Adrenal ganglioneuroma: features and outcomes of 27 cases at a referral cancer centre

Shawa, Hassan; Elsayes, Khaled M.; Javadi, Sanaz; Morani, Ajaykumar C.; Williams, Michelle D.; Lee, Jeffrey E.; Waguespack, Steven G.; Busaidy, Naifa L.; Vassilopoulou‐Sellin, Rena; Jiménez, Camilo; Habra, Mouhammed Amir

doi:10.1111/cen.12320

Cited by 60 publications

(82 citation statements)

References 30 publications

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“…In the case of the nephrectomy, the robotic dexterity and magnification also facilitated pericaval node dissection which was an advantage reported by Cost et al in their case report of a pediatric robotic nephrectomy [12]. In regards to our adrenalectomy specimen, gross pathology demonstrated the mass abutting a thin rim of pseudocapsule, which is common for ganglioneuromas [25]. The positive margin of this benign tumor reported microscopically thus corresponded to a close resection rather than residual disease at the site of resection.…”

Section: Discussionmentioning

confidence: 76%

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Varda

Cho

Wagner

et al. 2018

Journal of Pediatric Urology

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Summary Background In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions. Objectives To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children’s hospital. Design We retrospectively reviewed all robotic cases performed at our institution from 2014 to 2016 for patients with a GU malignancy or a suspicious mass. The surgeries were performed by a pediatric urologist with robotic experience and a fellowship-trained MIS adult urologist specializing in oncology. Perioperative and oncologic outcomes were recorded. Results A total of eight robotic cases were performed: four partial nephrectomies (PN) with retroperitoneal lymph node dissection (LND) (OT 269–338 min, EBL 5–300 mL, LOS 3–6 days), one adrenalectomy with LND (6.4 cm mass; OT 172 min, EBL 5 mL, LOS 3 days), one nephrectomy with pericaval LND (9.8 cm mass; 234 min, EBL 25 mL, LOS 3 days), and two retroperitoneal LNDs (OT 572 and 508 min, EBL 250 and 100, LOS 3 and 4 days). Patient weights ranged from 14 to 79 kg (mean 53.4 kg). There were no major complications (Clavien 3–5). Pathology results for PN included papillary RCC (AJCC pT1aNx) and two cases of segmental cystic renal dysplasia with nephrogenic rests. Bilateral template RPLNDs yielded paratesticular rhabdomyosarcoma (43 nodes; COG low risk group II stage I) and mixed non-seminomatous germ cell tumor (74 nodes; COG stage III). The nephrectomy yielded an undifferentiated sarcoma, low grade; the adrenalectomy favorable-type ganglioneuroma. Discussion In pediatrics, urologic oncology cases are often managed with open surgery. Our series demonstrates the feasibility of using the robotic approach in carefully selected cases. In doing so, the patient benefits from a minimally invasive surgery, while the surgeon benefits from robotic surgical dexterity. We seamlessly advanced these new techniques through a step-wise collaboration between an adult urologist who routinely performs robotic oncology procedures and a pediatric urologist experienced in robotics for benign conditions. Conclusion In this small series, we safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults.

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Section: Discussionmentioning

confidence: 76%

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Varda

Cho

Wagner

et al. 2018

Journal of Pediatric Urology

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“…Owing to the rarity, most of the available information on this type of tumor has been based on the series of case reports in the literature [6]. Ganglioneuromas usually appear as a well-demarcated homogenous round mass, often surrounding major blood vessels [19].…”

Section: Discussionmentioning

confidence: 99%

“…Ganglioneuromas have been presented as mixed or composite forms, accompanying myelolipoma or pheochromocytoma [22, 23]. Although both tumors are usually benign, 17.7% of ACOs and 3.7% of adrenal ganglioneuromas show malignant transformation [4, 6]. Therefore, a careful workup with laboratory, endocrine, and imaging studies is essential.…”

Section: Discussionmentioning

confidence: 99%

“…They occur in mediastinal and aortocaval sympathetic ganglia and less frequently in the adrenal gland. Both oncocytomas and ganglioneuromas are mostly found as a single mass [4, 6]. In this paper, we present a case of very rare and first reported collision tumors in the adrenal gland: the coexistence of a pigmented ACO and a ganglioneuroma.…”

Section: Introductionmentioning

confidence: 95%

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Adrenal Collision Tumor: Coexistence of Pigmented Adrenal Cortical Oncocytoma and Ganglioneuroma

Lee

Choi

Kim

et al. 2016

Case Reports in Surgery

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Background. Adrenal collision tumors (ACTs), in which distinct tumors coexist without intermingling in the same adrenal gland, are rare and their actual prevalence is unknown. ACTs commonly consist of adrenal cortical adenoma, pheochromocytoma, or metastatic malignant tumor. Case Report. A 32-year-old woman who had been experiencing gastric discomfort for one month was referred to our hospital with abnormal imaging findings. The physical examination and the laboratory data including endocrine studies were unremarkable. Abdomen computed tomography (CT) and magnetic resonance imaging (MRI) showed two adjacent masses in the left suprarenal fossa, and a laparoscopic left adrenalectomy was done. Histological and immunohistochemical (IHC) examinations revealed two distinct tumors: a pigmented adrenal cortical oncocytoma (ACO) and a ganglioneuroma, respectively. Conclusion. Both tumors are rare in the adrenal gland and exist as ACTs only exceptionally rarely. This is the first reported case of coexisting oncocytoma and ganglioneuroma in the same adrenal gland to our knowledge.

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“…The tumor has no hormonal hypersecretion. CT scan imaging characteristics of AGNs usually help to distinguish them from other adrenal neoplasms which include: (a) low attenuated (<40 Houndfield units) homogeneous mass in the precontrast phase (b) progressive enhancement on postcontrast phase and delayed images (c) presence of punctuate or discrete calcification in about 50 percent of cases [2][3][4]. Adrenal adenomas usually have similar morphology to AGN, however they are often smaller in size with characteristic washout of more than 50% contrast on delayed images; whereas adrenocortical carcinomas are typically large (>5 cm), heterogenous on precontrast images with inhomogenous contrast enhancement.…”

Section: Discussionmentioning

confidence: 99%

Case Report on Clinical Vignette

Hoang²,

Shwayhat³

et al. 2014

J Clin Case Rep

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Adrenal ganglioneuroma: features and outcomes of 27 cases at a referral cancer centre

Cited by 60 publications

References 30 publications

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Adrenal Collision Tumor: Coexistence of Pigmented Adrenal Cortical Oncocytoma and Ganglioneuroma

Case Report on Clinical Vignette

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