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.