Introduction: Adrenal neurilemoma (or schwannoma) are vary rare tumors. They usually present as incidental finding in asymptomatic patients, which makes them dificult to diagnose preoperatively.
Case report: We present a 60 year old woman with incidentally discovered adrenal mass of 5 cm on the right side. The tumor was detected by ultrasound and then it was confirmed by MSCT scan. We performed careful endocrine workup. Results showed normal levels of urinary catecholamines that excluded active pheochromocytoma. Midnight cortisol level was in the normal reference range with adequate suppression of cortisol in 1 mg overnight dexamethason suppression test and normal basal level of ACTH. Aldosteron was also in the normal reference range with normal aldosteron to PRA ratio. According to findings of MSCT scan, vena cava and diaphragm were infiltrated by tumor. Surgery was performed. Intraoperative findings showed adrenal tumor of about 6 cm in size. There was no evidence of the abdominal lymphadenopathy or vascular involvement. Tumor was completely and successfully removed with adrenalectomy. Pathohistology and immunohystochemistry of the tumor showed neurilemoma with perineural differentiation (diffusely positive on Vimentine, S100, Ki-67, and focally positive for EMA perineurium). Our patient is in good health recovering from surgery.
Conclusion: Although schwannomas are rare and usually benign, as it was in the case of our patient, malignant potency of these tumors raises complex questions regarding further follow up.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology