Neuroblastoma differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD [2]Haytham Allaham, M.D. [3]

Overview

Intra-abdominal neuroblastoma must be differentiated from other diseases that cause abdominal distension and constipation such as Wilms tumor and ganglioneuroma. Intra-thoracic neuroblastoma must be differentiated from other diseases that cause shortness of breath and chronic cough such as intrathoracic lymphoma and extra lobar pulmonary sequestration.

Differentiationg Neuroblastoma from other Diseases

Abbreviations

ACTH: Adrenocorticotropic hormone, ARR: Aldosterone-renin ratio, CAM: Cellular adhesion molecules, ERCP: Endoscopic retrograde cholangiopancreatography, ESR: Erythrocyte sedimentation rate, CT: Computerized tomography, Fluorescence in situ hybridization, FDG: Fluorodeoxyglucose, FSH: Follicle stimulating hormone, GI: Gastrointestinal, H&E stain: Hematoxylin and eosin stain, LCA: Leukocyte common antigen, LDH: Lactate dehydrogenase, LH: Luteinizing hormone, MEN: Multiple endocrine neoplasia, MRCP: Magnetic resonance cholangiopancreatography, MRI: Magnetic resonance imaging, N/A: Not applicable/Not available, N/L: Normal, PAS stain: Periodic acid–Schiff stain, PET: Position emission tomography, PGP: Protein gene product 9.5, TB: Tuberculosis, U/S: Ultrasound, ZF: Zona fasciculata, ZG: Zona granulosa, ZR: Zona reticularis.


