The majority of patients with ganglioneuromas are asymptomatic. Some cases may present with sweating & hypertension (due to elevated catecholamine levels), diarrhea (secondary to synthesis of vasoactive intestinal peptide), and virilization (secondary to the presence of testosterone secreting Leydig cells in some cases). Although most ganglioneuromas produce catecholamines, urinary levels of catecholamines and their metabolites are elevated only with very large tumors. Grossly, ganglioneuroma has a trabecular or whorled appearance resembling leiomyoma. Larger tumors may show areas of hemorrhage and necrosis. Note the circumscribed nature of the tumor and the rim of adrenal cortical tissue. Image courtesy of Dr. Mário R. Montemor Netto, Brazil; Used with permission.