Cases reported "Adrenal Gland Neoplasms"

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1/22. pheochromocytoma associated with neuroendocrine carcinoma. A new type of composite pheochromocytoma.

    The coexistence of pheochromocytoma and other tumor types in a single adrenal gland has been rarely documented. This type of pheochromocytoma is designated "composite" or "mixed," depending on whether the pheochromocytoma and the nonpheochromocytoma components show the same embryologic origin. The nonpheochromocytoma components reported in the composite pheochromocytoma include ganglioneuroma, ganglioneuroblastoma, neuroblastoma, and malignant schwannoma. The components found in the mixed pheochromocytoma include adrenal cortical neoplasms and spindle cell sarcoma. We report a unique case of composite pheochromocytoma in which the nonpheochromocytoma element is a neuroendocrine carcinoma. The histologic and the immunohistochemical profiles of the 2 distinct components of this tumor were typical for those of pheochromocytoma and neuroendocrine carcinoma. This dual differentiation was also supported by ultrastructural findings. This case not only broadens the morphologic spectrum of composite pheochromocytoma but also provides some additional insight into the histogenesis of this rare but fascinating type of tumor.
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2/22. Malignant schwannoma of the stomach in a patient with von Recklinghausen's disease.

    A patient with von Recklinghausen's disease died with a malignant schwannoma of the stomach and was found at autopsy to have neurofibromatosis of the gastrointestinal tract, a plexiform neurofibroma of the myocardium and a phaechromocytoma. Malignancy of the gastrointestinal tract in von Recklinghausen's disease is rare, and this case highlights the difficulties in histological diagnosis of malignant nerve sheath tumours.
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3/22. Retroperitoneal schwannoma presenting as an adrenal tumor.

    A retroperitoneal tumor in the region of the adrenal gland was diagnosed in a 56-year-old woman. The patient had been suffering from a dull abdominal pain for nearly four weeks before consulting her family physician. Ultrasound, CT and MRI scans revealed a giant tumor of the right adrenal gland. Endocrine activity could not be demonstrated. The size of the tumor was suggestive of an adrenal carcinoma. The patient was referred for adrenalectomy and complete exstirpation of the retroperitoneal mass. The histological examination revealed characteristical findings of a benign schwannoma.
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4/22. role of autologous blood transfusion in sacral tumor resection: patient selection and recovery after surgery and blood donation.

    We carried out sacral en-bloc resection in six patients (three with chordoma; one with pheochromocytoma; one with malignant schwannoma; and one with giant cell tumor) using preoperatively collected autologous blood, to avoid homologous blood transfusion. An average of 3200 ml was collected preoperatively, with patients receiving recombinant human erythropoietin (r-HuEPO), at a total dose of 130 000 units on average. In four patients, we were able to accomplish the surgery without homologous blood transfusion. Postoperatively, the hemoglobin level in these four patients recovered to the pre-collective level in 4.5 weeks, on average. These clinical results indicate that en-bloc sacrectomy, which requires a large volume of blood transfusion, can be accomplished with preoperatively collected autologous blood alone.
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5/22. Retroperitoneal schwannoma mimicking an adrenal lesion.

    Schwannomas are usually benign tumors that arise from the nerve supporting the Schwann cell. The majority arise at the cranial nerves or nerves of the upper extremities. Most patients with retroperitoneal schwannomas present with vague abdominal or back pain. We present a case in which a retroperitoneal mass thought to be arising from the adrenal gland on computed tomography and magnetic resonance imaging was found after excision to be a Schwannoma. The available literature on retroperitoneal schwannomas is then discussed.
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6/22. Benign retroperitoneal schwannoma mimicking an adrenal mass.

    Adrenal tumors are frequently incidental discoveries, and the therapy for them is the subject of controversial discussions. We report herein on such an incidentaloma, which proved to be a benign retroperitoneal schwannoma. A 48-year-old female with an unclear adrenal mass underwent retroperitoneoscopic tumor extirpation. A well-defined tumor that displaced the adrenal gland and adhered firmly to only one retroperitoneal nerve was discovered. The en bloc resection was performed without problem. The histopathologic examination revealed a benign schwannoma. Retroperitoneal schwannomas can mimic a multitude of different conditions. Because imaging methods frequently do not yield distinct results, quite often only the operative exploration can establish a definitive diagnosis. In a case of unclear retroperitoneal findings, an endoscopic extirpation should be considered.
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7/22. Benign retroperitoneal schwannoma presenting as a giant adrenal tumor.

    We report a 51-year-old man with a primary adrenal tumor presenting as a giant juxta-adrenal benign schwannoma. The patient was initially admitted for persistent fevers and underwent a sepsis workup. Abdominal ultrasound initially revealed an incidental right suprarenal mass, which measured 10 x 10 x 11 cm, estimated by computed tomography. Following a successful laparotomy, histologic examination confirmed that this giant tumor was a benign retroperitoneal schwannoma. Postoperatively, the patient remains disease-free, undergoing rehabilitation.
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8/22. Retroperitoneal schwannomas simulating adrenal tumors.

    Tumors in the area of the adrenal were detected by chance in two patients who underwent a regular physical check-up. On arteriography the tumors were found to be fed by the adrenal artery. The diagnosis was retroperitoneal schwannoma, but in both patients it was difficult to differentiate the schwannoma from an adrenal tumor preoperatively.
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9/22. Adrenal Schwannoma. Report of two cases.

    Adrenal tumours are frequently incidental discoveries, and their therapy is a subject of controversial discussions. Herein we describe two cases of adrenal schwannoma discovered during autopsy. The accidental observation of two benign schwannomas of the adrenal gland on asymptomatic patients led to the hypothesis that the real frequency of this type of lesion was underestimated. Furthermore, the adrenal origin of the superior retro-peritoneum schwannomas represents a diagnostic hypothesis to be considered when the original structure of the neoplasia can't be established.
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10/22. Schwannoma of the adrenal gland: report of two cases.

    Primary schwannomas of the adrenal gland are extremely uncommon. We report the clinical and pathologic features of two cases, occurring in a 73-year-old man and a 26-year-old woman, both of whom presented with abdominal pain and an adrenal mass on imaging studies. Both tumors were characterized by a proliferation of cytologically bland spindle cells. One case exhibited alternating compact Antoni A areas and less cellular Antoni B areas consistent with conventional schwannoma, whereas the other case was hypercellular and composed predominantly of Antoni A areas consistent with cellular schwannoma. Reactive inflammatory cells and lymphoid aggregates were present throughout both tumors. The diagnosis of schwannoma was supported by positive immunoreactivity for S-100 protein and collagen IV and absence of reactivity for keratin, muscle related antigens, and CD34 in both cases. Electron microscopy was also performed in the case of cellular schwannoma, which showed ultrastructural features confirming the diagnosis. Both cases had a favorable outcome without evidence of recurrence or metastasis. Because of its rarity, schwannoma occurring at this particular site can pose problems in diagnosis and should be distinguished from other spindle cell lesions of the adrenal gland.
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