Adrenal Cortex	Product	Clinical manifestations		Diagnosis							Other features
Adrenal Cortex	Product	Symptoms	Signs	Blood & Urine	Histopathological	Others	Ultrasound	CT scan	FDG PET/CT	MRI	Other features
Adrenal Adenoma	Aldosterone ^[1]^[2]^[3]^[4]	Headache Vision problems Muscle cramps Muscle weakness & cramps Numbness Temporary paralysis Polyuria and polydipsia	Hypertension Refractory hypertension	Hypokalemia Alkalosis ↑ Plasma aldosterone ↓ Plasma Renin ↑ ARR	Single or multiple nodules Encapsulated Abundant clear cytoplasm Uniforming nuclei Histopathology may resemble: ZF (large, lipid-laden clear cells) ZG (small, compact cells with moderate amount of lipid) ZR (lipid-sparse cytoplasm)	Fludrocortisone suppression testing (Gold standard) Oral Sodium loading Saline infusion testing Captopril test Adrenal venous sampling Posture test Genetic testing Immunohistochemical staining	Adrenal mass or nodule	Adrenal mass or nodule Unilateral or bilateral adrenal atrophy Hypodense mass	Iso and low FDG uptake compared with liver	Hyperintense on in-phase and hypointense on oppose-phase	Glucocorticoid-Remediable Aldosteronism responds to glucocorticoids Higher cardiovascular and cerebrovascular morbidity
	Cortisol ^[1]^[5]^[6]^[7]	Weight gain Growth retardation Headache Amenorrhea Virilization (rare) Acne Violaceous striae Acanthosis nigricans Sleep disruption Mental changes Muscular weakneness	Hypertension Hirsutism Hypogonadism Growth retardation Facial plethora Acne Striae Bruising Acanthosis nigricans Mental changes Muscular weakneness	↑ Plasma cortisol ↑ 24 Hour urinary cortisol ↓ or inappropriately normal plasma ACTH ↑ Blood glucose	Yellow fat Brown discoloration Large cells with increased lipid contetnt (zona fasciculata) May contain pigment (lipofuscin) Adjacent atrophied cells Hemorrhage and calcification (Pre-malignant lesions)	Diurnal plasma cortisol variation Low dose and high dose dexamethasone suppression test Dexamethasone-CRH test Adrenal venous sampling Genetic testing Immunohistochemical staining Dual-energy X-ray absorptiometry	Adrenal mass or nodule ↑ Fat	Adrenal mass or nodule Unilateral or bilateral adrenal atrophy ↑ Fat Hypodense mass	Iso and low FDG uptake compared with liver	Hyperintense on in-phase and hypointense on oppose-phase	Associated with Carney complex Associated with MEN-1 Plasma levels of cortisol and ACTH may show false positive and false negative results due to normal diurnal hormonal variation
	Androgens ^[4]^[8]^[9]^[10]	Hirsutism Virilization Amenorrhea Precocious puberty Testicular atrophy & diminished libido (male)	Clitorimegaly Male pattern baldness Resistant hypertension Gynecomastia	↑ Serum testosterone ↑ Serum androstenedione ↑ Serum dehydroepiandrosterone sulfate (DHEA-S) ↑ Urine 17-ketosteroids ↑ Plasma and urine estrogens	Pale tan to brown Pseudocapsule or the fibrous capsule Nesting, alveolar, cords, trabeculae Eosinophilic cytoplasm May see clear, vacuolated cytoplasm	FSH, LH, prolactin levels Cortisol levels FDG PET/CT Pelvic Ultrasound Adrenal Venous sampling	Well-defined Solid mass	Homogeneous enhancement (CT contrast)	N/A	Hyperintense on in-phase and hypointense on oppose-phase	Extremely rare Most androgen secreting adenomas are mixed tumors
	Non-functional ^[1]^[11]^[12]^[13]	Asymptomatic Abdominal pain Abdominal distenstion Nausea/vomiting Sub-clinical Cushing syndrome Sub-clinical hyperaldosteronism	Asymptomatic Abdominal asymmetry Abdominal mass Sub-clinical Cushing syndrome Sub-clinical hyperaldosteronism	N/L ↓ Adrenal hormones ↑ Serum cortisol (sub-clinical) ↑ Serum aldosterone(sub-clinical) ↑ Serum androgens (sub-clinical)	Well-defined margins Large monomorphic cells Abundant/foamy cytoplasm Typically resemble normal adrenal histology May see hemorrhage & necrosis	Adrenal hormones levels Blood glucose level Plasma catecholamines and urinary metanephrines ARR Immunohistochemical staining	Solid, well defined mass	High lipid content and adjacent compression	N/A	Hyperintense on in-phase and hypointense on oppose-phase	2-fold increased risk for Diabetes mellitus in some studies Work up must exclude Cushing syndrome, pheochromocytoma and adrenal carcinoma
Adrenal Carcinoma ^[12]^[14]^[15]^[16]^[17]	Cortisol Aldosterone Androgens Non-functional Erythropoietin	Symptoms of adrenal hormones excess as mentioned in adrenal adenoma Constitutional symptoms such as cachexia, night sweats, fever Localized symptoms such as abdominal pain, mass, fullness, early satiety	Hypertension Signs of adrenal hormones excess as mentioned in adrenal adenoma Constitutional Localized signs such as abdominal mass,abdominal distension	N/L ↑ Serum cortisol ↑ Serum aldosterone ↑ Serum androgens Hypokalemia Alkalosis ↑ ARR ↑ Blood glucose	Brown to orange to yellow Necrosis & mitosis Hypercellular & solid and/or diffuse growth pattern Low to high lipid content Nuclear pleomorphism Lymphovascular invasion	Serum ACTH Low dose and high dose dexamethasone suppression test Urinary adrenal metabolites Proton MR spectroscopy [¹¹C]MTO PET Immunohistochemical staining	N/A	Heterogeneous enhancement	Heterogeneous mass with intense FDG uptake greater than liver	Heterogenous hyper-intensity (T2-weighted) and hypo-intensity on (T1-weighted)	May cause hypoglycemia (Anderson's syndrome} May be associated with: Hyperreninemic Hyperaldosteronism Erythropoietin-associated polycythemia Leukocytosis
