*Konrad Wroński1, Janusz Kaczor1, Zbigniew Masłowski1, Leszek Frąckowiak2, Michał Frąckowiak3, Przemysław Stefaniak1
Benign retroperitoneal schwannoma – a rare case report
1Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
2Department of Public Health and Epidemiology, University of Warmia and Mazury in Olsztyn, Poland
Head of Department: Professor Anna Abramczyk, MD, PhD
3Faculty of Medicine, Medical University in Gdańsk, Poland
Dean of University: Professor Janusz Moryś, MD, PhD
Retroperitoneal schwannoma is an extremely rare benign neoplasm, except for patients suffering from Von Recklinghausen’s disease. Most schwannomas (neurilemmomas, neurinomas) are tumors that develop slowly from the Schwann cells. Schwannomas are observed in adult population aged 20-50. Women are affected nearly two times as often as men. Retroperitoneal schwannomas are benign, encapsulated, slow-growing tumors. The majority of retroperitoneal schwannomas are asymptomatic and are often diagnosed incidentally during abdomen ultrasound or computer tomography. Malignant schwannomas are large in size and aggressive. The most common symptoms include abdominal pain and abdominal distention. Because of the rarity of retroperitoneal schwannomas, it is necessary for the radiologist to establish the diagnosis before the operation as well as to have a qualified pathologist available to examine the needle biopsy specimen. Radical surgical resection of the retroperitoneal schwannoma is the best treatment option. Aggressive surgery is not recommended in case of benign retroperitoneal schwannomas.
The authors present a case of a 58-year-old white man who was admitted to the hospital with the diagnosis of retroperitoneal schwannoma. The patient had been suffering from the pain in the right lumbar region for 5 months. He underwent surgical excision of the tumor and was discharged five days after surgery. After the operation, the symptoms were alleviated. The author also presents literature review on retroperitoneal schwannomas.
Retroperitoneal schwannoma is an extremely rare benign neoplasm, except for patients suffering from Von Recklinghausen’s disease. Most schwannomas (neurilemmomas, neurinomas) are tumors that slowly develop from the Schwann cells (1, 2). Schwannomas are observed in adult population aged 20-50 (2, 3). Women are affected nearly two times as often as men (2, 3).
A 58-year-old white man was referred to the Department of Surgical Oncology of Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre in Olsztyn due to a retroperitoneal tumor diagnosed in computer tomography. The patient reported pain in the right lumbar region that had first started 5 months before. There was no trauma history of the right lumbar region. He had no other symptoms. The medical history was negative for drug abuse, weight loss and loss of appetite. He had never undergone any surgical procedures. Family history of cancer was positive – the patient’s father suffered from leukemia and died of it aged 82.
The patient did not report pain of the right lumbar region on physical examination. Blood tests were all within normal limits. Ultrasound examination revealed pathological hypoechogenic mass of size 47 x 34 x 43 mm located in the right lower abdominal region. Computer tomography of the pelvis revealed a pathological solid mass of size 45 x 44 x 55 millimeters in the right retroperitoneal region (fig. 1). Histopathological examination of the thick-needle aspiration biopsy specimen under the control of computer tomography was performed before the surgical procedure. The patient was preoperatively diagnosed with schwannoma.
Fig. 1. Axial CT image demonstrates a retroperitoneal mass of size 45 x 44 x 55 millimeters on the right side
Complete surgical excision of the tumor was performed without damage to the main neuro-vascular structures of the retroperitoneum. The material was sent for routine histopathological examination. The surgery lasted 60 minutes.
Histopathological examination showed areas with nuclear palisading which are typical for schwannomas. The Ki-67 proliferation index was very low in the examined specimen. The specimen underwent immunochemical examinations and occurred to be S-100 positive and CD-34 negative. The patient felt good after the surgery and did not report any pain. After the surgery, the symptoms were alleviated. The postoperative period was uncomplicated and the patient was discharged five days after the procedure.
Retroperitoneal schwannomas are rare benign neoplasms which comprise up to 6% of primary retroperitoneal tumors (4). Retroperitoneal schwannomas are usually located in the paravertebral space or in the presacral region (5). Schwannomas have a predilection for head and neck, but also are observed in upper and lower extremities (1-3).
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Płatny dostęp do wszystkich zasobów Czytelni Medycznej
1. Fierro N, D’ermo G, Di Cola G et al.: Posterior mediastinal schwannoma. Asian Cardiovasc Thorac Ann 2003; 11: 72-73. 2. Guerrissi JO: Solitary benign schwannomas in major nerve systems of the head and neck. J Craniofac Surg 2009; 20: 957-961. 3. Wong CS, Chu TY, Tam KF: Retroperitoneal schwannoma: a common tumour in an uncommon site. Hong Kong Med J 2010; 16(1): 66-68. 4. Lane RH, Stephens DH, Reiman HM: Primary retroperitoneal neoplasms: CT findings in 90 cases with clinical and pathologic correlation. AJR 1989; 152: 83-89. 5. Kapan M, Onder A, Gumus M et al.: Retroperitoneal shwannoma. JSCR 2011; 10: 1. 6. Goh BKP, Tan Y, Chung YA et al.: Retroperitoneal schwannoma. Am J Surg 2006; 192: 14-18. 7. Kralick F, Koenigsberg R: Sciatica in a patient with unusual peripheral nerve sheath tumors. Surg Neurol 2006; 66: 634-637. 8. Hughes MJ, Thomas JM, Fisher C et al.: Imaging features of retroperitoneal and pelvic schwannomas. Clinical Radiology 2005; 60(8): 886-893. 9. Suh JS, Abenoza P, Galloway HR et al.: Peripheral (extracranial) nerve tumors: correlation of MR imaging and histologic findings. Radiology 1992; 183: 341-346. 10. Wright BA, Jackson D: Neural tumors of the oral cavity. A review of the spectrum of benign and malignant oral tumors of the oral cavity and jaws. Oral Surg Oral Med Oral Pathol 1980; 49: 509-522. 11. Kim SM, Seo SW, Lee JY et al.: Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb. International Orthopaedics 2012; 36(8): 1721-1725. 12. Park MJ, Seo KN, Kang HJ: Neurological deficit after surgical enucleation of schwannomas of the upper limb. J Bone Joint Surg Am – Series B 2009; 91(11): 1482-1486. 13. Sawada T, Sano M, Ogihara H et al.: The relationship between pre-operative symptoms, operative findings and postoperative complications in schwannomas. Journal of Hand Surgery 2006; 31(6): 629-634. 14. Donner TR, Voorhies RM, Kline DG: Neural sheath tumors of major nerves. J Neurosurg 1994; 81(3): 362-373. 15. Song JY, Kim SY, Park EG et al.: Schwannoma in the retroperitoneum. J Obstet Gynaecol 2007; 33: 371-375.