Benign diaphragmatic neurilemmoma mimicking a left adrenal cyst

Abstract

Neurilemmomas are benign, slow growing, encapsulated nerve sheath tumor. These tumors arise from the schwann cells of neural crest. Neurilemmomas can manifest in various form according to site, extent and severity of involvement of organ. Diaphragmatic neurilemmomas are very unusual and even difficult to diagnose on preoperative imaging. We will report a case of 39 year old male, who presented with complaints of occasional left flank pain for one year and subsequently investigated, which showed left adrenal cyst with haemorrhagic fluid content. On the contrary, when surgical exploration of the lesion was done, it showed a cyst within the diaphragm, completely separated from left kidney and left adrenal with haemorrhagic content in situ. Histopathological examination of the lesion showed it to be a benign neurilemmoma with cystic degeneration. Post opearatively patient did well. We believe that this is the first case report, which is addressing such kind of initial manifestation of diaphragmatic neurilemmomas.

Clinical features and outcomes of adrenal schwannoma: a study of 13 cases from a single centre

“…AS is a rare incidentaloma found in the adrenal medulla, and fewer than 100 cases have been reported to date (10,6,(11)(12)(13)(14)(15)(16)(17)(18). The vast majority of AS patients are sporadic.…”

Laparoscopic resection of a primary diaphragmatic schwannoma: a case report and literature review

“…Schwannomas are nerve sheath tumors that commonly originate from the extremities, head, neck, and the posterior mediastinum [1]. The most common sites of a schwannoma are the stomach and small intestine, and primary schwannoma of the diaphragm is rare [2]. We searched all articles on schwannomas in the PubMed database, published up to April 2020 using the following keywords: ((((schwannoma) OR (neurinoma)) OR (neurilemoma)) AND (diaphragm)) AND (English [Language]).…”

“…We acquired 36 records, from which 20 articles were excluded because of obvious irrelevance, narrowing the list down to 16 case reports. Finally, including our case, 17 cases of primary diaphragmatic schwannoma were collected, and their summary is provided in Table 1 [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Schwannomas are nerve sheath tumors that commonly originate from the extremities, head, neck, and the posterior mediastinum [1]. The most common sites for schwannomas are the stomach and small intestine, and they rarely occur in the liver, pancreas, kidney, brain, heart, adrenal gland, retroperitoneum, and diaphragm [2]. Primary schwannoma of the diaphragm is rare, and the patients do not show any symptoms until it grows to a certain size.…”

“…1 Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. 2 Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.…”