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Neurogenic Tumors in the Abdomen: Tumor Types and Imaging Characteristics¹

¹ From the Department of Radiology, College of Medicine, Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul 137-040, South Korea. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received March 8, 2002; revision requested April 25 and received June 3; accepted June 4. Address correspondence to J.Y.B. (e-mail: jybyun@catholic.ac.kr).

View larger version (110K): [in a new window]   Figure 1.  Retroperitoneal ganglioneuroma in a 48-year-old woman. Contrast material-enhanced CT scan shows a relatively homogeneous mass (black arrows) that is hypoattenuating relative to muscle. The mass partially surrounds the inferior vena cava (V) and aorta (A). The right lateral gland (white arrow) is seen lateral to the posterior portion of the mass.

View larger version (93K): [in a new window]   Figure 2a.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (97K): [in a new window]   Figure 2b.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (95K): [in a new window]   Figure 2c.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (93K): [in a new window]   Figure 2d.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (100K): [in a new window]   Figure 2e.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (107K): [in a new window]   Figure 2f.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (102K): [in a new window]   Figure 2g.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (93K): [in a new window]   Figure 2h.  Right adrenal ganglioneuroma in a 24-year-old woman. (a) Axial unenhanced CT scan demonstrates a well-defined oval mass (thick arrow) in the right adrenal gland. The mass appears homogeneous, is hypoattenuating relative to muscle, and contains central small punctate calcifications (thin arrow). (b, c) Nephrographic phase (b) and excretory phase (c) contrast-enhanced CT scans show delayed gradual contrast enhancement of the mass (arrow). (d) On an axial T1-weighted MR image, the tumor (arrow) is homogeneous and is hypointense relative to liver. (e) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and is hyperintense relative to liver. (f-h) Axial contrast-enhanced dynamic T1-weighted MR images obtained 15 seconds (f), 55 seconds (g), and 3 minutes (h) after contrast material injection also show gradual but heterogeneous enhancement of the mass.

View larger version (100K): [in a new window]   Figure 3a.  Left retroperitoneal ganglioneuroma in a 20-year-old man. (a) Axial T1-weighted MR image shows a homogeneous, low-signal-intensity tumor (arrow) in the retroperitoneum medial to the left kidney. (b) Axial T2-weighted MR image shows linear and curvilinear low-signal-intensity areas within the markedly high-signal-intensity tumor (arrow), which has a somewhat whorled appearance. (c) On a coronal contrast-enhanced T1-weighted MR image, the tumor is poorly enhanced, except for the central portion (arrow). LK = left kidney.

View larger version (82K): [in a new window]   Figure 3b.  Left retroperitoneal ganglioneuroma in a 20-year-old man. (a) Axial T1-weighted MR image shows a homogeneous, low-signal-intensity tumor (arrow) in the retroperitoneum medial to the left kidney. (b) Axial T2-weighted MR image shows linear and curvilinear low-signal-intensity areas within the markedly high-signal-intensity tumor (arrow), which has a somewhat whorled appearance. (c) On a coronal contrast-enhanced T1-weighted MR image, the tumor is poorly enhanced, except for the central portion (arrow). LK = left kidney.

View larger version (135K): [in a new window]   Figure 3c.  Left retroperitoneal ganglioneuroma in a 20-year-old man. (a) Axial T1-weighted MR image shows a homogeneous, low-signal-intensity tumor (arrow) in the retroperitoneum medial to the left kidney. (b) Axial T2-weighted MR image shows linear and curvilinear low-signal-intensity areas within the markedly high-signal-intensity tumor (arrow), which has a somewhat whorled appearance. (c) On a coronal contrast-enhanced T1-weighted MR image, the tumor is poorly enhanced, except for the central portion (arrow). LK = left kidney.

View larger version (110K): [in a new window]   Figure 4a.  Left adrenal neuroblastoma in an 18-year-old woman. (a) Axial T1-weighted MR image shows a huge heterogeneous mass (arrows) that involves the left side of the retroperitoneum. The anterior portion of the mass has higher signal intensity than the posterior portion, a finding that suggests hemorrhagic necrosis of the tumor. (b) On an axial T2-weighted MR image, the tumor (arrows) demonstrates heterogeneous high signal intensity. (c) Coronal contrast-enhanced T1-weighted MR image also shows a huge suprarenal mass (arrows) with heterogeneous contrast enhancement. The mass displaces the left kidney (LK) inferiorly.