Adrenal Hyperplasia ^[2]^[5]^[4]^[8]^[9]^[15]^[18]^[19]	Cortisol (most common) Aldosterone Androgens Non-functional	Depending on the product secreted, may present as: Cushing syndrome Hyperaldosteronism Virilization Hirsutism Menstrual irregularities Testicular atrophy Diminished libido Localized symptoms such as abdominal pain, mass, fullness, early satiety	Depending on the product secreted, may present as: Cushing syndrome Hyperaldosteronism Virilization Hirsutism Menstrual irregularities Testicular atrophy Gynecomastia Localized symptoms such as abdominal pain, mass, fullness, early satiety	↑ Serum cortisol ↑ Serum aldosterone ↑ Serum androgens Hypokalemia Alkalosis ↑ ARR ↑ Blood glucose ↑ Serum testosterone ↑ Serum androstenedione ↑ Serum dehydroepiandrosterone sulfate (DHEA-S) ↑ Plasma and urine estrogens	Diffuse or nodular enlargement Increased thickness of zona reticularis and zona fasciculata Large polygonal cells with/without lipid depletion May contain pigment (lipofuscin) endocrine atypia Small nodules	Adrenal venous sampling Pelvic & pituitary imaging Genetic testing Fludrocortisone suppression testing Saline infusion testing Diurnal plasma cortisol variation Low dose and high dose dexamethasone suppression test FSH, LH, prolactin levels Cortisol levels	Adrenal mass Unilateral or bilateral adrenal enlargement or thickening	Unilateral or bilateral adrenal enlargement or thickening Density is same as that of normal adrenal gland	N/A	Unilateral or bilateral adrenal enlargement or thickening Signaling is same as that of normal adrenal gland	Congenital adrenal hyperplasia presents in children/young adults Associated with Carney complex Plasma levels of cortisol and ACTH may show false positive and false negative results due to normal diurnal hormonal variation
Medulla	Product	Clinical manifestations		Diagnosis							Other features
Medulla	Product	Symptoms	Signs	Blood & Urine	Histopathological	Others	Ultrasound	CT scan	FDG PET/CT	MRI	Other features
Pheochromocytoma ^[20]^[21]^[22]^[23]^[24]	Catecholamines	Headaches Palpitations Excessive sweating Anxiety Pallor Pain in chest/abdomen Weakness, fatigue Nausea/vomiting Dizziness Paresthesias Constipation (rarely diarrhea) Visual disturbance	Hypertension Postural hypotension Tachycardia or reflex bradycardia Tremulousness Pallor Flushing (rare) Weight loss Fasting hyperglycaemia Decreased GI motility Pallor ↑ Respiratory rate Psychosis	↑ Plasma and urine catecholamines (Gold standard) ↑ Plasma and urine metanephrines (Gold standard) ↑ Chromogranin A ↑ Plasma methoxytyramine	Loosely cohesive clusters Scattered tumor cells with prominent anisokaryosis, abundant eosinophilic granular cytoplasm and indistinct cell borders Occasional bi-nucleate cells	Genetic testing Provacative glucagon test Clonidine suppression test Metaiodobenzyl-guanidine scintigraphy PET scan Octereoscan	Cystic or solid with necrotic areas or hemorrhages	Heterogeneous appearance, often with some cystic areas. Calcification or hemorrhage may also be present	N/A	T2-bright lesions, with/without cystic or necrotic components	May mimic panic attack May be associated with Von Hippel-Lindau disease, MEN type 2 and neurofibromatosis type 1. Arise from the chromaffin cells Stains positive for Chromogranin A (CGA) Protein gene product (PGP) 9.5 Synaptophysin (SYN) CD56 (N-CAM) Glial fibrillary acidic protein (GFAP)
Neuroblastoma ^[15]^[25]^[26]^[27]	Catecholamines	Constitutional Failure to thrive Abdominal pain Diarrhea Constipation Dyspnea Prolonged cough Strabismus Proptosis	Abdominal mass Pallor Tachycardia Hypertension Failure to thrive Strabismus Proptosis	N/L Slight elevation in catecholamines ↑ Urinary metanephrines Anemia ↑ Ferritin ↑ LDH Thrombocytosis	Pathological examinations are gold standard. Cells may show: Undifferentiation Poor differentiation Differentiating neuroblasts Necrosis Salt and pepper chromatin Spindle-like fibers	Immunohistochemical staining PET scan Octereoscan ¹³¹I-metaiodobenzylguanidine (MIBG) scintigraphy FISH Genetic testing	Large mass May cross midline	Large mass extending across the midline Heterogeneous enhancement Calcification & hemorrhage	N/A	Calcification & hemorrhage Non-homogeneous and hyperintense Hypointense (T1-weighted)	Stains positive for: Chromogranin A (CGA) Protein gene product (PGP) 9.5 Neuron-specific enolase Synaptophysin (SYN) CD56 & CD57 Glial fibrillary acidic protein (GFAP)
Ganglioneuroma ^[15]^[28]^[29]^[30]	Catecholamines VIP Cortisol Androgens	Asymptomatic Abdominal pain Diarrhea	N/L Abdominal mass Hypertension	N/L ↑ Plasma and urinary catecholamine ↑ VIP ↑ Cortisol and testosterone	Pathological examinations are gold standard. Mature type: mature Schwann cells, ganglion cells and peri-neural cells Maturing type: Schwann cells, ganglion cells and peri-neural cells with varying maturation	Pathological examinations are gold standard. Ultrasound Immunohistochemical staining ¹⁸F-2-fluoro-deoxy-D-glucose-positron emission tomography (PET)	N/A	Well-defined, Homogeneous Punctate or discrete calcification	N/A	Hypointense (T1-weighted) Varied signal (T2-weighted)	Stains positive for: S100 Synaptophysin Neurofilament (NF) protein Chromogranin A Glial fibrillary acidic protein PGP 9.5 Type IV collagen VIP
