Diagnostic challenge of an adrenal mass in multiple myeloma: A case of ganglioneuroma.

Adrenal ganglioneuroma is a rare benign tumor that is often discovered incidentally and may present a significant diagnostic challenge because of its nonspecific imaging features. This difficulty is particularly pronounced in patients with known malignancy, in whom an adrenal mass is more readily interpreted as metastatic or plasmacytic disease. We report the case of a patient with multiple myeloma in whom an incidental adrenal mass was detected during staging computed tomography. Imaging findings were indeterminate and raised suspicion for adrenal metastasis or extramedullary plasmacytoma. Magnetic resonance imaging demonstrated several features favoring a benign lesion, including a well-circumscribed appearance and the absence of local invasion; however, definitive diagnosis remained uncertain, particularly given the patient's oncological context. A computed tomography-guided percutaneous biopsy was therefore performed and confirmed the diagnosis of adrenal ganglioneuroma. This case illustrates the diagnostic challenge posed by adrenal incidentalomas in patients with underlying malignancy and emphasizes the value of image-guided biopsy in establishing an accurate diagnosis and preventing unnecessary surgical management.