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Macciò A, Abis P, Sole G, D'Angelo N, Nemolato S, Madeddu C. A giant pelvic infiltrating schwannoma misdiagnosed as an ovarian neoplasm that was resected using a laparoscopic approach: A case report. Int J Surg Case Rep 2024; 122:110138. [PMID: 39128216 PMCID: PMC11367093 DOI: 10.1016/j.ijscr.2024.110138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction and importance: Large retroperitoneal schwannomas are rare and present significant challenges in surgical management, particularly when located in the pelvic region. Gynecologists can encounter rare problems when a pelvic schwannoma is mistaken for an adnexal pathology. Case Presentation: A 62-year-old woman presented with a giant retroperitoneal mass suspected of a potentially malignant ovarian tumor preoperatively. Computed tomography revealed a large mixed solid-cystic mass near the right adnexa measuring 118 × 100 × 80 mm. The cancer antigen 125 level was 196 U/mL. We performed a diagnostic-operative laparoscopy, which showed a retroperitoneal neoformation below the cava and aortic bifurcation adherent to the sacrum, right pelvic vessels, and hypogastric nerve up to the vagina. We carefully detached the mass from the nearby tissues using the most appropriate laparoscopic devices. The entire neoplasm was removed through the vagina into a surgical bag. The surgery lasted 180 min without complications. Histology revealed a grade I benign schwannoma. At the 12-month follow-up, the patient was asymptomatic without signs of recurrence. Clinical Discussion: Pelvic retroperitoneal schwannomas can mimic ovarian carcinomas; misdiagnosis may occur due to their rarity and the difficulty of interpreting preoperative imaging. In case of unexpected giant presacral schwannomas surgical management is challenging due to their peculiar location. Conclusion: This case underscores the need for a skilled, experienced team of gynecological oncologists to achieve favorable outcomes when performing laparoscopic surgery of giant pelvic retroperitoneal schwannoma. Adequate knowledge of the complex pelvic anatomy, careful surgical planning, and familiarity with the most appropriate surgical tools are critical points.
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Affiliation(s)
- Antonio Macciò
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy; Department of Surgical Sciences, University of Cagliari, SS 554, km 4,500, 09042 Monserrato, Italy
| | - Paola Abis
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Gabriele Sole
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Nicola D'Angelo
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Sonia Nemolato
- Unit of Anatomic Pathology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, SS 554, km 4,500, 09042 Monserrato, Italy.
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Zhou S, Wan S, Li L, Dong W, Ma X, Chu H, Zhong Y. Rare retroperitoneal giant sacral schwannoma: A case report. Oncol Lett 2024; 27:261. [PMID: 38646494 PMCID: PMC11027106 DOI: 10.3892/ol.2024.14394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/15/2024] [Indexed: 04/23/2024] Open
Abstract
Schwannomas localized in the sacrum are relatively infrequent, accounting for 1-5% of all spinal axis schwannomas; they present with vague symptoms or are symptomless, so often grow to a considerable size before detection. Sacral schwannomas occasionally present with enormous dimensions, and these tumors are termed giant sacral schwannomas. However, their surgical removal is challenging owing to an abundant vascularity. The present study retrospectively analyzed the clinical and follow-up data of a patient with a giant sacral schwannoma. The patient experienced numbness in the left buttock and lower extremity, with radiating pain in the sole of the foot that had persisted for 3 years. A presacral mass was found by computed tomography examination 6 months after the stool had become thin. A tumor resection was performed using the anterior abdominal approach. A schwannoma was diagnosed by postoperative pathology. The postoperative course was uneventful, with the complete resolution of symptoms during the 21-month clinical follow-up. Overall, the present study reports the case of a giant sacral schwannoma with pelvic pain that was resected without complications and also discusses its successful management. Additionally, the study presents a systematic review of the literature. We consider that the surgical treatment of giant sacral schwannomas with piecemeal subtotal excision can achieve good outcomes, avoiding unnecessary neurological deficits.
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Affiliation(s)
- Shunchang Zhou
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Shenyi Wan
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Liang Li
- Department of Radiology, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Wei Dong
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Xuhui Ma
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Haibo Chu
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, Shandong 266300, P.R. China
| | - Yuxu Zhong
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, P.R. China
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Yin L, Sun Y, Cao Q, Yang T, Li W, Zhu Y, Liu T, Li B. Two giant connected retroperitoneal schwannomas: a rare case report. J Int Med Res 2022; 50:3000605221119423. [PMID: 36036264 PMCID: PMC9434686 DOI: 10.1177/03000605221119423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Schwannoma is a type of tumor originating from Schwann cells of peripheral
nerves. In this study, we report a rare case of two giant connected
retroperitoneal schwannomas. The patient presented to our department with a
1-day history of abdominal pain and without other symptoms. There were no
abnormalities in the patient’s tumor markers. Abdominal plain computed
tomography (CT) revealed two (combined) retroperitoneal masses appearing as soft
tissue-density shadows with uneven internal density, cystic low-density shadows,
and patchy calcification shadows. The larger mass measured approximately
12.0 cm × 12.3 cm in size. The tumors were completely excised by a reasonable
surgical approach while the surrounding organs closely related to the tumor were
preserved. Postoperative pathology confirmed that the tumors were benign
schwannomas. In the 18-month follow-up, the patient had no recurrences and was
asymptomatic. We summarize the diagnosis and treatment of two rare combined
giant retroperitoneal schwannomas in a single patient. Laparotomy for the
management of retroperitoneal giant schwannomas may be safe and effective.
