病例報告：腎上腺神經鞘瘤

羅偉恩、王曉暹、黃家倫、楊景偉、陳光國、張心湜、謝啟誠、蔡昇翰

振興醫療財團法人振興醫院泌尿部

Case Report: Adrenal Schwannoma

Wei-En Luo, Hsiao-Hsian Wang, Chia-Lun Huang, Chin-Wei Yang, Kuang-Kuo Chen, Luke S. Chang, Chieh-Chen Hsieh, Sheng-Han Tsai

Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan

Case presentation: 

A 47 years old female with an abdominal mass discovered at abdominal sonography without any symptoms was referred to urology department for right adrenal tumor. At outpatient department, blood test revealed normal aldosterone and electrolytes. 24 hours urine VMA was within reference value. Urine catecholamine test showed norepinephrine 110.4 ug/day with normal dopamine and epinephrine. Serial image study of Abdominal CT revealed a right adrenal tumor with 52 mm in size suspect adrenocortical carcinoma or metastatic tumor. Abdominal and pelvis MRI showed a right adrenal mass in size of 4.1x4.2 cm, suspected adenoma, pheochromocytoma with accessory right inferior hepatic vein just abutting on the upper margin of right adrenal tumor.

The patient underwent right laparoscopic adrenalectomy and the pathologist reported a Schwannoma composed of interlacing spindle cells. The patient recovered well and was discharged under stable condition.

Discussion:

Schwannoma, also called neurilemmoma, is a tumor with very low incidence (<1%) of malignant changes. Retroperitoneal Schwannoma was also rare. Those tumors were usually found incidentally and asymptomatic. The radiology study usually could not provide evidence to differentiate schwannoma from other adrenal malignancies. However, CT and MRI study are still essential for measuring the size and the content of the tumor, adjacent organs and vessels preoperatively. Differential diagnosis is difficult before pathological examination.

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