View larger version (122K): [in a new window]   Figure 4b.  Left adrenal neuroblastoma in an 18-year-old woman. (a) Axial T1-weighted MR image shows a huge heterogeneous mass (arrows) that involves the left side of the retroperitoneum. The anterior portion of the mass has higher signal intensity than the posterior portion, a finding that suggests hemorrhagic necrosis of the tumor. (b) On an axial T2-weighted MR image, the tumor (arrows) demonstrates heterogeneous high signal intensity. (c) Coronal contrast-enhanced T1-weighted MR image also shows a huge suprarenal mass (arrows) with heterogeneous contrast enhancement. The mass displaces the left kidney (LK) inferiorly.

View larger version (130K): [in a new window]   Figure 4c.  Left adrenal neuroblastoma in an 18-year-old woman. (a) Axial T1-weighted MR image shows a huge heterogeneous mass (arrows) that involves the left side of the retroperitoneum. The anterior portion of the mass has higher signal intensity than the posterior portion, a finding that suggests hemorrhagic necrosis of the tumor. (b) On an axial T2-weighted MR image, the tumor (arrows) demonstrates heterogeneous high signal intensity. (c) Coronal contrast-enhanced T1-weighted MR image also shows a huge suprarenal mass (arrows) with heterogeneous contrast enhancement. The mass displaces the left kidney (LK) inferiorly.

View larger version (126K): [in a new window]   Figure 5.  Right adrenal neuroblastoma in a 5-year-old girl. Contrast-enhanced CT scan shows a lobulated, inhomogeneous mass with low attenuation that is located in the right suprarenal region and extends across the midline. Dense intratumoral calcifications are also noted (arrows). The tumor displaces the aorta (A) and inferior vena cava (V) ventrally.

View larger version (95K): [in a new window]   Figure 6a.  Pheochromocytoma in a 32-year-old woman with hypertension. (a) Contrast-enhanced CT scan shows a 7-cm mass (arrow) in the right adrenal gland with marked contrast enhancement and well-defined internal cystic change. (b) On a coronal T2-weighted MR image, the mass (arrow) demonstrates high signal intensity. (c) Coronal contrast-enhanced T1-weighted MR image shows the right adrenal mass (arrow) with strong contrast enhancement and internal cystic change.

View larger version (97K): [in a new window]   Figure 6b.  Pheochromocytoma in a 32-year-old woman with hypertension. (a) Contrast-enhanced CT scan shows a 7-cm mass (arrow) in the right adrenal gland with marked contrast enhancement and well-defined internal cystic change. (b) On a coronal T2-weighted MR image, the mass (arrow) demonstrates high signal intensity. (c) Coronal contrast-enhanced T1-weighted MR image shows the right adrenal mass (arrow) with strong contrast enhancement and internal cystic change.

View larger version (101K): [in a new window]   Figure 6c.  Pheochromocytoma in a 32-year-old woman with hypertension. (a) Contrast-enhanced CT scan shows a 7-cm mass (arrow) in the right adrenal gland with marked contrast enhancement and well-defined internal cystic change. (b) On a coronal T2-weighted MR image, the mass (arrow) demonstrates high signal intensity. (c) Coronal contrast-enhanced T1-weighted MR image shows the right adrenal mass (arrow) with strong contrast enhancement and internal cystic change.

View larger version (91K): [in a new window]   Figure 7a.  Paraganglioma involving the organ of Zuckerkandl in a 33-year-old woman. (a) Contrast-enhanced CT scan shows a lobulated, inhomogeneous solid mass (arrow) in the left side of the retroperitoneum. (b) Anterior abdominal radionuclide scan obtained 72 hours after injection of 123-iodine metaiodobenzylguanidine demonstrates focal uptake in the left paraspinal area (arrow), a finding that suggests a paraganglioma.