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Affiliation(s)
- Liquan Yin
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yao Sun
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Qian Cao
- Department of Education, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Tao Yang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Wei Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Yuecheng Zhu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Tongjun Liu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Bo Li
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
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Surgical management of sacral schwannomas: a 21-year mayo clinic experience and comparative literature analysis. J Neurooncol 2022; 159:1-14. [PMID: 35752722 DOI: 10.1007/s11060-022-03986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sacral and presacral schwannomas are rare, accounting for a minority of spinal schwannomas. We present our institution's experience surgically treating spinal schwannomas and compare it to the literature. METHODS Data were collected for 27 patients treated surgically for sacral or presacral schwannoma between 1997 and 2018 at all Mayo Clinic locations and 93 patients in the literature. Kaplan-Meier disease-free survival analysis was conducted. Unpaired two-sample t tests and Fisher's exact tests assessed statistical significance between groups. RESULTS Our patients and those in the literature experienced a similar age at diagnosis (49.9 y/o. vs 43.4 y/o., respectively). Most of our patients (59.3%) reported full recovery from symptoms, while a minority reported partial recovery (33.3%) and no recovery (11.1%). A smaller percentage in the literature experienced full recovery (31.9%) and partial recovery (29.8%) but also no recovery (1.1%). Our patients experienced fewer complications (14.8% versus 25.5%). Disease-free survival curves for all patients showed no significant variation in progression by extent of resection of schwannoma (log-rank P = 0.26). No lesion progression was associated with full or partial symptom improvement (p = 0.044), and female patients were more likely to undergo resection via a posterior approach (p = 0.042). CONCLUSION Outcomes of patients with sacral or presacral schwannomas vary based on patient demographics, tumor characteristics, symptoms, and surgical treatment. Among the range of symptoms experienced by these patients, the most common is pain. Prognosis improves and overall survival is high when the surgical approach towards sacral schwannomas is prepared and executed appropriately.
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Wu Q, Liu B, Lu J, Chang H. Clinical Characteristics and Treatment Strategy of Retroperitoneal Schwannoma Adjacent to Important Abdominal Vessels: Three Case Reports and Literature Review. Front Surg 2021; 7:605867. [PMID: 33585546 PMCID: PMC7874029 DOI: 10.3389/fsurg.2020.605867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to review the clinical characteristics and treatment strategies of patients with retroperitoneal schwannomas adjacent to important abdominal vessels. Case Presentation: A total of three patients with retroperitoneal schwannoma immediately adjacent to important blood vessels in the abdominal cavity underwent successful surgical resection. They all had symptoms of abdominal pain and discomfort, two cases underwent three-dimensional reconstruction. There were no serious complications such as peripheral blood vessels and organ damage in all three cases. One case had chyle leakage after surgery, conservative treatment was successfully discharged. Conclusions: Retroperitoneal schwannomas immediately adjacent to important abdominal vessels have unique clinical characteristics. Preoperative three-dimensional reconstruction can fully show the local vascular relationship of the tumor, which is conducive to surgical planning and risk assessment. Benign tumors with large size and adjacent complex vessels can still be completely resected by surgery. Laparotomy resection is safe and feasible.
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Affiliation(s)
- Qi Wu
- Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Bingqiang Liu
- Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jun Lu
- Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Hong Chang
- Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
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Sultan S, Barrett N, Curran S, Hynes N. Non-functioning retroperitoneal abdominal schwannoma. BMJ Case Rep 2020; 13:13/6/e233371. [PMID: 32554461 DOI: 10.1136/bcr-2019-233371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There are less than 150 cases of non-functioning retroperitoneal abdominal schwannoma (NRS) reported. Hormonal assay is crucial in confirming the diagnosis of NRS, as manipulation of a functional retroperitoneal paraganglioma will instigate an abrupt liberation of catecholamines, resulting in devastating consequences. We report the case of 42-year-old woman who presented with headache, night sweats and abdominal discomfort. Cross-sectional imaging demonstrated a retroperitoneal mass adherent to the aorta and inferior vena cava but biochemical testing of blood and urine was negative for metanephrines and normetanephrines. She underwent successful tumour resection via laparotomy, as location increased the complexity and risk of laparoscopic resection.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway, Ireland .,Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Ireland
| | - Nora Barrett
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway, Ireland
| | | | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Ireland
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