engleski

Adrenal gland schwannoma mimicking breast cancer metastasis. A case report

INTRODUCTION: Schwannoma is a benign, usually encapsulated nerve sheath tumor originating from Schwann cells. Typically, schwannomas affect the cutaneous nerves of the head and neck, upper and lower extremities and trunk. They predominantly occur in females between the second and fifth decade of life. Visceral schwannomas are very rare, and according to literature were described in the heart, kidney and lung. The retroperitoneal space is another localization of schwannomas. Except in cases of von Reclinghausen´s disease, the adrenal localization of schwannoma is particularly rare. CASE REPORT: We present a case of a 55 year-old female patient with previously diagnosed breast cancer treated with mastectomy followed by lymphadenectomy. Histologically, breast cancer was classified as ductal invasive breast cancer, histological grade 2, without lymph nodes metastases. Hormone receptors (estrogen and progesterone) were highly positive while HER2/neu was negative. Clinical examination did not find any signs of neurofibromatosis. Patient was treated with hormonal therapy. Three months after mastectomy ultrasound examination revealed a hormonally inactive tumor in the left adrenal gland that was suspected for a metastatic process. After adrenalectomy, macroscopic examination revealed a partially encapsulated tumor within the adrenal gland with yellowish solid cut surface, measuring 5x4x3 cm. Microscopically, the tumor was composed of solid sheets and bundles of uniform spindle shaped cells, along with various vascular and inflammatory elements embedded in an extensive extracellular matrix. No Verocay bodies were found. Immunohistochemicaly, tumor cells were positive for S-100 protein. Extensive histological analysis revealed no ganglion cells. DISCUSSION: Histological and immunohistochemical analysis of described adrenal gland tumor was consistent with the diagnosis of schwannoma. Adrenal tumors are frequently incidental and asymptomatic discoveries, and their therapy is a subject of controversial discussion. The combination of adrenal gland schwannoma and primary breast cancer is very rare, very probably incidental, but preoperatively difficult to distinguish from metastasis.

adrenal gland schwannoma ; breast cancer metastasis

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