Stroma	Product	Clinical manifestations		Diagnosis							Other features
Stroma	Product	Symptoms	Signs	Blood & Urine	Histopathological	Others	Ultrasound	CT scan	FDG PET/CT	MRI	Other features
Lipoma/Myolipoma ^[15]^[31]^[32]^[33]	N/A	Asymptomatic Abdominal pain Back pain Fever	N/L Abdominal mass Fever	N/L	Pathological examinations are gold standard. Yellow adipose tissue Hemorrhagic foci Islands of hematopoietic cells (myolipoma) and mature fat cells (Lipoma)	RFTs LFTs Urine analysis Ultrasound	Heterogeneous mass	Retro-peritoneal mass Well-defined heterogenous enhancement	N/A	High signal	Myolipoma: mature adipose tissue and haematopoietic elements Lipoma: mature fat cells
Others	Product	Clinical manifestations		Diagnosis							Other features
Others	Product	Symptoms	Signs	Blood & Urine	Histopathological	Others	Ultrasound	CT scan	FDG PET/CT	MRI	Other features
Tuberculosis ^[34]^[35]^[36]^[37]^[38]	N/A	Weakness Malaise Nausea Fatigue Anorexia Abdominal pain Orthostatic hypotension Constipation Salt craving Adrenal crisis Symptoms of pulmonary TB	Weight loss Hyperpigmentation of the skin Fever Hypotension Adrenal crisis Signs of pulmonary tuberculosis	Anemia Leukocytosis Hyponatremia Hyperkalemia Hypoglycemia Low early morning serum cortisol levels Low basal urinary cortisol ↑ ACTH ↓ Aldosterone ↑ Plasma renin	Enlarged, necrotic adrenal glands Central caseous necrosis Rim of granulomatous inflammatory cells (Langerhans giant cells and lymphocytes) Identifiable acid-fast stain-positive bacteria with Ziehl-Neelsen or fluorescent stains	Laparoscopic adrenalectomy Chest X-ray Chest CT scan Tuberculin test ACTH stimulation test Insulin induced hypoglycemia Metyrapone stimulation tests	Variable	Calcification Hypodense areas Rim enhancement	High FDG uptake by adrenal glands	Calcification Variable signals	Majority of the cases are secondary to: Pulmonary TB Genitourinary TB HIV infection May present with shock with severe hypotension and hypoglycemia due to glucocorticoid insufficiency
Histoplasmosis ^[39]^[40]^[41]^[42]^[43]	N/A	No adrenal symptoms Adrenal insufficiency: Weakness & malaise Nausea, fatigue and anorexia Abdominal pain Orthostatic hypotension Constipation Salt craving Symptoms of pulmonary/skin/bone histoplasmosis	Weight loss Hyperpigmentation of the skin Fever Hypotension Adrenal crisis Signs of pulmonary/skin/bone histoplasmosis	Anemia Leukocytosis Hyponatremia Hyperkalemia Hypoglycemia Low early morning serum cortisol levels Low basal urinary cortisol ↑ ACTH ↓ Aldosterone ↑ Plasma renin	Necrotizing granulomatous inflammation similar to tuberculosis Capsulated yeast forms of Histoplasma (Giemsa stain) Histoplasma identification (H&E stain) Focal ovoid bodies with a clear halo (PAS stain)	Ultrasound-guided fine needle aspiration cytology (USG-FNAC) is gold standard. Laparoscopic adrenalectomy Endoscopic ultrasound Abdominal ultrasound Chest X-ray ACTH stimulation test Metyrapone stimulation tests	Enlarged adrenal glands Calcification	Enlarged adrenal glands Calcification Heterogeneous enhancement	Abnormal FDG uptake by adrenal glands	Enlarged adrenal glands Calcification Isointense adrenal mass (MRI)	Patient may exhibit no clinical manifestations of adrenal involvement Majority of the cases are secondary to: Pulmonary histoplasmosis HIV infection May present with shock with severe hypotension and hypoglycemia due to glucocorticoid insufficiency
Cysts ^[15]^[44]^[45]^[46]	N/A	Abdominal pain Abdominal mass Abdominal fullness Hematuria Infection Symptoms of malignancy (Cystic part of other tumors)	Abdominal mass & assymetry Fever Hypertension (Renal compression) Hypotension (Hemorrhage into cyst) Signs of malignancy (Cystic part of other tumors)	N/L Anemia Leukocytosis	Vascular or endothelial cyst: lined by flattened endothelial cells Epithelial: lined by epithelium Pseudocyst: lined by fibrous tissue Hydatid cyst: 3 layers (germinal layer, laminated membrane and dense fibrovascular tissue)	Complete endocrine panel [¹⁸F]FDG PET/CT (if malignancy is suspected) Biopsy (if malignancy is suspected) ACTH stimulation test	Gold standard Circumscribed anechoic or hypoechoic mass	Homogeneous mass No enhancement Calcification Low density	N/A	High signal	3 major subtypes Pure cysts (vascular or endothelial cyst, pseudocyst and 'true' epithelial cysts) Parasitic cysts Cystic part of an otherwise solid tumor
