ROBOTIC RESECTION OF ADRENAL GANGLIONEUROMA PRESENTING AS INCIDENTALLY FOUND ADRENAL MASS

Objectives:

Background:
Incidentally found adrenal masses or incidentalomas may be composed of a variety of cell types and are clinically described based on size and functionality. Workup and management of these incidentalomas can be challenging and a definitive histologic diagnosis is not always made prior to an operation. Adrenal ganglioneuroma is a rare, usually nonfunctional adrenal mass that is generally found incidentally given its asymptomatic clinical picture. It accounts for less than 2% of all adrenal masses. These mainstay of treatment for ganglioneuromas is surgical excision, and we demonstrate that they may be safely removed with a minimally invasive technique.

Case Description:
We present a case of a 79-year-old male with history of coronary artery disease, hypertension, aortic stenosis requiring transcatheter aortic valve replacement (TAVR), prostate cancer with prior robotic prostatectomy who presented to our clinic with an incidentally found left adrenal mass on computed topography angiogram (CTA) noted on his TAVR workup. After presentation to our clinic, computed topography (CT) adrenal protocol was obtained showing 5.6 cm left adrenal lesion. Labs were obtained at this clinic visit showing plasma renin 5.8, aldosterone 7, DHEA-S 15, free metanephrine < 25, free normetanephrine 134, and cortisol 9.8. After obtaining appropriate medical risk stratification and optimization, he was taken to the operating room for a robotic-assisted left adrenalectomy. The mass was densely adherent to the retroperitoneum, though able to be excised en block. Frozen section of the mass was performed and demonstrated a benign nerve tumor, likely schwannoma. The patient was able to be discharged home on post-operative day 1. Final pathology revealed adrenal ganglioneuroma, and he required no adjuvant therapy. He has been seen in follow up and is doing well without evidence of recurrence.

Discussion:
Adrenal ganglioneuromas are rare adrenal tumors of neural crest origin that require histologic evaluation for diagnosis. They are often found incidentally and are typically non-functional. This case report describes a successful robotic excision of an adrenal ganglioneuroma. We advocate for further study into this rare entity of adrenal incidentaloma.

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