11 Jun 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128712/
Camacho-Castro AJ, Aguilar-Enríquez I, Gerardo-Osuna I, Moya-Núñez JL. Ganglioneuroma suprarrenal gigante: reporte de un caso. Rev Mex Urol. 2018;78(4):298–302.