View larger version (143K): [in a new window]   Figure 7b.  Paraganglioma involving the organ of Zuckerkandl in a 33-year-old woman. (a) Contrast-enhanced CT scan shows a lobulated, inhomogeneous solid mass (arrow) in the left side of the retroperitoneum. (b) Anterior abdominal radionuclide scan obtained 72 hours after injection of 123-iodine metaiodobenzylguanidine demonstrates focal uptake in the left paraspinal area (arrow), a finding that suggests a paraganglioma.

View larger version (110K): [in a new window]   Figure 8a.  Spontaneous rupture of a paraganglioma in a 52-year-old man who presented with acute abdominal pain. (a) Contrast-enhanced CT scan shows a retroperitoneal mass (arrow) with strong peripheral enhancement and central low-attenuation necrosis. (b) Contrast-enhanced CT scan obtained caudad to a demonstrates a low-attenuation fluid collection and hazy infiltration (arrows) along the left paraaortic space, findings that mimic rupture of an aortic aneurysm. Surgical findings confirmed a paraganglioma with spontaneous rupture.

View larger version (107K): [in a new window]   Figure 8b.  Spontaneous rupture of a paraganglioma in a 52-year-old man who presented with acute abdominal pain. (a) Contrast-enhanced CT scan shows a retroperitoneal mass (arrow) with strong peripheral enhancement and central low-attenuation necrosis. (b) Contrast-enhanced CT scan obtained caudad to a demonstrates a low-attenuation fluid collection and hazy infiltration (arrows) along the left paraaortic space, findings that mimic rupture of an aortic aneurysm. Surgical findings confirmed a paraganglioma with spontaneous rupture.

View larger version (113K): [in a new window]   Figure 9a.  Malignant paraganglioma with peritoneal seeding in a 73-year-old woman. (a) Contrast-enhanced CT scan shows a large, lobulated mass (T) with central necrosis in the pelvic cavity. (b) Contrast-enhanced CT scan obtained caudad to a shows another solid mass (M) adjacent to the primary mass, a finding that suggests peritoneal tumor seeding. Surgical findings confirmed malignant paraganglioma with peritoneal tumor seeding.

View larger version (113K): [in a new window]   Figure 9b.  Malignant paraganglioma with peritoneal seeding in a 73-year-old woman. (a) Contrast-enhanced CT scan shows a large, lobulated mass (T) with central necrosis in the pelvic cavity. (b) Contrast-enhanced CT scan obtained caudad to a shows another solid mass (M) adjacent to the primary mass, a finding that suggests peritoneal tumor seeding. Surgical findings confirmed malignant paraganglioma with peritoneal tumor seeding.

View larger version (163K): [in a new window]   Figure 10.  Multiple neurilemmomas in a 48-year-old woman. Coronal contrast-enhanced reformatted CT scan shows two lobulated soft-tissue-attenuation masses (arrows) in the left paravertebral space. The lower mass shows prominent cystic degeneration.

View larger version (104K): [in a new window]   Figure 11.  Retroperitoneal neurilemmoma in a 43-year-old woman. Contrast-enhanced CT scan shows a well-defined round mass in the left retroperitoneal space adjacent to the left kidney. The mass appears to have homogeneous low attenuation with a thick rim. Dense peripheral calcifications (arrows) are also seen in the periphery of the mass.

View larger version (110K): [in a new window]   Figures 12.  Neurilemmoma in a 35-year-old man. Contrast-enhanced CT scan shows a tumor with poor contrast enhancement (arrow) in the anterior abdominal wall. The tumor causes splaying of the left rectus abdominis muscle.

View larger version (94K): [in a new window]   Figure 13a.  Retroperitoneal neurilemmoma in a 38-year-old woman. (a) Contrast-enhanced CT scan shows a well-defined low-attenuation mass adjacent to the right kidney. (b) Axial T1-weighted MR image shows a homogeneous low-signal-intensity tumor (arrow). (c) On an axial turbo spin-echo T2-weighted MR image, the tumor has heterogeneous high signal intensity and is located posterior to the inferior vena cava (V). (d) Axial contrast-enhanced T1-weighted MR image shows the mass with inhomogeneous contrast enhancement (arrow), although it looked like a cystic tumor at CT (cf a).

