Adrenal schwannoma: A case report

Fuentes, Clara; Garaizabal, Leire; Pérez, Octavio

doi:10.1016/j.medcle.2020.04.059

array:24 ["pii" => "S2387020621003181" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.04.059" "estado" => "S300" "fechaPublicacion" => "2021-07-23" "aid" => "5309" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:90-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775320304760" "issn" => "00257753" "doi" => "10.1016/j.medcli.2020.04.060" "estado" => "S300" "fechaPublicacion" => "2021-07-23" "aid" => "5309" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:90-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Schwannoma suprarrenal: descripción de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "90" "paginaFinal" => "91" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Adrenal schwannoma: a case report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Clara Fuentes, Leire Garaizabal, Octavio Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Clara" "apellidos" => "Fuentes" ] 1 => array:2 [ "nombre" => "Leire" "apellidos" => "Garaizabal" ] 2 => array:2 [ "nombre" => "Octavio" "apellidos" => "Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621003181" "doi" => "10.1016/j.medcle.2020.04.059" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003181?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320304760?idApp=UINPBA00004N" "url" => "/00257753/0000015700000002/v1_202107100526/S0025775320304760/v1_202107100526/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020621003211" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.04.060" "estado" => "S300" "fechaPublicacion" => "2021-07-23" "aid" => "5307" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:91-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Cryptogenic organizing pneumonia by alectinib" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "91" "paginaFinal" => "92" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonía organizada criptogenética por alectinib" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1233 "Ancho" => 1500 "Tamanyo" => 138519 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "PA chest X-ray in supine position on his first arrival at the A&E." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patricia López Pardo, Ana María Sánchez Peña, María Teresa Río Ramírez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Patricia" "apellidos" => "López Pardo" ] 1 => array:2 [ "nombre" => "Ana María" "apellidos" => "Sánchez Peña" ] 2 => array:2 [ "nombre" => "María Teresa" "apellidos" => "Río Ramírez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320304747" "doi" => "10.1016/j.medcli.2020.04.058" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320304747?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003211?idApp=UINPBA00004N" "url" => "/23870206/0000015700000002/v1_202107200643/S2387020621003211/v1_202107200643/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020621003247" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.02.003" "estado" => "S300" "fechaPublicacion" => "2021-07-23" "aid" => "5628" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:89-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Management of aplastic anemia during the phase of defervescence of the COVID-19 pandemic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "89" "paginaFinal" => "90" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abordaje de la aplasia medular en la fase de defervescencia de la pandemia por COVID-19" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Carlos Vallejo Llamas" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Vallejo Llamas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775321001780" "doi" => "10.1016/j.medcli.2021.02.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321001780?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003247?idApp=UINPBA00004N" "url" => "/23870206/0000015700000002/v1_202107200643/S2387020621003247/v1_202107200643/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Adrenal schwannoma: A case report" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "90" "paginaFinal" => "91" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Clara Fuentes, Leire Garaizabal, Octavio Pérez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Clara" "apellidos" => "Fuentes" "email" => array:1 [ 0 => "clararosario.fuentesgomez@osakidetza.eus" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Leire" "apellidos" => "Garaizabal" ] 2 => array:2 [ "nombre" => "Octavio" "apellidos" => "Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Endocrinología, Hospital Universitario Araba, Vitoria-Gasteiz, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Schwannoma suprarrenal: descripción de un caso" ] ] "textoCompleto" => "A schwannoma is a benign, encapsulated tumor originating in the Schwann cells of the peripheral sympathetic nervous system, the cranial nerves of the head and neck, and the upper or lower limbs. Its occurrence in an adrenal gland is unusual.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Most of these tumors are benign, with malignant ones being more common in cases of Von Recklinghausen’s disease. They are more prevalent among women than men (1.2:1), and the mean age of onset is 49 years. Most are discovered as incidental findings, and their symptoms seem to be related to the size of the tumor, such as abdominal pain caused by the mass effect. Hormonal test findings tend to be normal. Computed tomography (CT) images tend to show a well-defined, encapsulated, homogeneous mass and magnetic resonance imaging (MRI) reveals a heterogeneous mass, with either cystic degeneration or hemorrhagic areas with a hypointense T1 signal and a hyperintense T2 signal, which, therefore, lead to a differential diagnosis of pheochromocytoma or adrenal carcinoma.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>We hereby present the case of a 55-year-old woman with hypertransaminasemia secondary to alcohol consumption. A requested MRI revealed a heterogeneous, left adrenal mass with a diameter of 3.5 × 3 cm, with some irregular areas of hyperintense T2 signal and others of hypointense cystic degeneration/central necrosis. The lesion contained no adipose or hemorrhagic material, and exhibited no signs of invasion of the adjacent structures or adenopathies. A differential diagnosis of either pheochromocytoma or adrenal carcinoma was proposed as the main option.The patient was referred to the Endocrinology Department for further examination. She reported a three-year history of arterial hypertension, with a worse control of her blood pressure levels over the previous year (mean 160/100 mmHg), owing to which she is currently under treatment with two antihypertensive drugs. A hormonal study was requested to determine the concentrations of renin mass, aldosterone, urinary free cortisol, plasma cortisol after