Hematoma ^[15]^[47]^[48]^[49]	N/A	Flank/back pain Weakness Hypovolemic shock Adrenal crisis (massive hemorrhage) Adrenal insufficiency Symptoms of underlying cause	Hypotension Abdominal/flank mass Hypovolemic shock Adrenal crisis (massive hemorrhage) Adrenal insufficiency Signs of underlying cause	Anemia ↓ Serum and urinary adrenal hormones and metabolites Findings related to underlying cause	Pseudocyst: lined by fibrous tissue Findings related to underlying cause	Adrenal ultrasound ACTH stimulation test Tests related to underlying cause	Variable	High density (acute hemorrhage)	N/A	Isointense and low signal (Early hemorrhage) Hypointense (Late hemorrhage)	Majority of the cases in neonantal peiod Majority of the cases caused by trauma
Hemangioma ^[15]^[50]^[51]^[52]	Cortisol (rare) Aldosterone (rare) Androgens (rare)	Abdominal mass & discomfort Nausea & vomiting Back pain Hypovolemic shock (hemorrhage) Symptoms of hormonal excess (very rare)	Abdominal mass Hypovolemic shock (hemorrhage) Symptoms of hormonal excess (very rare)	N/L Anemia (hemorrhage) ↑ Serum and urinary adrenal hormones and metabolites (very rare)	Histopathology is gold standard Most often cavernous Peripheral dilated vascular spaces Monostromatic endothelium Absence of atypia Central necrosis Calcification Hemorrhage	Complete endocrine panel Ultrasound FDG-PET scan Endoscopic ultrasound Post-resection biopsy (if malignancy is suspected)	Calcification Phleboliths	Calcification Phleboliths Irregular peripheral enhancement	N/A	Hyperintensity (T2) hypointensity (T1) Peripheral spotty and centripetal enhancement	Majority of the cases diagnosed incidentally Majority of the lesions are non-functional with female pre-dominance
Lymphoma ^[15]^[53]^[54]^[55]	N/A	Fatigue Loss of appetite Weight loss Pigmentation of skin Flank/abdominal pain Fever Nausea & vomiting	Hypotension Altered mental status Abdominal/flank mass Fever Weight loss	↑ ESR ↑ LDH ↑ Serum ACTH ↓ Hyponatremia Low early morning serum cortisol levels Low basal urinary cortisol ↓ Aldosterone	Histopathology is gold standard Diffuse growth pattern with large cells ( 5× normal lymphocytes) resembling immunoblasts Extensive necrosis May resemble anaplastic large cell lymphoma or metastatic carcinoma Abundant T-cells	Complete endocrine panel Ultrasound ACTH stimulation test CT-guided needle biopsy ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography PET/CT	Heterogeneous mass Hemorrhages	Heterogeneous mass Hemorrhages Necrosis	N/A	Enlarged retroperitoneal lymph nodes Low intensity (T1) High intensity (T2)	May stain positive for: CD3, CD19, CD20, CD22 BCL6 / CD10 CD43, CD45 Surface Ig CD68 CD79a LCA Pax 5
Cystic Lymphangioma ^[15]^[56]^[57]^[58]	N/A	Asymptomatic Flank/back/abdominal pain Abdominal/flank mass GI obstruction	N/L Palpable mass Hypertension Fever	N/L	Histopathology is gold standard Cystic channels and spaces Flat endothelial cells Mature lymphoid aggregates	Complete endocrine panel Ultrasound FDG-PET scan Aspiration & biopsy	Well-demarcated Calcification	Well-demarcated Low-density Calcification	N/A	T1 hypointense & T2 hyperintense	Associated with Gorlin-Goltz syndrome Stains positive for CD31, CD34, and D2-40 and negative for cytokeratin
Teratoma ^[15]^[59]^[60]^[61]	N/A	Asymptomatic Abdominal/back discomfort & pain Abdominal distension Lumbago Nausea & vomiting Local obstructive symptoms	N/L Abdominal distension Abdominal mass Weight loss Urinary retention Lower extremity edema Peritoneal effusion or peritonitis (rupture)	N/L	Fibrous tissue, adipose tissue and muscle fibers Stratified squamous epithelium, hair shafts, fat cells, GI and respiratory epithelium Necrosis Calcification	Complete endocrine panel ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography PET/CT Post-resection biopsy (if malignancy is suspected)	Heterogeneous Mixed echo (U/S)	Heterogeneous Mixed density elements Egg-shell calcification Mild enhancement	N/A	Mild enhancement Mixed signals (MRI)	Derived from germ layers Majority are benign, but about one forth of adrenal teratoma are malignant lesions
Metastases ^[15]^[62]^[63]^[64]^[65]	Related to the primary tumor	Asymptomatic Adrenal insufficiency Abdominal mass & discomfort Symptoms due to primary tumor that may include: Lung cancer Breast cancer Gastric cancer Liver cancer Pancreatic cancer Renal cell carcinoma Melanoma Lymphoma	Asymptomatic Adrenal insufficiency Abdominal mass Signs due to primary tumor that may include Lung cancer Breast cancer Gastric cancer Liver cancer Pancreatic cancer Renal cell carcinoma Melanoma Lymphoma	Varies depending on the primary tumor N/L If adrenal insufficiency: Hyponatremia Hyperkalemia Hypoglycemia Low early morning serum cortisol levels Low basal urinary cortisol ↑ ACTH ↓ Aldosterone ↑ Plasma renin	Single or multiple firm masses Hemorrhage Necrosis Morphology similar to the primary tumor Compression and atrophy of adjacent adrenal tissue	Blood and urine lab testing Complete endocrine panel Imaging of chest, abdomen, and pelvis Immunohistochemistry Endoscopy MRCP & ERCP ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography PET/CT	Calcification Hemorrhage	Calcification Hemorrhage Irregular peripheral enhancement	N/A	Low signal on T1-weighed MRI and high signal on T2-weighed MRI OR Isointense on T1- and T2-weighed MRI	Metastases more common than primary adrenal tumors Adrenal hemorrhage is the most serious complication and may present as adrenal crisis and/or shock

