Clinical presentation and surgical resolution of atypical non-adenomas adrenal tumors

Adrenal tumors are very common in medical practice, including a wide spectrum of etiologies. Although most of them are adenomas, infrequent lesions can become a diagnostic and therapeutic challenge for clinicians. Here we present two atypical cases of non-adenomas adrenal tumors with specific imaging, biochemical profile, and surgical resolution. The first case is a 54-year-old woman with a history of hypertension and type 2 diabetes, with an incidentally discovered 7 cm adrenal mass on CT, compatible with a myelolipoma. Biochemical work-up was remarkable for hypersecretion of both cortisol and aldosterone. She underwent laparoscopic adrenalectomy. During follow-up, biochemical cure of hormonal hypersecretion was confirmed. The second case is a 44-year-old woman in whom a 7 cm left non-adenoma adrenal mass was diagnosed incidentally by magnetic resonance. Complete hormonal screening was normal. Laparoscopic adrenalectomy was performed. Biopsy informed a solid neoplasm separated from normal adrenal tissue, with immunohistochemistry compatible with a Schwannoma. These case vignettes describe atypical adrenal cases that should be considered in the differential diagnosis of non-adenomas adrenal tumors. They represent uncommon presentations and illustrate the importance of an appropriate multidisciplinary evaluation of adrenal tumors, in order to improve the surgical and clinicalmanagement of these patients. Keywords: adrenal incidentaloma; adrenal tumor; adrenal myelolipoma; adrenal schwannoma.