Schwannoma of the psoas major muscle presenting with abdominal and back pain

Laparoscopic resection of retroperitoneal intra-psoas muscle schwannoma: A case report and extensive literature review

INTRODUCTION

Soft tissue tumors of Schwann cells in either the peripheral or cranial nerves are known as schwannomas or also as neurilemmomas. Limited data exists regarding psoas muscle schwannoma in the literature. Therefore, we have done an extensive literature review and found a total number of 46 cases of intra-psoas schwannoma including our case, which are summarized in this article along with reporting our new case.

PRESENTATION OF CASE

We report a very rare case of primary left intra-psoas muscle schwannoma in a 39-year-old Saudi gentleman, smoker with an unremarkable medical and surgical history. The patient presented to the emergency department with exacerbated chronic lower abdominal pain since almost 2 years. After conforming the diagnosis, the patient was admitted electively and underwent uneventful laparoscopic hand-assisted resection.

DISCUSSION

Schwannomas are neurogenic tumors which known to be solitary, benign, well circumscribed, encapsulated, and slow-growing tumors. Multiple imaging modalities are used to detect such a tumor. Although there is no consensus on the best surgical approach, endoscopic mini-laparotomy, laparoscopy (anterior [as in our case] or lateral), and robotic resection were reported with good outcomes.

CONCLUSION

Retroperitoneal schwannoma and intra-psoas muscle variant are a rare entity, with slow growing rate and risk of malignant transformation. Therefore, high index of suspicion, good follow-up, and large-cohort studies are encouraged.

Unusual Etiology of Chronic Posterior Leg Pain in a Running Athlete: Could It Be a Schwannoma? A Case Report and Review of the Literature

Schwannomas represent only 5% of all soft tissue tumors. As a variant of this tumor, the plexiform schwannoma is rare accounting for less than 5% of all schwannomas. Herein, we report a rare case of a 49-year-old athlete who suffered from a pain in the posterior aspect of the right leg one year before his presentation. Initially, a radiograph of his right leg showed no abnormality, and so, the emergency physician discharged him on analgesics and anti-inflammatory medications, and rest was advised. The persistent pain obliged the patient to consult our orthopedic department. On examination, we found a firm mass in the proximal medial aspect of his right leg. The neurovascular exam was normal. Sonography of the leg was not conclusive. Therefore, magnetic resonance imaging was performed, and a hemangioma or schwannoma was suspected. The patient underwent surgery in which the entire tumor mass was shelled out in one piece with no damage. The histopathological finding was concomitant with a plexiform schwannoma. Follow-up evaluation, sixteen months later, showed no evidence of recurrence, and the patient has regained his previous level of sportive activities. So, given the case described here, despite the rarity of the schwannoma, it should be taken into consideration as a possible diagnosis in such situation to promote early diagnosis and appropriate treatment.

Paraspinal Schwannoma of dorsal ramus nerve: A case report

Spinal Schwannomas are benign nerve sheath tumors and the most common intradural extramedullary tumors of the spine, mainly occurring in the cervical and lumbar region. The location distinct from the spinal canal is very rare. We report a rare case of a 45year old male with Schwannoma in the dorsal paraspinal musculature. Complete surgical excision of the lesion was performed with clear margins and neuropathological analysis revealed a Schwannoma. There has been no recurrence after 6 months.

Retroperitoneal metastatic poorly differentiated carcinoma with β-human chorionic gonadotropin secretion presenting as a psoas abscess: A case report and review of the literature

RATIONALE

Psoas abscesses generally arise from a contiguous intra-abdominal or pelvic infectious process or hematogenous spreading of bacteria. The serum β-human chorionic gonadotropin has been used to detect normal or ectopic pregnancy. It also can be utilized in following up carcinomas.

PATIENT CONCERNS

Here, we reported a case of a 47-year-old woman who presented with a left psoas mass presumptively diagnosed as an abscess secondary to lumbar tuberculosis In addition, the patient had abnormal increase of β-human chorionic gonadotropin. The computed tomography (CT) scan and magnetic resonance imaging (MRI) showed that the 5th lumbar vertebral infection or tuberculosis with left psoas abscess. CT-guided percutaneous biopsy, surgical exploration and biopsy, and F-FDG (fluorodeoxyglucose) positron emission tomography-CT (PET-CT) were used to make a definite diagnosis. The sigmoidoscopy and biopsy were used to further diagnose.