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↑ Lam KY, Lo CY (September 2001). "Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution". J. Clin. Pathol. 54 (9): 707–12. PMC 1731508. PMID 11533079.
↑ Gershuni VM, Bittner JG, Moley JF, Brunt LM (January 2014). "Adrenal myelolipoma: operative indications and outcomes". J Laparoendosc Adv Surg Tech A. 24 (1): 8–12. doi:10.1089/lap.2013.0411. PMC 3931430. PMID 24328509.
↑ Luo J, Chen L, Wen Q, Xu L, Chu S, Wang W, Alnemah MM, Fan S (2015). "Lipoadenoma of the adrenal gland: report of a rare entity and review of literature". Int J Clin Exp Pathol. 8 (8): 9693–7. PMC 4583971. PMID 26464739.
↑ Rodríguez-Gutiérrez R, Rendon A, Barrera-Sánchez M, Carlos-Reyna KE, Álvarez-Villalobos NA, González-Saldivar G, González-González JG (2016). "Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test". Int J Endocrinol. 2016: 9051865. doi:10.1155/2016/9051865. PMC 4781954. PMID 27006656.
↑ Haddara WM, van Uum SH (September 2004). "TB and adrenal insufficiency". CMAJ. 171 (7): 710, author reply 710–1. doi:10.1503/cmaj.1041046. PMC 517840. PMID 15451821.
↑ Huang YC, Tang YL, Zhang XM, Zeng NL, Li R, Chen TW (October 2015). "Evaluation of primary adrenal insufficiency secondary to tuberculous adrenalitis with computed tomography and magnetic resonance imaging: Current status". World J Radiol. 7 (10): 336–42. doi:10.4329/wjr.v7.i10.336. PMC 4620114. PMID 26516430.
↑ Vinnard C, Blumberg EA (January 2017). "Endocrine and Metabolic Aspects of Tuberculosis". Microbiol Spectr. 5 (1). doi:10.1128/microbiolspec.TNMI7-0035-2016. PMID 28233510.
↑ Rajasekharan C, Ajithkumar S, Anto V, Parvathy R (May 2013). "Extrapulmonary disseminated tuberculosis with tuberculous adrenalitis: a stitch in time saves nine". BMJ Case Rep. 2013. doi:10.1136/bcr-2012-008011. PMID 23687365.
↑ Rog CJ, Rosen DG, Gannon FH (December 2016). "Bilateral adrenal histoplasmosis in an immunocompetent man from Texas". Med Mycol Case Rep. 14: 4–7. doi:10.1016/j.mmcr.2016.11.006. PMC 5154969. PMID 27995051.
↑ Wahab NA, Mohd R, Zainudin S, Kamaruddin NA (2013). "Adrenal involvement in histoplasmosis". EXCLI J. 12: 1–4. PMC 4817423. PMID 27047312.
↑ May D, Khaled D, Gills J (July 2018). "Unilateral adrenal histoplasmosis". Urol Case Rep. 19: 54–56. doi:10.1016/j.eucr.2018.03.010. PMC 5991316. PMID 29888193.
↑ Gupta RK, Majumdar K, Srivastava S, Varakanahalli S, Saran RK (2018). "Endoscopic Ultrasound-guided Cytodiagnosis of Adrenal Histoplasmosis with Reversible CD4 T-Lymphocytopenia and Jejunal Lymphangiectasia". J Cytol. 35 (2): 110–113. doi:10.4103/JOC.JOC_234_15. PMC 5885598. PMID 29643659.
↑ Padma S, Sreehar S (May 2014). "18F FDG PET/CT identifies unsuspected bilateral adrenal histoplasmosis in an elderly immuno compromised patient". Indian J. Med. Res. 139 (5): 786–7. PMC 4140048. PMID 25027093.
↑ Carsote M, Ghemigian A, Terzea D, Gheorghisan-Galateanu AA, Valea A (2017). "Cystic adrenal lesions: focus on pediatric population (a review)". Clujul Med. 90 (1): 5–12. doi:10.15386/cjmed-677. PMID 28246490.
↑ Słapa RZ, Jakubowski WS, Dobruch-Sobczak K, Kasperlik-Załuska AA (December 2015). "Standards of ultrasound imaging of the adrenal glands". J Ultrason. 15 (63): 377–87. doi:10.15557/JoU.2015.0035. PMC 4710689. PMID 26807295.
↑ Olaoye IO, Adesina MD, Afolayan EA (June 2018). "A giant adrenal cyst with an uncertain preoperative diagnosis causing a dilemma in management". Clin Case Rep. 6 (6): 1074–1076. doi:10.1002/ccr3.1519. PMC 5986023. PMID 29881567.
↑ Hamilton D, Harris MD, Foweraker J, Gresham GA (February 2004). "Waterhouse-Friderichsen syndrome as a result of non-meningococcal infection". J. Clin. Pathol. 57 (2): 208–9. PMC 1770213. PMID 14747454.
↑ Di Serafino M, Severino R, Coppola V, Gioioso M, Rocca R, Lisanti F, Scarano E (September 2017). "Nontraumatic adrenal hemorrhage: the adrenal stress". Radiol Case Rep. 12 (3): 483–487. doi:10.1016/j.radcr.2017.03.020. PMC 5551907. PMID 28828107.
