We report a case of two incidental lesions, a benign adrenal schwannoma and cerebral meningioma. There are no cases in the literature to link de-novo adrenal schwannoma and meningioma in patients. This case highlights the importance of multidisciplinary working to ensure expedited management in such cases.
A 76 year old gentleman presented to ED with a seizure and a community-acquired pneumonia. Past medical history included atrial fibrillation and ischaemic heart disease, for which he was on warfarin and bisoprolol. CT head revealed a left frontal lobe lesion, radiologically in keeping with a meningioma. As part of his work-up, CT chest/abdo/pelvis showed an incidental left adrenal lesion, approximately 5.5×4.0 cm. On examination, he reported having gained little weight recently, but had no clinical signs to suggest cortisol excess. Abdomen was soft with no palpable masses. Initial biochemistry showed normal electrolytes. His renin/aldosterone, 24-hour urinary catecholamines and overnight dexamethasone suppression tests were normal. Triple phase CT adrenal scan showed an indeterminate solid tumour with no contrast wash-out, and features concerning for a primary adrenocortical carcinoma.
Following discussion at both neurosurgical and adrenal MDTs, despite initial presentation of a seizure, decision was made for left adrenalectomy prior to resection of the meningioma. Clinical priority for this was based on the size of the adrenal lesion and CT appearances being suggestive of adrenocortical carcinoma. Final histology for both lesions confirmed a benign adrenal tumour consistent with schwannoma and a Grade 2 frontal lobe meningioma. There have been no cases of a link between de-novo adrenal schwannoma and meningioma in patients. Adrenal schwannomas overall are very rare tumours that are difficult to diagnose preoperatively, and in the context of possible malignancy, complete laparoscopic excision is the treatment of choice. However, awareness of benign adrenal lesions is vital for accurate pathological diagnosis to guide optimal patient management.