Incidental detection of adrenal schwannoma: a case report.

BACKGROUND: Adrenal schwannomas (AS) are rare benign peripheral nerve sheath tumors that originate from Schwann cells. They are often asymptomatic and discovered incidentally on imaging for unrelated conditions. Owing to its rarity and nonspecific clinical presentation, AS can be misdiagnosed as other adrenal neoplasms, necessitating radiological and histopathological evaluation for accurate diagnosis.

CASE PRESENTATION: We report the case of a 53-year-old Iranian man with a history of hypertension and fatty liver disease, who presented with mild abdominal pain. Imaging studies revealed a large, well-circumscribed, heterogeneous adrenal lesion with cystic changes and calcifications, raising suspicion of an adrenal neoplasm. Laboratory investigations ruled out functional adrenal tumors. The patient underwent laparotomy and left adrenalectomy, and histopathological examination revealed a well-encapsulated tumor with spindle cell proliferation, nuclear palisading (Verocay bodies), and hyalinized blood vessels. To further confirm the diagnosis, immunohistochemical (IHC) staining was performed, which demonstrated positivity for S-100 protein, consistent with AS.

CONCLUSIONS: This case highlights the importance of considering AS in the differential diagnosis of adrenal masses. Histopathological and IHC remain the gold standard for definitive diagnosis. Complete surgical resection is considered curative, and the long-term prognosis is excellent.