TUMORS 333 



no symptoms, and are only discovered as incidental autopsy 

 findings. As found in the adrenal they resemble similar tu- 

 mors derived from other parts of the sympathetic nervous 

 system. They are sometimes found within the adrenal but 

 more commonly arise from the tissue around the capsule. 

 Although generally benign, the less differentiated type of 

 ganglioneuroma may be malignant and give rise to metastases, 

 in which case they are often spoken of as ganglionic sarcoma. 215 



Microscopically, the ganglioneuroma resemble the para- 

 ganglioma to be described next but may be differentiated by 

 the absence of the chromate reaction and by their fibrillar 

 stroma which is interspersed with ganglionic cells. 230 



Paraganglioma or chromaffinoma. These tumors are derived 

 from the chromaphil cells of the adrenal medulla or extra- 

 adrenal chromaphil tissue. They are also called phaeochromo- 

 cytoma or chromaphil cell carcinoma. They form perhaps the 

 rarest of the adrenal tumors. 515 



Eisenberg and Wallerstein 176 have collected and analyzed 53 

 cases of this tumor from reports in the literature. Only 5 of 

 these 53 cases were malignant and all of these 5 were bilateral. 

 The chromaffinomas are most often found in the right gland. 

 Half of all the cases occur during the fourth and fifth decades of 

 life. In some cases they have been associated with tumors in 

 other organs or with neurofibromatosis (von Recklinghausen's 

 disease). 



The chromamnoma vary in size from 1 to 12 centimeters in 

 diameter. The larger tumors are usually cystic and hemor- 

 rhagic and are more apt to be benign than the small growths. 

 The latter are greyish bodies of firm consistency, while the 

 larger tumors are usually soft and reddish in appearance. 

 They are characterized microscopically by cells of irregular 

 size, shape, and staining properties. These epithelial-like 

 cells assume an alveolar arrangement. When treated with 

 chromates the typical chromaphil reaction is elicited. The 

 cells are free of fat and glycogen. This differentiates them 

 from similarly appearing tumors of the kidney. 230 