DIAGNOSES

The biopsy of left psoas demonstrated metastatic or infiltrating poorly differentiated carcinoma with secretion of β-human chorionic gonadotropin. The subsequent pathological examination of neoplasm showed the same pathologic morphology.

INTERVENTIONS

Appropriate treatment of infected retroperitoneal mass, systematic chemotherapy and cancer biotherapy for metastatic poorly differentiated carcinoma were taken.

OUTCOMES

Interventions provided little help until the patient died of secondary infection and multiple organ failure.

LESSONS

This case represents an extremely unusual clinical presentation of metastatic poorly differentiated carcinoma with secretion of β-human chorionic gonadotropin presenting as a psoas abscess. Physicians also need to sharpen their awareness of the potential malignant carcinomas mimicking psoas abscess.

Intramuscular schwannoma: clinical and magnetic resonance imaging features

INTRODUCTION

Schwannomas that arise within the muscle plane are called intramuscular schwannomas. The low incidence of these tumours and the lack of specific clinical features make preoperative diagnosis difficult. Herein, we report our experience with intramuscular schwannomas. We present details of the clinical presentation, radiological diagnosis and management of these tumours.

METHODS

Between January 2011 and December 2013, 29 patients were diagnosed and treated for histologically proven schwannoma at the National University Hospital, Singapore. Among these 29 patients, eight (five male, three female) had intramuscular schwannomas.

RESULTS

The mean age of the eight patients was 40 (range 27-57) years. The most common presenting feature was a palpable mass. The mean interval between surgical treatment and the onset of clinical symptoms was 17.1 (range 4-72) months. Six of the eight tumours (75.0%) were located in the lower limb, while 2 (25.0%) were located in the upper limb. None of the patients had any preoperative neurological deficits. Tinel's sign was present in one patient. Magnetic resonance (MR) imaging showed that the findings of split-fat sign, low signal margin and fascicular sign were present in all patients. The entry and exit sign was observed in 4 (50.0%) patients, a hyperintense rim was observed in 7 (87.5%) patients and the target sign was observed in 5 (62.5%) patients. All patients underwent microsurgical excision of the tumour and none developed any postoperative neurological deficits.

CONCLUSION

Intramuscular schwannomas demonstrate the findings of split-fat sign, low signal margin and fascicular sign on MR imaging. These findings are useful for the radiological diagnosis of intramuscular schwannoma.

Erector Spinal Muscular Schwannoma of the Dorsal Ramus Nerve: A Case Report

We present a rare case of intramuscular schwannoma originating from the dorsal ramus nerve in a 62-year-old woman. The mass grew slowly, with pain developing upon touch five years prior. No neurological deficit was detected. The mass was observed in the erector spinae muscles in magnetic resonance imaging (MRI), and surgical excision was performed. The mass was well encapsulated with clear margin. The lesion appeared to originate from the cranial side. We completely removed the mass including the origin. Histopathology confirmed a schwannoma diagnosis. This is the first report, to our knowledge, of a dorsal ramus-nerve schwannoma within the erector spinae muscles.

Intramuscular schwannoma arising from the psoas muscle presenting with femoral nerve neuropathy

A spherical mass of the right psoas muscle was found incidentally by magnetic resonance health examination in a 43-year-old woman. The patient had complained of numbness in her right leg over the previous six months and neuralgia at the time of computed tomography-guided core biopsy, which was done to establish the diagnosis. To our knowledge, femoral nerve neuropathy caused by an intramuscular schwannoma arising from the psoas muscle has not been previously published.

Pain images: hip pain--wrong diagnosis, wrong operation

OBJECTIVE

The clinical presentation of retroperitoneal schwannoma with neuropathic pain and its subsequent management is presented.

DESIGN AND SETTING

This is a case report of a 67-year-old woman who developed left hip pain radiating into the postero-lateral portion of her left thigh and extending to the knee.

INTERVENTION

The patient underwent a left hip replacement for suspected pain from osteoarthritis of the hip joint.

OUTCOME MEASURE

The location of her pain was unchanged from the initial presentation, and more extensive investigations were carried out.

RESULT

The pain was found to be neuropathic in nature caused by a 54 mm retroperitoneal schwannoma.

CONCLUSION

Our case demonstrates the principle that unless the diagnosis is very clear (based on history, examination and diagnostic local anaesthetic injection, and confirmed by special investigations), surgery should not be considered. Where doubt exists, further assessment and investigation is required.