Large retroperitoneal schwannoma: a rare cause of chronic back pain

Long-standing retroperitoneal schwannoma in a 36-year-old female: A case report

INTRODUCTION

Schwannomas are encapsulated nerve sheath tumors derived from Schwann cells, primarily found in the head, neck, and extremities. Retroperitoneal schwannomas are rare and typically asymptomatic.

CASE PRESENTATION

A 36-year-old female presented with a long-standing, asymptomatic right lower abdominal mass. Imaging revealed a retroperitoneal cystic mass displacing adjacent structures. The tumor was surgically excised, and histopathology confirmed the diagnosis of schwannoma. The patient had an uneventful postoperative recovery and remains symptom-free with no signs of recurrence.

DISCUSSION

Schwannomas are benign nerve tumors primarily affecting women aged 30 to 50. This case involved an asymptomatic retroperitoneal schwannoma displacing the inferior vena cava without neurological symptoms. Imaging methods like ultrasound and CT are useful but often lack definitive results, and preoperative biopsy is not recommended due to risks of vascular injury. While conservative management may be suitable for asymptomatic cases, complete surgical excision is crucial to prevent recurrence. Although some suggest partial excision, most literature supports curative resection with negative margins, as incomplete removal can lead to a 10-20 % recurrence rate. The patient underwent successful complete resection.

CONCLUSION

Retroperitoneal schwannomas are rare tumors that are difficult to diagnose preoperatively. Radiologic findings are usually nondiagnostic. The treatment of choice is complete surgical excision.

Successful management of a giant retroperitoneal ancient schwannoma mimicking malignant tumors: A case report and literature review

Introduction and Importance

Schwannomas, originating from Schwann cells surrounding nerve sheaths, tend to be slow-growing. Among these, giant ancient schwannomas are remarkable for their rare occurrence and their capacity for substantial growth and regressive changes. Furthermore, the expansiveness and flexibility of the retroperitoneal space often conceal the symptoms of retroperitoneal schwannomas, leading to delayed diagnosis and allowing these tumors to grow significantly and become large and long-standing before detection.

Case Presentation

A 24-year-old man presented with left flank pain and a growing abdominal bulge in the left upper quadrant. Computed tomography scan revealed a 15×15×10 cm lytic expansile lesion. Consequently, the encapsulated mass was surgically excised and diagnosed as an ancient retroperitoneal schwannoma through histological and immunohistochemical studies.

Clinical Discussion

Comprehensive preoperative planning and a multidisciplinary strategy are imperative for the complete excision of schwannomas. These tumors can present diagnostic complexities, particularly due to nuclear atypia and pleomorphism, which might lead to misinterpretation regarding malignancy. Despite the risks associated with percutaneous biopsies, the low mitotic count is a critical diagnostic factor. Our study underscores the consensus that the definitive diagnosis should rely on postoperative histopathological findings, highlighting the importance of accurate assessment.

Conclusion

Rare giant retroperitoneal ancient schwannomas pose diagnostic challenges due to their rarity, lack of distinct symptoms, and atypical locations. This study presents a successful case and management.

Retroperitoneal schwannoma: Uncommon location of a benign tumor

Schwannoma is a type of nerve tumor of the nerve sheath. They are preferentially localized on the head, neck, and flexor surfaces of the extremities. Retroperitoneal schwannoma is extremely rare. The diagnosis is uncommon and based on the anatomopathological and immunochemistry examination of the surgical specimen. We herein report an uncommon location of schwannoma treated with conventional surgery in a 53‐year‐old female patient admitted to our department for chronic abdominal pain. Retroperitoneal schwannoma is a rare disease that occurs in adult females. The histopathological examination is the only reliable examination for the diagnosis after total surgical resection.

A Rare Case of an Adrenal Mass Proved to Be a Benign Cellular Schwannoma

Adrenal schwannomas are extremely uncommon tumors. We report the case of a 39-year-old male with a right adrenal mass. Laboratory tests were normal and radiological exams revealed the adrenal tumor. Open surgical adrenalectomy was performed. The postoperative course was uneventful. Microscopy and immunohistochemistry revealed a cellular schwannoma. Adrenal schwannomas are rare tumors, very difficult to diagnose in preoperative evaluation. Surgical excision of the tumor, histological and immunohistochemical examination of the specimen provide a definitive diagnosis. Prognosis is generally very good. Recurrence rates are related to positive surgical margins.