↑ Ierardi AM, Petrillo M, Patella F, Biondetti P, Fumarola EM, Angileri SA, Pesapane F, Pinto A, Dionigi G, Carrafiello G (April 2018). "Interventional radiology of the adrenal glands: current status". Gland Surg. 7 (2): 147–165. doi:10.21037/gs.2018.01.04. PMC 5938278. PMID 29770310.
↑ Alhajri K, Alhasan I, Alzerwi N, Abudaff N (April 2011). "Adrenal haemangioma". BMJ Case Rep. 2011. doi:10.1136/bcr.12.2010.3604. PMC 3079485. PMID 22701011.
↑ Iwamoto G, Shimokihara K, Kawahara T, Takamoto D, Yao M, Teranishi JI, Otani M, Uemura H (2018). "Adrenal Hemangioma: A Case of Retroperitoneal Tumor". Case Rep Med. 2018: 8796327. doi:10.1155/2018/8796327. PMC 5836307. PMID 29560018.
↑ Tarchouli M, Boudhas A, Ratbi MB, Essarghini M, Njoumi N, Sair K, Zentar A (2015). "Giant adrenal hemangioma: Unusual cause of huge abdominal mass". Can Urol Assoc J. 9 (11–12): E834–6. doi:10.5489/cuaj.2967. PMC 4639440. PMID 26600897.
↑ Harada K, Kimura K, Iwamuro M, Terasaka T, Hanayama Y, Kondo E, Hayashi E, Yoshino T, Otsuka F (September 2017). "The Clinical and Hormonal Characteristics of Primary Adrenal Lymphomas: The Necessity of Early Detection of Adrenal Insufficiency". Intern. Med. 56 (17): 2261–2269. doi:10.2169/internalmedicine.8216-16. PMC 5635296. PMID 28794358.
↑ Laurent C, Casasnovas O, Martin L, Chauchet A, Ghesquieres H, Aussedat G, Fornecker LM, Bologna S, Borot S, Laurent K, Bouillet B, Verges B, Petit JM (February 2017). "Adrenal lymphoma: presentation, management and prognosis". QJM. 110 (2): 103–109. doi:10.1093/qjmed/hcw174. PMID 27795295.
↑ Karimi F (October 2017). "Primary Adrenal Lymphoma Presenting with Adrenal Failure: A Case Report and Review of the Literature". Int J Endocrinol Metab. 15 (4): e12014. doi:10.5812/ijem.12014. PMC 5750783. PMID 29344029.
↑ Michalopoulos N, Laskou S, Karayannopoulou G, Pavlidis L, Kanellos I (December 2015). "Adrenal Gland Lymphangiomas". Indian J Surg. 77 (Suppl 3): 1334–42. doi:10.1007/s12262-015-1206-y. PMC 4775622. PMID 27011561.
↑ Zhao M, Gu Q, Li C, Yu J, Qi H (2014). "Cystic lymphangioma of adrenal gland: a clinicopathological study of 3 cases and review of literature". Int J Clin Exp Pathol. 7 (8): 5051–6. PMC 4152068. PMID 25197378.
↑ Joliat GR, Melloul E, Djafarrian R, Schmidt S, Fontanella S, Yan P, Demartines N, Halkic N (February 2015). "Cystic lymphangioma of the adrenal gland: report of a case and review of the literature". World J Surg Oncol. 13: 58. doi:10.1186/s12957-015-0490-0. PMC 4335415. PMID 25889625.
↑ Ramakant P, Rana C, Singh KR, Mishra A (2018). "Primary adrenal teratoma: An unusual tumor - Challenges in diagnosis and surgical management". J Postgrad Med. 64 (2): 112–114. doi:10.4103/jpgm.JPGM_588_16. PMC 5954807. PMID 29067922.
↑ Li S, Li H, Ji Z, Yan W, Zhang Y (November 2015). "Primary adrenal teratoma: Clinical characteristics and retroperitoneal laparoscopic resection in five adults". Oncol Lett. 10 (5): 2865–2870. doi:10.3892/ol.2015.3701. PMC 4665718. PMID 26722254.
↑ Zhou L, Pan X, He T, Lai Y, Li W, Hu Y, Ni L, Yang S, Chen Y, Lai Y (October 2018). "Primary adrenal teratoma: A case series and review of the literature". Mol Clin Oncol. 9 (4): 437–442. doi:10.3892/mco.2018.1687. PMC 6125700. PMID 30214733.
↑ Karanikiotis C, Tentes AA, Markakidis S, Vafiadis K (November 2004). "Large bilateral adrenal metastases in non-small cell lung cancer". World J Surg Oncol. 2: 37. doi:10.1186/1477-7819-2-37. PMC 535544. PMID 15541184.
↑ ABRAMS HL, SPIRO R, GOLDSTEIN N (January 1950). "Metastases in carcinoma; analysis of 1000 autopsied cases". Cancer. 3 (1): 74–85. PMID 15405683.
↑ Gerber E, Dinlenc C, Wagner JR (2004). "Laparoscopic adrenalectomy for isolated adrenal metastasis". JSLS. 8 (4): 314–9. PMC 3016821. PMID 15554272.
↑ Vaughan ED (September 1998). "Diagnosis and management of surgical adrenal disorders". Int. J. Urol. 5 (5): 401–17. PMID 9781426.

