Extra-adrenal retroperitoneal ganglioneuroma

Abstract

A 74-year-old woman presented to the hospital complaining of fatigue and atypical epigastric discomfort. Physical examination revealed epigastric tenderness. She had no relevant clinical history. Laboratory findings were within normal limits. A CT scan of the abdomen was performed and showed a large well-defined, lobulated hypodense mass in the retroperitonium (Fig. A, arrows), containing small punctate calcifications (Fig. A, arrowheads). After intravenous contrast administration the mass showed slight and inhomogeneous enhancement. The mass surrounded the celiac trunc (Fig. B, arrowhead) and superior mesenteric artery, without evidence of luminal narrowing. On MRI, the lesion was homogeneous and hypointense relatively to the liver on T1, and heterogeneous and hyperintense on T2. Axial contrast-enhanced dynamic T1- weighted MR images obtained 40 seconds (Fig. C1, arrows) and 100 seconds (Fig. C2, arrows) after contrast material injection showed gradual but heterogeneous enhancement of the mass. The radiological differential diagnosis included lymphadenopathy and neurogenic tumor. No malignancy was found elsewhere in the body. CT guided percutaneous biopsy of the mass was performed and pathology revealed an extra-adrenal ganglioneuroma. Encasement of the vascular structures made radical excision impossible. Followup by imaging after 6 months was recommended.