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Feigl GC, Jugovic D, Staribacher D, Buslei R, Kuzmin D. Total resection of presacral giant schwannoma via minimally invasive dorsal approach: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21319. [PMID: 35855057 PMCID: PMC9265199 DOI: 10.3171/case21319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Giant presacral schwannomas are extremely rare in neurosurgery. There are various approaches to the surgical treatment of symptomatic giant presacral schwannomas. The least traumatic is the one-stage surgery with a dorsal approach. OBSERVATIONS The authors describe a case of a 52-year-old male with pain in the sacral region and partial urinary dysfunction. A total tumor resection through a minimally invasive dorsal approach was performed, and anatomical and functional preservation of all sacral nerves with no postoperative complications was achieved. LESSONS The authors have shown the possibility of total tumor resection with a minimally invasive dorsal approach without the development of intra- and postoperative complications. Operative corridors that have been created by a tumor can be used and expanded for a minimally invasive dorsal approach to facilitate resection and minimize tissue disruption.
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Affiliation(s)
- Guenther C. Feigl
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
- Departments of Neurosurgery and
| | - Domagoj Jugovic
- Departments of Neurosurgery and
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Rolf Buslei
- Pathology and Neuropathology, General Hospital Bamberg, Bamberg, Germany; and
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AlQahtani A, AlAli MN, Allehiani S, AlShammari S, Al-Sakkaf H, Arafah MA. Laparoscopic resection of retroperitoneal intra-psoas muscle schwannoma: A case report and extensive literature review. Int J Surg Case Rep 2020; 74:1-9. [PMID: 32759038 PMCID: PMC7399171 DOI: 10.1016/j.ijscr.2020.07.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Awadh AlQahtani
- Department of Surgery, College of Medicine, King Saud University, Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Mohammed N AlAli
- Department of Surgery, College of Medicine, King Saud University, Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Safaa Allehiani
- Department of Surgery, College of Medicine, King Saud University, Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Sulaiman AlShammari
- Department of Surgery, College of Medicine, King Saud University, Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia.
| | - Hussein Al-Sakkaf
- Department of Radiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
| | - Maria A Arafah
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia.
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Macciò A, Kotsonis P, Aste L, Voicu MA, Madeddu C, Conti C, Camparini S. An interdisciplinary approach for laparoscopic removal of a large retroperitoneal pelvic schwannoma attached to vital vessels: A case report. Medicine (Baltimore) 2019; 98:e18149. [PMID: 31860962 PMCID: PMC6940178 DOI: 10.1097/md.0000000000018149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.
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Affiliation(s)
| | | | - Laura Aste
- Department of Neurosurgery, Azienda Ospedaliera Brotzu
| | | | - Clelia Madeddu
- Department of Medical Sciences and Public Health University of Cagliari
| | - Carlo Conti
- Department of Neurosurgery, Azienda Ospedaliera Brotzu
| | - Stefano Camparini
- Department of Vascular Surgery, Azienda Ospedaliera Brotzu, Cagliari, Italy
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Ohsawa M, Miguchi M, Yoshimitsu M, Oishi K, Kohashi T, Hihara J, Mukaida H, Kaneko M, Egi H, Ohdan H, Hirabayashi N. Laparoscopic excision of a retroperitoneal schwannoma: A case report. Asian J Endosc Surg 2019; 12:192-196. [PMID: 29808539 DOI: 10.1111/ases.12607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 01/04/2023]
Abstract
Schwannomas are tumors originating from the Schwann cells of the peripheral nerve sheath. Only 1%-3% of schwannomas reportedly occur in the pelvis. In a 67-year-old man, a pelvic mass that was 52 mm in diameter was incidentally diagnosed during a preoperative CT evaluation for prostate cancer. Preoperative 3-D reconstruction CT showed that the feeding artery to the tumor originated from the internal iliac artery and the drainage vein from the internal iliac vein. Each vessel could be isolated, clipped, and cut with minimal bleeding. The tumor was easily dissected from adjacent structures and was completely resected via laparoscopic surgery. Histopathology and immunohistochemistry of the excised specimen revealed a benign schwannoma. Using 3-D reconstruction to recognize a tumor's positional relation with the supplying vessels is important for avoiding complications during laparoscopic resection in the narrow pelvis. Laparoscopic resection is safe, feasible, and effective for retroperitoneal schwannoma.
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Affiliation(s)
- Manato Ohsawa
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masashi Miguchi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Toshihiko Kohashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hidenori Mukaida
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoki Hirabayashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
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Renal Oncocytoma and Retroperitoneal Ancient Schwannoma: A Benign Mimic of Metastatic Renal Cell Carcinoma. Case Rep Urol 2019; 2019:2561289. [PMID: 30915254 PMCID: PMC6402212 DOI: 10.1155/2019/2561289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022] Open
Abstract
Renal oncocytomas and retroperitoneal schwannomas are rare and typically benign tumors with characteristic histopathologic features. Ideal management of both renal oncocytoma and retroperitoneal schwannoma is surgical resection. We present a rare case of a 63-year-old man with multifocal renal oncocytoma and retroperitoneal ancient schwannoma which, preoperatively, masqueraded as metastatic renal cell carcinoma. Both tumors were successfully resected surgically. Immunochemistry and histopathology confirmed each diagnosis.
