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Wilson MP, Katlariwala P, Huang J, Low G, Wiebe E. Benign adrenal and suprarenal retroperitoneal schwannomas can mimic aggressive adrenal malignancies: case report and review of the literature. Intractable Rare Dis Res 2020; 9:156-162. [PMID: 32844073 PMCID: PMC7441032 DOI: 10.5582/irdr.2020.01027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The suprarenal retroperitoneum and adrenal gland is a rare site of origin for benign schwannomas which frequently present as larger and more aggressive lesions than schwannomas identified elsewhere. These tumors are often surgically excised. We present a case of an 81-year-old asymptomatic man presenting with an incidental 10 cm left suprarenal retroperitoneal mass identified on CT. The mass was indiscernible from the adrenal gland, demonstrating heterogeneous enhancement with a centrally cystic/necrotic core, and punctate calcifications. Subsequent core needle biopsy demonstrated a benign adrenal schwannoma. The lesion has been managed conservatively with imaging follow up and without complication. DISCUSSION: Our review of the literature identifies 121 reported in vivo benign adrenal and suprarenal schwannomas published to date with imaging features available for 90 cases (74%). All cases were encapsulated with the average size measuring over 6.5 cm. Fifteen percent (13/84) of reported lesions measured over 10 cm at presentation. Punctate calcification was present in 50% (26/52) of reporting cases. Nearly 50% (40/86) of cases demonstrate cystic/necrotic appearances on imaging. Despite aggressive appearances, our case demonstrates that biopsy and surveillance may represent a reasonable alternative to surgery in suboptimal surgical candidates.
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Affiliation(s)
- Mitchell P. Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Prayash Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Jingyang Huang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Edward Wiebe
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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AlMalki MH, Alotaibi M, Ahmad MM, Rahman MAU, Alharthi T. Schwannoma Misdiagnosed as Adrenal Adenoma: A Case Report and Review of the Literature. Case Rep Endocrinol 2020; 2020:8020761. [PMID: 32082650 PMCID: PMC7019206 DOI: 10.1155/2020/8020761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/10/2020] [Indexed: 12/03/2022] Open
Abstract
Schwannoma is a benign neurogenic tumor originating from the neural sheath of Schwann cells. It is an extremely rare cause of adrenal adenoma which is very difficult to diagnose preoperatively. We report the case of a right adrenal schwannoma discovered incidentally in a 62-year-old woman during evaluation of right flank pain. The biochemical and hormonal evaluations were unremarkable. Radiological examination revealed a 4.8 cm lesion keeping with right adrenal adenoma. Surgical intervention was done due to the large size of the tumor, and laparoscopic right adrenalectomy was performed. The postoperative course was uneventful. Histological examination established the diagnosis of schwannoma, which was further confirmed by immunohistochemical staining. In conclusion, adrenal schwannoma is extremely rare and can be misdiagnosed as nonsecreting adrenal adenoma. Complete surgical excision is the treatment of choice which is associated with favorable outcome and also helps in clarifying its histopathological nature.
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Affiliation(s)
- Mussa H. AlMalki
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
- King Fahad Medical City, College of Medicine, King Saud Bin Abdul Aziz University for Health Science, Riyadh, Saudi Arabia
| | - Metib Alotaibi
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Muhammad Amin ur Rahman
- Department of Pathology and Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Turki Alharthi
- Department of Endocrinology, Military Hospital, Jeddah, Saudi Arabia
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Juxta-adrenal schwannoma presenting as a giant adrenal tumor: A case report and a literature review. Int J Surg Case Rep 2018; 53:132-136. [PMID: 30391738 PMCID: PMC6216048 DOI: 10.1016/j.ijscr.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022] Open
Abstract
Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. RS can be misdiagnosed preoperatively, especially when they stick to other structures (the adrenal in our case). Complete surgical resection is the treatment of choice and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirm the diagnosis.
