Schwannoma masquerading as adrenocortical tumor: A case repo
A healthy 32 years old male patient presented to the primary care clinic with recurrent vague loin pain with no other associated symptoms. He is not known to have hypertension or on long-term medications. He has no history of fever or weight loss. Physical examination was normal. CT scan of the abdomen with contrast showed a 47 x 43 x 52 mm inhomogeneously enhancing mass within the right adrenal gland in the retrocaval region of the upper abdomen abutting and splaying the limbs of the adrenal gland. Hormonal workup showed normal levels of catecholamines with normal hypothalamic- pituitary adrenal axis. He was declared a case of nonfunctional right adrenal adenoma. Treatment plan was discussed with the patient and he elected for robotic transperitoneal right adrenalectomy.

General endotracheal intubation was induced followed by placing the patient in the flank position. Four 8-mm robotic trocars were placed in a straight line in the right midclavicular line. Two aadditional midline trocars were placed. A 5-mm trocar was placed in the sub-xiphoidal area for liver retraction. The liver was mobilized superiorly and the duodenum was kocherized.A large adrenal mass was encountered and the right renal vein was identified. Dissection along the side of the IVC was done till identifying the insertion of the right adrenal vein which was controlled with hem-o-lock. The tumor was then dissected off the inferior surface of the liver and the upper pole of the kidney. Multiple collateral veins were seen going into the tumor from the upper border of the renal vein and the lateral border of the IVC. After removing the tumor, we could see clearly the retroperitoneal area indicating that the tumor was completely excised. Postoperatively, the patient had uneventful recovery and was discharged home on the 3rd postoperative day.

Histopathological examination showed spindle cells arranged in intervening fascicles with frequent degenerative and necrotic changes and focal degenerative atypia with many foamy histiocytes. Immunohistochemical staining showed positive immunoreactivity of the spindle cells with S100 antibodies (diffuse strong cytoplasmic and nuclear) and negative staining with CD34, inhibin, cytokeratin, smooth muscle actin, synaptophysin and chromogranin The morphological findings and the immunohistochemical staining profile were consistent with peripheral nerve schwannoma.

Source: Urology case reports

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