A Composite Tumor in the Adrenal Gland: Pheochromocytoma and Ganglioneuroma

Abstract

Composite tumor in the adrenal medulla is a rare tumor containing endocrine and neural components. Pheochromocytoma together with ganglioneuroma combination is the most common compound tumor in the adrenal medulla. Pheochromocytoma originates from the chromaffin cells in adrenal medulla and the ganglioneuroma originates from autonomic ganglion cells. A 49-years-old male patient refers to hospital with the complaint of abdominal pain which had started 1month ago. A mass was detected in his right adrenal gland, and he underwent right adrenalectomy. Macroscopic study of the adrenalectomy material section revealed a 7 x 5 x 4.5 cm dark brown-yellow mass. Histopathological studies revealed that the tumor was consisted of two components 1) areas compatible with pheochromocytoma characterized by islands of polygonal cells with eosinophilic cytoplasm, round-oval nucleus and a prominent nucleolus, and forming small nodules with well-defined margins in a fibrovascular stroma and 2) mature ganglion cells scattered in a stroma with Schwann-like cells. In immunohistochemical study, pheochromocytoma foci were stained positive for chromogranin, synaptophysin and tyrosine hydroxylase. Schwann and ganglion cells were stained positive with S100. On the basis of histomorphological and immunohistochemical findings, the patient diagnosed with compound tumor of pheochromocytoma and ganglioneuroma. Although ganglioneuroma is encountered as a rare tumor, it should be kept in mind in the differential diagnosis of the adrenal masses. © 2018 OMU