Adrenal Ganglioneuroma. A Neoplasia to Exclude in Patients with Adrenal Incidentaloma

OBJECTIVE: To determinate the MRI and CT scanning appearance of adrenal ganglioneuroma and correlate the imaging with histological features. SUMMARY BACKGROUND DATA: In the last 10 years, eight patients with a pathologically proven adrenal ganglioneuroma were operated on in our department of endocrine surgery. To our knowledge, these patients represent one the largest reported cohorts of adrenal ganglioneuroma treated in a single institution. METHODS: All these eight patients had a comprehensive hormonal work up and underwent CT and/or MRI. Biological data, radiological features and histological findings were thoroughly reviewed in order to further characterize these tumours. RESULTS: The most relevant characteristics of adrenal GN resected in our patients were: No hormonal hypersecretion, Presence of calcifications; no vessel involvement; and a non-enhanced attenuation of less than 40 HU on CT, A low non-enhanced T1W signal, a slightly high and heterogeneous T2W signal, a late and gradual enhancement on dynamic MRI, especially if associated with a whorled pattern. CONCLUSIONS: Even if many aggressive tumours, mainly adrenal carcinoma, may share some of these radiological features, the presence of all or most of them must made the clinician evoke the diagnosis of GN.