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Harada TL, Nagao G, Aoyagi T, Kuroda I, Tokuyama N, Takahashi M, Takahashi Y, Morishita Y, Shinji S. Giant retroperitoneal schwannoma in a 52-year-old man. Radiol Case Rep 2018; 13:810-814. [PMID: 29988943 PMCID: PMC6034139 DOI: 10.1016/j.radcr.2018.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 02/06/2023] Open
Abstract
Schwannoma in the retroperitoneal space is rare, and it is extremely rare in patients with no history of neurofibromatosis. We present a case of giant retroperitoneal schwannoma in a 52-year-old man who did not have neurofibromatosis. Because malignant transformation would be extremely rare in this circumstance, close imaging follow-up could avert the necessity for complete resection. The possibility of schwannoma should be considered when evaluating retroperitoneal tumors with the characteristic findings, even if there is no connection between the tumor and the intervertebral foramina.
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Affiliation(s)
- Taiyou L. Harada
- Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
- Corresponding author at: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Go Nagao
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Teiichiro Aoyagi
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Isao Kuroda
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Naoto Tokuyama
- Department of Urology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Masahide Takahashi
- Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Yuri Takahashi
- Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Yukio Morishita
- Department of Pathology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Sugahara Shinji
- Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
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Latino R, Bosco D, Frattallone ME, Amico A, Lanteri R, Di Cataldo A. Unusual presentation of retroperitoneal Schwannoma: case report. G Chir 2018; 38:295-298. [PMID: 29442061 DOI: 10.11138/gchir/2017.38.6.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schwannoma is a rare tumor that develops from the Schwann cells in the nerve sheath. A 42 years old woman was found incidentally to have a bulky mass in epigastric region. Abdominal ultrasonography CT and MRI have been of aid to know the position and size of the tumor. A massive capsulated retroperitoneal lesion was identified. It moved forward the hepatoduodenal ligament, inferior vena cava laterally and aorta medially. The mass is exte-riorized and detached from adhesions. There were no complications after the operation and the patient was discharged on the fourth post-operative day. The microscopically examina-tion showed features suggestive of Cellular Schwannoma. After 8 months during follow-up, the patient did not report any neurological deficit and control CT did not suggest the presence of recurrent disease.
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Lee BH, Hyun SJ, Park JH, Kim KJ. Single Stage Posterior Approach for Total Resection of Presacral Giant Schwannoma: A Technical Case Report. KOREAN JOURNAL OF SPINE 2017; 14:89-92. [PMID: 29017303 PMCID: PMC5642101 DOI: 10.14245/kjs.2017.14.3.89] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1–3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6 cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.
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Affiliation(s)
- Byoung Hun Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Hwa Park
- Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Laparoscopic Extirpation of a Schwannoma in the Lateral Pelvic Space. Case Rep Surg 2016; 2016:1351282. [PMID: 27900226 PMCID: PMC5120176 DOI: 10.1155/2016/1351282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/23/2016] [Indexed: 11/25/2022] Open
Abstract
Schwannomas in the lateral pelvic space are very rare. Here, we report the case of a 48-year-old woman who had a tumor detected in her abdomen by abdominal ultrasonography. Abdominal computed tomography and magnetic resonance imaging revealed a well-defined solid tumor of 65 mm in diameter in the right lateral pelvic space. We performed laparoscopic surgery under a diagnosis of a gastrointestinal tumor or neurogenic tumor. The tumor was safely dissected and freed from the surrounding tissues using sharp and blunt maneuvers. The tumor originated from the right sciatic nerve. Complete laparoscopic extirpation was performed with preservation of the right sciatic nerve. Pathological examination suggested schwannoma. The patient recovered well but had remaining sciatic nerve palsy in her right foot. Laparoscopic extirpation for a schwannoma in the lateral pelvic space was safe and feasible due to the magnified surgical field afforded by laparoscopy.
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Diagnostic dilemma of a rare, giant retroperitoneal schwannoma: a case report and review of literature. Case Rep Oncol Med 2014; 2014:628538. [PMID: 25247101 PMCID: PMC4163445 DOI: 10.1155/2014/628538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/17/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022] Open
Abstract
Schwannoma is a benign tumour of peripheral nerve sheath. It usually arises from head, neck, and trunk. Retroperitoneal schwannoma is a rare entity, accounting for only 0.3–3% of total schwannomas. Majority of retroperitoneal schwannomas reported in literature have a diameter of 5 to 15 cm. Preoperative diagnosis is difficult due to low frequency, nonspecific clinical course, and nonspecific imaging features. Histology usually provides definitive diagnosis. Schwannomas are solitary, well-circumscribed, and noninvasive, so complete surgical excision provides good result. We report a case of a 23-year-old male, who presented with progressive abdominal distension and intermittent episodes of intestinal obstruction. CECT was suggestive of huge solid-cystic mass in abdominopelvic region. Image guided percutaneous aspiration revealed around 1 litre of frank pus and FNAC was suggestive of abscess. Exploratory laparotomy revealed a large 32 × 28 × 26 cm mass with solid and cystic components containing 1 litre of pus. Histological features of tumour were suggestive of benign schwannoma and immunohistochemistry for S-100 was positive. Postoperative recovery was uneventful. We report this case of a retroperitoneal schwannoma because of giant size, rare location, unusual presentation, and diagnostic dilemma.
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