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[pmid29881567-46] Olaoye IO, Adesina MD, Afolayan EA (June 2018). "A giant adrenal cyst with an uncertain preoperative diagnosis causing a dilemma in management". Clin Case Rep. 6 (6): 1074–1076. doi:10.1002/ccr3.1519. PMC 5986023. PMID 29881567.

[pmid14747454-47] Hamilton D, Harris MD, Foweraker J, Gresham GA (February 2004). "Waterhouse-Friderichsen syndrome as a result of non-meningococcal infection". J. Clin. Pathol. 57 (2): 208–9. PMC 1770213. PMID 14747454.

[pmid28828107-48] Di Serafino M, Severino R, Coppola V, Gioioso M, Rocca R, Lisanti F, Scarano E (September 2017). "Nontraumatic adrenal hemorrhage: the adrenal stress". Radiol Case Rep. 12 (3): 483–487. doi:10.1016/j.radcr.2017.03.020. PMC 5551907. PMID 28828107.

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[pmid22701011-50] Alhajri K, Alhasan I, Alzerwi N, Abudaff N (April 2011). "Adrenal haemangioma". BMJ Case Rep. 2011. doi:10.1136/bcr.12.2010.3604. PMC 3079485. PMID 22701011.

[pmid29560018-51] Iwamoto G, Shimokihara K, Kawahara T, Takamoto D, Yao M, Teranishi JI, Otani M, Uemura H (2018). "Adrenal Hemangioma: A Case of Retroperitoneal Tumor". Case Rep Med. 2018: 8796327. doi:10.1155/2018/8796327. PMC 5836307. PMID 29560018.

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Neuroblastoma differential diagnosis

Overview

Differentiationg Neuroblastoma from other Diseases

References

References

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