administering 1 mg of dexamethasone, urinary metanephrines, dehydroepiandrosterone sulphate, total testosterone, androstenedione, and 17-hydroxyprogesterone, all of which fell within normal limits.The patient was subsequently referred to the Surgery Department to undergo a left adrenalectomy and reach a definitive pathological diagnosis. This procedure was performed laparoscopically in March 2017, with the pathological study of the samples obtained yielding a diagnosis of a schwannoma limited to the adrenal gland. The macroscopic description was reported as an adrenal gland measuring 8.5 × 4 × 3 cm, with a 3.5 × 3.2-cm nodule delimited by a capsule. The nodule corresponded to a solid mass with whitish-grayish cystic areas. The microscopic description reported a tumor in the adrenal medulla that was displacing its cortex and was comprised by a proliferation of spindle cells with a fascicular pattern, elongated nuclei, and an ill-defined cytoplasm, with areas of increased cellularity, nuclear “pseudo-palisading”, myxoid areas with poor cellular representation, and blood vessels with thick and hyalinized walls. Areas of ischemia, cystic degeneration, and polymorphous nuclei without mitosis were also observed. The mitotic index was less than 1 mitosis/10 high power fields (HPFs), and the Ki-67 index was 5%. In addition, an immunohistochemistry study revealed a positive result for the S-100 protein and a negative one for actin, caldesmon, desmin, AE1-AE3, and inhibin.After the procedure, the patient was re-examined in the Endocrinology Department with the aid of a Holter blood pressure device, which revealed mean blood pressure levels of 107/74 mmHg and, therefore, a need for decreasing her antihypertensive medication. A physical examination revealed no “café au lait” spots, but several axillary freckles were detected in a region where, according to the patient, several, small, pedunculated, benign tumors had previously been removed. The corresponding pathology report could not be retrieved from her medical history.To conclude, schwannomas are solid, encapsulated tumors, frequently presenting with areas of bleeding, necrosis, and cysts, which are generally located in the cranial and cervical cutaneous nerves, with their presence in the retroperitoneum and adrenal glands being rare. Because CT or MRI images rarely allow their preoperative differentiation from pheochromocytomas or adrenal carcinomas,<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> preoperative hormonal testing is advised to rule out an increase in metanephrine levels requiring prior treatment with alpha-blockers. Only a single case of a schwannoma associated with increased levels of urinary catecholamines in the laboratory tests has been described. Pathological studies often reveal hemorrhagic and cystic areas within the tumors. In addition, despite not being pathognomonic, positivity for the S-100<a class="elsevierStyleCrossRef" href="#bib0025">5</a> protein in the immunohistochemistry studies is a fundamental finding. The clinical evolution of this condition is generally benign, except in cases associated with Von Recklinghausen’s fibromatosis, where malignancy is more frequent.The patient was also examined in the Ophthalmology Department to have an optic glioma ruled out owing to the suspected diagnosis of type 1 neurofibromatosis, although she did not fulfill the criteria for genetic testing." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Fuentes C, Garaizabal L, Pérez O. Schwannoma suprarrenal: descripción de un caso. Med Clin (Barc). 2021;157:91–92." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary adrenal schwannoma: a series of 31 cases emphasizing their clinicopathologic features and favorable prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Zhou" 1 => "D. Zhang" 2 => "W. Li" 3 => "L. Zhou" 4 => "H. Xu" 5 => "S. Zheng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12020-019-01992-z" "Revista" => array:6 [ "tituloSerie" => "Endocrine." "fecha" => "2019" "volumen" => "65" "paginaInicial" => "662" "paginaFinal" => "674" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31278687" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adrenal schwannoma: CT, MR manifestations and pathological correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Tang" 1 => "X.R. Yu" 2 => "L.P. Zhou" 3 => "H.B. Gao" 4 => "Q.F. Wang" 5 => "W.J. Peng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3233/CH-170316" "Revista" => array:6 [ "tituloSerie" => "Clin Hemorheol Microcirc." "fecha" => "2018" "volumen" => "68" "paginaInicial" => "401" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29660928" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adrenal schwannoma: a rare incidentaloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Kumar" 1 => "V.S. Karthikeyan" 2 => "C.S. Manohar" 3 => "K. Sreelakshmi" 4 => "M. Shivalingaiah" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Clin Diagn Res." "fecha" => "2016" "volumen" => "10" "numero" => "8" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT findings of adrenal schwannoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.M. Zhang" 1 => "P.F. Lei" 2 => "M.N. Chen" 3 => "X.F. Lv" 4 => "Y.H. Ling" 5 => "P.Q. Cai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crad.2016.01.010" "Revista" => array:6 [ "tituloSerie" => "Clin Radiol." "fecha" => "2016" "volumen" => "71" "paginaInicial" => "464" "paginaFinal" => "470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26897337" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and retroperitoneal laparoscopic resection of adrenal schwannoma in 19 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.Q. Li" 1 => "Y.S. Zhang" 2 => "J. Shi" 3 => "H.Z. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/EP14453.OR" "Revista" => array:6 [ "tituloSerie" => "Endocr Pract." "fecha" => "2015" "volumen" => "21" "paginaInicial" => "323" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25932565" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000002/v1_202107200643/S2387020621003181/v1_202107200643/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000002/v1_202107200643/S2387020621003181/v1_202107200643/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003181?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 157. Issue 2.

Pages 90-91 (July 2021)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Medicina Clínica (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Medicina Clínica (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Medicina Clínica

Tools

Free access articles

Associations of physical activity, sedentary time,...

Med Clin. 2024;163:327-35

Burden of COVID-19 variant omicron in immunocompromised...

Med Clin. 2024;163:347-59

Raynaud phenomenon in a baseball...

Med Clin. 2024;163:e79

Medicina Clínica (English Edition) follows the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter