Department of Pathology, First People's Hospital of Linping District, Hangzhou, China.
Department of Pathology, Taizhou People's Hospital of Jiangsu Province, China.
Medicine (Baltimore). 2024 Mar 22;103(12):e37452. doi: 10.1097/MD.0000000000037452.
Adrenal cellular schwannomas are exceptionally rare stromal tumors that are often misdiagnosed due to the lack of specific radiological, serological, or clinical features. In this report, we describe the differential diagnosis of a rare adrenal cellular schwannoma.
A 69-year-old man with a history of persistent hypertension, chronic kidney disease, hypertensive heart disease, and cardiac insufficiency was hospitalized due to bilateral lower extremity edema lasting for 3 months. Plain computed tomography at that time revealed a space-occupying lesion in the right adrenal gland. As serum levels of catecholamines, cortisol, and adrenocorticotropic hormone were within normal ranges, the edema was attributed to the chronic kidney disease and cardiac insufficiency, and the patient was referred to our hospital for surgical treatment. Contrast-enhanced computed tomography revealed heterogeneous enhancement in the adrenal mass indicating pheochromocytoma. An irregularly shaped 5 cm mass with a complete capsule in the right adrenal gland was laparoscopically resected. The postoperative histopathological diagnosis was adrenal cellular schwannoma.
The postoperative course was unremarkable and the tumor did not recur during 5 years of follow-up.
Adrenal cellular schwannoma is a very rare tumor that is extremely difficult to preoperatively diagnose. Histological and immunohistochemical analyses are required for differential diagnosis and confirmation. Cellular schwannomas can transform into malignant peripheral nerve sheath tumors, but not often. Consequently, regular postoperative follow-up is required for such patients, especially imaging.
肾上腺细胞性 schwann 瘤是非常罕见的间质肿瘤，由于缺乏特定的影像学、血清学或临床特征，常被误诊。本报告描述了一种罕见的肾上腺细胞性 schwann 瘤的鉴别诊断。
一名 69 岁男性，有持续性高血压、慢性肾脏病、高血压性心脏病和心功能不全病史，因双侧下肢水肿持续 3 个月而住院。当时的平扫 CT 显示右肾上腺有占位性病变。由于血清儿茶酚胺、皮质醇和促肾上腺皮质激素水平在正常范围内，水肿归因于慢性肾脏病和心功能不全，因此患者被转至我院进行手术治疗。增强 CT 显示肾上腺肿块呈不均匀强化，提示嗜铬细胞瘤。在腹腔镜下切除了右肾上腺一个包膜完整、形状不规则的 5cm 肿块。术后组织病理学诊断为肾上腺细胞性 schwann 瘤。
术后恢复顺利，5 年随访期间肿瘤未复发。
肾上腺细胞性 schwann 瘤是一种非常罕见的肿瘤，极难在术前诊断。需要进行组织学和免疫组织化学分析以进行鉴别诊断和确认。细胞 schwann 瘤可能会转化为恶性外周神经鞘瘤，但并不常见。因此，此类患者需要定期进行术后随访，特别是影像学检查。
