Adrenal area occupancy in children [?] There are characteristics, need to be identified~

Cases and related data display:

Male, 14 years old, abdominal pain with vomiting for 3 days
.

CT findings: mass in the left adrenal area, slightly high-density (hemorrhage) on plain scan, insignificant strengthening, and uneven
density.
The surrounding clearance is slightly cloudy
.

Final diagnosis:

Left adrenal ganglion cell neuroblastoma

Neuroblastoma is divided into central and peripheral, and peripheral neuroblastoma (NB), ganglioneuroblastoma (GNB) (including mixed and nodular) and benign ganglioneuroma (GN).

GNB is a mixed tumor, that is, mature gangliocytoma and malignant neuroblastoma coexist, are transitional, can transform into the other two, and their occurrence is related to the failure of primitive nerve spine cells or neuroblasts to
mature or degenerate normally.

GNB is clinically rare, mostly in children, and rare in infants
and young children.
The biological behavior is between NB and GN, and the treatment and prognosis of the three are also different
.

Most of them have no obvious clinical symptoms, the main symptoms are tumor compression or invasion, metastasis to organs to produce corresponding symptoms, some can be caused by the secretion of catecholamines and their derivatives caused by hypertension, diarrhea, etc
.

GNB tends to occur in the adrenal glands, retroperitoneal area, thoracic cavity and pelvis
.

Tumor morphology can be regular or irregular, generally uneven in density, and because of interstitial abundance, tumor density is lower, lower than muscle
.

Calcification is more common, calcified morphology is considered to be an important indication to distinguish benign and malignant tumors, benign is mostly spotted calcification, coarser and irregular calcification is more malignant
.

Most of the enhanced scans showed moderate or greater significant enhancement, similar to NB, unlike
GN, which was mainly lightly strengthened.
Dynamic enhancement appears progressive, similar to GN, mainly because the tumor contains a nerve fiber stroma
.

Similar to NB, GNB is prone to retroperitoneal lymph node metastasis and metastasis of other organs throughout the body, such as bone, liver, etc.
, which can invade surrounding neighboring organs and envelop the surrounding large blood vessels without narrowing
the lumen.

Let's look at another example

differential diagnosis

Gangliocytoma

• Occurs mostly in older children/young adults, with a predominance of women

• Benign tumors of neural crest cell origin, including paraspinal and sympathetic ganglia of the adrenal glands

•In the gangliocytoma/gangliocytoma/neuroblastoma histological spectrum, most are benign and well-differentiated tumors

• Encapsulated masses consisting of mature ganglion cells and Schwannian matrix with thick fibrosacs (capsules).

No intraneoplastic hemorrhage or neuroblasts
.

•The most common locations of onset were posterior mediastinum (41.
5 percent), retroperitoneal (37.
5 percent), adrenal glands (21 percent), and neck (8 percent)

•Often incidental findings that may lead to symptoms associated with local mass effects

•VMA/HMA is elevated but usually not enough to cause symptoms of
catecholamine overdose.

• T1 slightly lower signal, T2 etc.
or slightly higher signal, uneven signal

•Delayed centripetal reinforcement of heterogeneity that can be filled incompletely

• Calcifications are common, accounting for about 50%

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