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Findings:
CT: Round, heterogeneous mass in the RUQ, displacing the liver cranially and the right kidney inferiorly. A capsule appears to contain the mass, and there is no evidence of intraluminal IVC involvement. The mass demonstrates heterogeneous contrast enhancement and area of central necrosis. The right adrenal gland is not visualized; the left is normal.. No metastatic foci appreciated. Mass: 15 cm in largest diameter.
MRI : Same as above.
Angiogram: For preoperative roadmap. Feeders to mass include inferior adrenal just inferior to origin at right renal artery off the aorta. Neovascularity and contrast puddling centrally suspicious for carcinoma. A second feeder arises from right renal artery - the middle adrenal branch.
Diagnosis::Schwannoma
Discussion: Schwannomas are benign, slow growing tumors from schwann cells, neural crest derivatives. A typical appearance consists of a round, well encapsulated mass that may contain areas of cystic change, necrosis or hemorrhage. These do not undergo malignant degeneration.
However, in this case, based on size and location, adrenal origin was suspected. The presumed diagnosis was adrenal cortical carcinoma.
References:
Latchaw, Richard E: MR and CT Imaging of the Head, Neck
nd Spine,, Mosby Year Book, St. Louis, 1991.
Osborn, Anne G: Diagnostic Neuroradiology, Mosby Year Book, St. Louis, 1994.
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