Adrenal ganglioneuroma in an adolescent presenting as an incidentaloma: Imaging–pathology correlation and diagnostic challenges: A case report

RATIONALE: Adrenal ganglioneuroma (AGN) is a rare, benign, and usually nonfunctioning tumor arising from neural crest-derived sympathetic ganglion cells. Preoperative diagnosis is difficult because the clinical presentation is often nonspecific, and imaging findings overlap with those of other adrenal neoplasms. We describe an adolescent adrenal incidentaloma with detailed imaging-pathology correlation, adding to the small number of reported adolescent cases. PATIENT CONCERNS: A previously healthy 16-year-old male underwent contrast-enhanced computed tomography (CT) after a bicycle accident. No traumatic injury was identified, but imaging incidentally revealed a well-circumscribed right adrenal mass measuring approximately 6.1 cm × 3.6 cm × 5.0 cm. DIAGNOSES: CT and magnetic resonance imaging showed progressive, persistent enhancement across the arterial, venous, and delayed phases without demonstrable washout (attenuation increased from 20 Hounsfield units unenhanced to 55 Hounsfield units in the venous phase, with further qualitative enhancement on 15-minute delayed images) and no intralesional fat, suggesting a non-adenomatous lesion and raising suspicion for a neurogenic tumor. Biochemical evaluation showed no evidence of hormonal hypersecretion. Histopathological examination after resection established the diagnosis of AGN. INTERVENTIONS: The patient underwent right adrenalectomy because of the size and radiologically indeterminate nature of the mass. OUTCOMES: The postoperative course was uneventful. Transient elevation of blood pressure noted during follow-up prompted biochemical reevaluation, which showed no evidence of excess catecholamine. Follow-up CT at 9 months showed no recurrence. LESSONS: Progressive delayed enhancement without washout and absence of signal loss on opposed-phase magnetic resonance imaging, a pattern previously described in ganglioneuroma, may suggest the diagnosis preoperatively, although definitive diagnosis requires histopathological confirmation. Complete surgical excision established the diagnosis and achieved a favorable short-term outcome; the excellent long-term prognosis of AGN is supported by the published literature, and our patient remains recurrence-free at 9 months.