Ancient schwannoma and myelolipoma coexist in an adrenal incidentaloma

Ancient schwannoma is rare in the adrenal gland and so is myelolipoma. These two uncommon tumors existing together in one adrenal incidentaloma is extremely rare, and have gone unreported in the literature to date. We describe a 47-year-old female case of ancient schwannoma and myelolipoma in a left adrenal incidentaloma. The patient was obese with diabetes mellitus. Chronic epigastralgia and acute hepatitis related to cholelithiasis was present. Abdominal computed tomography depicted a 7-cm left adrenal incidentaloma. Fine-needle biopsy for diagnosis is challenging on retrospective reviews. Due to the malignant potency of the tumor and symptomatic cholelithiasis, laparoscopic left adrenalectomy and cholecystectomy were performed simultaneously. The only way to definitely diagnose adrenal schwannoma is by immunohistochemical examination which exhibits positive for S-100 protein, but negative for CD34, desmin, smooth muscle actin, and synaptophysin as in our case. We also discuss clinical, pathological, and image characteristics of adrenal schwannoma and myelolipoma in the literature.