View larger version (90K): [in a new window]   Figure 13b.  Retroperitoneal neurilemmoma in a 38-year-old woman. (a) Contrast-enhanced CT scan shows a well-defined low-attenuation mass adjacent to the right kidney. (b) Axial T1-weighted MR image shows a homogeneous low-signal-intensity tumor (arrow). (c) On an axial turbo spin-echo T2-weighted MR image, the tumor has heterogeneous high signal intensity and is located posterior to the inferior vena cava (V). (d) Axial contrast-enhanced T1-weighted MR image shows the mass with inhomogeneous contrast enhancement (arrow), although it looked like a cystic tumor at CT (cf a).

View larger version (90K): [in a new window]   Figure 13c.  Retroperitoneal neurilemmoma in a 38-year-old woman. (a) Contrast-enhanced CT scan shows a well-defined low-attenuation mass adjacent to the right kidney. (b) Axial T1-weighted MR image shows a homogeneous low-signal-intensity tumor (arrow). (c) On an axial turbo spin-echo T2-weighted MR image, the tumor has heterogeneous high signal intensity and is located posterior to the inferior vena cava (V). (d) Axial contrast-enhanced T1-weighted MR image shows the mass with inhomogeneous contrast enhancement (arrow), although it looked like a cystic tumor at CT (cf a).

View larger version (88K): [in a new window]   Figure 13d.  Retroperitoneal neurilemmoma in a 38-year-old woman. (a) Contrast-enhanced CT scan shows a well-defined low-attenuation mass adjacent to the right kidney. (b) Axial T1-weighted MR image shows a homogeneous low-signal-intensity tumor (arrow). (c) On an axial turbo spin-echo T2-weighted MR image, the tumor has heterogeneous high signal intensity and is located posterior to the inferior vena cava (V). (d) Axial contrast-enhanced T1-weighted MR image shows the mass with inhomogeneous contrast enhancement (arrow), although it looked like a cystic tumor at CT (cf a).

View larger version (155K): [in a new window]   Figure 14a.  Extraperitoneal pelvic neurofibroma in a 59-year-old man. (a) Sagittal T2-weighted MR image shows a well-defined round tumor in the pelvic cavity with mixed low and high signal intensity due to myxoid degeneration. R = rectum, U = urinary bladder. (b) On a sagittal contrast-enhanced T1-weighted MR image, the tumor has heterogeneous contrast enhancement and indents the urinary bladder (U) anteriorly and the rectum (R) posteriorly.

View larger version (151K): [in a new window]   Figure 14b.  Extraperitoneal pelvic neurofibroma in a 59-year-old man. (a) Sagittal T2-weighted MR image shows a well-defined round tumor in the pelvic cavity with mixed low and high signal intensity due to myxoid degeneration. R = rectum, U = urinary bladder. (b) On a sagittal contrast-enhanced T1-weighted MR image, the tumor has heterogeneous contrast enhancement and indents the urinary bladder (U) anteriorly and the rectum (R) posteriorly.

View larger version (94K): [in a new window]   Figure 15.  Neurofibroma originating from the urinary bladder in a 55-year-old man. Contrast-enhanced CT scan shows a well-enhanced solid mass that abuts the left lateral wall of the urinary bladder (U) and has marked internal heterogeneity due to myxoid degeneration. Occasionally, neurogenic tumors can involve the bladder.

View larger version (98K): [in a new window]   Figure 16.  Neurofibroma in the left iliac fossa in a 34-year-old woman. Contrast-enhanced CT scan shows a mass with a target-like enhancement pattern. The central portion of the mass (nerve tissue) is more hyperattenuating than the periphery (myxoid degeneration).

View larger version (94K): [in a new window]   Figure 17.  Plexiform neurofibromatosis in a 17-year-old girl. Contrast-enhanced CT scan demonstrates multiple low-attenuation nodular lesions (arrows) along the right paravertebral region. Note the scalloping of the adjacent vertebral body.

View larger version (96K): [in a new window]   Figure 18.  Malignant nerve sheath tumor in a 57-year-old man. Contrast-enhanced CT scan shows a well-defined, heterogeneously enhancing solid mass (arrow) in the extraperitoneal pelvic cavity, posterior to the right external iliac vessels. There is no one specific imaging finding that can help differentiate malignant from benign nerve sheath tumors.