Introduction Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. Juxta-adrenal schwannomas may be misdiagnosed with giant adrenal tumors. This article reports the case of a RS that presented as an asymptomatic adrenal mass in a 50 Y.O female. Presentation of case An abdominal ultrasound of our asymptomatic patient showed right adrenal lesion of 9 cm of diameter. Endocrinological evaluation was negative. The patient was considered to have a non-secreting right adrenal mass confirmed by adrenal scan. We began a right laparoscopic trans peritoneal adrenalectomy, but when we discovered intra operatively that the wall of the IVC and the renal vein were very adherent to the mass which had a lot of small vessels that were bleeding, we converted to open surgery that allowed us to remove the mass safely. The operative time was 200 min, the blood loss was 850 cc and the patient was discharged uneventfully on the sixth day after surgery. Discussion Although we thought that we removed a huge adrenal tumor from the retroperitoneum of our patient, the pathological exam revealed a RS that comprises the adrenal gland which was normal. Preoperative establishment of diagnosis is difficult in case of RS that can be misdiagnosed, especially when they stick to other structures (the adrenal in our case). Conclusion Complete surgical resection is the treatment of choice for RS and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirms the diagnosis that can be easily missed preoperatively.
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Babaya N, Makutani Y, Noso S, Hiromine Y, Ito H, Taketomo Y, Ueda K, Ushijima H, Komoike Y, Yamazaki Y, Sasano H, Kawabata Y, Ikegami H. Case report: schwannoma arising from the unilateral adrenal area with bilateral hyperaldosteronism. BMC Endocr Disord 2017; 17:74. [PMID: 29212491 PMCID: PMC5719664 DOI: 10.1186/s12902-017-0225-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We report a rare case of a juxta-adrenal schwannoma that could not be discriminated from an adrenal tumor before surgical resection and was complicated by bilateral hyperaldosteronism. To the best of our knowledge, this is first case in which both a juxta-adrenal schwannoma and hyperaldosteronism co-existed. CASE PRESENTATION A 69-year-old male treated for hypertension was found to have a left supra-renal mass (5.8 × 5.2 cm) by abdominal computed tomography. His laboratory data showed that his plasma aldosterone concentration (PAC) was within the normal range, but his plasma renin activity (PRA) was reduced, resulting in an increased aldosterone/renin ratio (ARR). Load tests of captopril or furosemide in the standing position demonstrated autonomous aldosterone secretion and renin suppression. Adrenal venous sampling (AVS) with ACTH stimulation indicated bilateral hypersecretion of aldosterone. A left supra-renal tumor was resected because of the possibility of malignancy and was found to be a benign schwannoma arising from the juxta-adrenal region together with an adrenal gland. The dissected left adrenal gland was morphologically hyperplastic in the zona glomerulosa, but was immunohistochemically negative for CYP11B2 (aldosterone synthase). Multiple CYP11B2-positive adrenocortical micronodules were detected in the adrenal gland, indicating micronodular hyperplasia. Although bilateral aldosteronism was indicated by AVS before the operation, the PRA, PAC and ARR values were within their respective reference ranges after resection of the unilateral tumor, suggesting that the slight increase in hormone secretion from the remaining right-sided lesion could not be detected after resection. CONCLUSION A clinical and morphologic diagnosis of juxta-adrenal schwannoma is difficult, particularly in a case of hyperaldosteronism, as shown in this case. These data suggest the complexity and difficulty diagnosing adrenal incidentaloma.
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Affiliation(s)
- Naru Babaya
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Yukako Makutani
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Yoshihisa Hiromine
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Hiroyuki Ito
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Yasunori Taketomo
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Kazuki Ueda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Hokuto Ushijima
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Yoshifumi Komoike
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Yumiko Kawabata
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan
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Schwannoma Localized Retroperitoneally in a 14-Year-Old Boy. Case Rep Pediatr 2016; 2016:1210874. [PMID: 28078159 PMCID: PMC5203868 DOI: 10.1155/2016/1210874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/25/2016] [Accepted: 11/30/2016] [Indexed: 01/08/2023] Open
Abstract
Schwannomas usually occur in adults being between the second and fifth decades, and such neoplasms are extremely rare in a pediatric population. In addition, they are not normally found in the retroperitoneal region. Here, we present a pediatric case of a retroperitoneal schwannoma in an adrenal location where the tumor was not able to be preoperatively differentiated from other benign or malign adrenal gland tumors. In our opinion, this tumor can be included in the differential diagnosis of a nonfunctioning retroperitoneal adrenal mass in children.
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