International Surgery Journal | July 2019 | Vol 6 | Issue 7 Page 2605 International Surgery Journal Oberoi A et al. Int Surg J. 2019 Jul;6(7):2605-2608 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Management of giant adrenal schwannoma Ajit Oberoi 1 , Kamal Kataria 1 *, Om Prakash 1 , Rajni Yadav 2 , Ankur Goyal 3 INTRODUCTION Adrenal incidentaloma (AI) has a prevalence of 4-6% in general population. 1 Schwannoma is a rare differential of adrenal incidentaloma with scarce literature available at present. They are slow growing nerve sheath tumours with no evidence of hormone secretion. Patient usually present with vague abdominal complaints. Management includes adrenalectomy via open or minimal invasive approach. Diagnosis is confirmed on histopathology and immunohistochemistry (IHC). 2 Herein we describe a case of a very large non-secreting adrenal mass detected incidentally which had large area of contact with renal vessels, aorta and surrounding viscera. Adrenalectomy was done with careful dissection and histopathology with IHC confirmed a diagnosis of conventional schwannoma. CASE REPORT An Asian female aged 50 years (BMI- 30.2 kg/m 2 ) presented to surgical OPD for left adrenal mass detected incidentally on ultrasound abdomen done for an unrelated fever episode 6 months ago. On examination her vitals were normal, per abdomen examination revealed a 12×10 cms firm, non-tender mass with smooth surface in the left hypochondrium extending till left lumbar region. Upper margin of the mass could not be felt. The mass was ballotable and moving with respiration. Ultrasound abdomen revealed 13.4×12.5 cms round to oval hypoechoic mass at upper pole of left kidney. Contrast enhanced CT scan (Fig. 1A, 1B, 1C) revealed well defined heterogeneously enhancing 10.4×11 cms mass in the left suprarenal location. Mass had >180 degrees area of contact with left renal artery and vein and 90 degrees area of contact with the left lateral aspect of descending abdominal aorta at the level of branching of left gonadal artery but with no evidence of vascular invasion (Figure 1B, 1C, 1D). Mass displaced the surrounding organs, but fat planes were maintained. MIBG SPECT/CT revealed no radiotracer uptake (Figure 2). A provisional diagnosis of adrenocortical carcinoma was made. Blood investigations including complete blood count (CBC), liver function test, kidney function test, serum cortisol, cortisol post dexamethasone suppression test, DHEAS, serum testosterone, 24 hours urinary VMA were normal. Patient underwent open transabdominal left adrenalectomy. Intraoperatively adrenal mass was ABSTRACT Adrenal schwannoma is a rare differential of adrenal incidentaloma with scarce literature available at present. Adrenal schwannomas are usually non-secreting tumours but can very rarely secrete catecholamines. Specimen of our patient was 14 cm in diameter and weighed 900 gm which is the largest adrenal schwannoma in literature. Although it is a benign lesion but there are no standard treatment guidelines because of rarity of lesion. Keywords: Adrenal incidantiloma, Adrenal schwannoma, Adrenalectomy 1 Department of Surgical Disciplines, 2 Department of Pathology, 3 Department of Radiology, AIIMS, New Delhi, India Received: 09 April 2019 Accepted: 11 June 2019 *Correspondence: Dr. Kamal Kataria, E-mail: drkamalkataria@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20193003