Background:

Ganglioneuromas are rare benign tumors that arise from the neural crest. Their clinical presentation is silent, and diagnosis is generally incidental. More frequently located in the retroperitoneum and the mediastinum, ganglioneuromas rarely present in the adrenal gland (1/1 000 000 in the general population).

Case report:

A 56-year-old man was referred for evaluation of an adrenal mass incidentally found in a non-contrast tomography scan ordered to study microscopic hematuria. He presented with no symptoms. A contrast-enhanced tomography scan revealed a left, 4 cm, homogeneous adrenal tumor with attenuation <20 HU upon intravenous contrast agent administration. Tumor washout was negative. Serum and urinary catecholamine metabolites were normal. Laparoscopic left adrenalectomy was performed. The histopathologic study reported spindle cell proliferation at the level of the adrenal medulla and mature ganglion cells, corresponding to adrenal ganglioneuroma.

Discussion:

Due to its silent clinical presentation, adrenal ganglioneuroma is a diagnostic challenge. The tomographic finding of a metabolically non-functioning adrenal mass, with attenuation <40 uh in the non-contrast phase, together with the presence of punctiform calcifications, is reason to suspect ganglioneuroma. If the tumor has the predictive characteristics of malignancy, such as a diameter >4 cm and delayed tumor washout, the most adequate diagnostic and therapeutic treatment is laparoscopic adrenalectomy.