PMC7924149_01
Axial (A) and coronal (B) computed tomography images of the upper abdomen after the injection of intravenous water-soluble contrast material. There is a nodule in the right adrenal gland (arrows). The left adrenal gland is normal. Noncontrast HU of the right-sided adrenal nodule, 36; enhanced HU, 106; and 10-min washout HU, 70; with a calculated washout of 34%. No calcification or fat was detected. HU = Hounsfield units.
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The calculated washout was 34%, inconsistent with a lipid-rich adrenal adenoma (Fig. 1).
T2-weighted coronal MRI of the abdomen showed a 2.5-cm right-sided adrenal nodule (arrow). The lesion did not demonstrate significant loss of signal between in-phase and out-of-phase imaging and was inconsistent with a lipid-rich adenoma. MRI = magnetic resonance imaging.
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The lesion did not demonstrate significant loss of signal between in-phase and out-of-phase imaging; therefore, it did not have the characteristics typical of a lipid-rich adenoma (Fig. 2).
A, Low-power view of the tumor. The tumor is composed of groups of short nerve bundles mixed with ganglion cells, Schwann cells, and perineural cells. The normal adrenal tissue is displaced to the periphery (upper left), and adjacent hemorrhage is noted. B, Adjacent to the nerve bundles (black arrowhead), mature ganglion cells mixed with Schwann cells and perineural cells (white arrowhead) can be observed. C, High-power view of a group of ganglion cells (white arrowheads) mixed with perineural cells (black arrowhead) in a rich capillary background. The ganglion cells contain large round nucleoli, open chromatin, prominent nucleoli, and abundant clear to eosinophilic cytoplasm. All tumor cells are mature, lacking features of nuclear pleomorphism, tumor cell necrosis, or mitosis.
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Microscopic examination demonstrated typical histological features of a ganglioneuroma, with numerous large ganglion cells, Schwann cells, and some short nerve bundles (Figure 3).