Retroperitoneal shwannoma: A case report

INTRODUCTION

Schwannomas are tumors that arise from Schwann cells of the peripheral nerve sheath and rarely occur in the retroperitoneum (3% of all schwannomas). Patients are usually asymptomatic or have nonspecific symptoms, making accurate preoperative diagnosis difficult. Schwannomas are usually benign, but infrequently undergo malignant transformation. Herein, we report a case of retroperitoneal schwannoma and review the relevant literature.

PRESENTATION OF CASE

A 25-year-old woman presented to our department with a 2-year history of abdominal pain that was localized in the right flank without radiation, constipation/diarrhea or externalized digestive hemorrhage. On physical examination, we found a painless palpable mass in the right hypochondrium extending to the right iliac fossa, measuring approximately 10 cm. The MRI and CT scan showed the presence of a large intra-abdominal oval formation in the right para-umbilical region. It was well limited, measuring 110*69mm with discrete irregular contours, thickened wall and heterogeneous content mostly fluid. They also showed the presence of a cystic formation in the right ovary measuring 84*52mm and extending over 76mm. The procedure consisted of resection of the retroperitoneal solid cystic mass, right ovariectomy and drainage of the right parietal-colic gutter by Salem sump tube. A laparotomy with a median incision above and below the umbilicus was performed. After the resection, the specimens were sent for anatomopathological examination which concluded that the retroperitoneal mass was a schwannoma and the ovarian mass was a serous cystadenoma.

DISCUSSION

Retroperitoneal schwannomas are rare tumors and a pre-operative diagnosis is often difficult. The diagnosis is most often fortuitous and late, given the latency of the tumor's evolution, and the definitive diagnosis is based on histopathologic examination. Herein we presented a case of retroperitoneal schwannoma and studied the features of this phenomenon on the basis of the literature.

CONCLUSION

Retroperitoneal schwannomas are rare. The diagnosis is often late at the stage of a large tumor. Radiologic findings are usually nondiagnostic. The treatment of choice is complete surgical excision. Prognosis is good but because of the risk of recurrence and malignant transformation, further follow-up is necessary.

Paraspinal plexiform schwannoma of unknown nerve origin: A case report

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Plexiform schwannomas are exceedingly rare in paediatric populations.

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This is a unique case located outside the spinal canal without a nerve of origin.

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Preoperative planning is imperative for complete resection and cosmesis.

Introduction and importance

Schwannomas are benign, slow-growing nerve sheath tumors of neoplastic Schwann cells. They are the most common peripheral nerve tumors in adults and are typically discovered incidentally due to their asymptomatic presentation. Despite the fact that most schwannomas are unassociated with a syndrome, their etiology is thought to be related to alterations or loss of the neurofibromatosis type two tumor suppressor gene.

Case presentation

We present the case of a fifteen-year-old female who presented with a recurrent lower back/upper buttocks 9 cm mass with imaging suspicious for schwannoma. Needle biopsy revealed an S100 positive cellular schwannoma with patchy Ki-67. During surgical dissection down to the sacrum, no nerve of origin was identified.

Clinical discussion

Schwannomas have no pathognomonic findings on MRI and may occur at any location that Schwann cells are present; therefore, confirming a diagnosis relies on histopathology. Plexiform schwannomas are defined by a “network-like” intraneural growth pattern and are exceedingly rare in paediatric populations. A location distinct from the spinal canal is also very rare as schwannomas typically originate from the head and neck region.

Conclusion

Paediatric plexiform schwannomas have been rarely reported. Surgical planning relies on multiple factors such as tumor size, tumor location, pathologic features and symptomatic burden. The distinctive features of this case including an unknown nerve origin and a location outside the spinal canal provide a unique opportunity to discuss the diagnosis and management of paraspinal schwannomas and the impact on operative planning when a nerve of origin is not identified.

A rare case of giant retroperitoneal neurilemmoma

Neurilemmoma, also known as schwannoma or neurinoma, is a tumor that originates from neural sheath Schwann cells. Giant neurilemmomas derived from the retroperitoneum have rarely been reported. We herein describe a woman with a giant retroperitoneal neurilemmoma that was initially incorrectly diagnosed as an inflammatory abdominal mass. The tumor extended from the patient's hypogastrium to her pelvic cavity and measured 20 × 15 × 10 cm. The tumor was excised via laparotomy and diagnosed as a retroperitoneal neurilemmoma through histological and immunohistochemical examination. Although rare, particularly in the giant form, neurilemmoma should be considered as an important differential diagnosis in patients with a retroperitoneal tumor or inflammatory abdominal mass. Complete excision should be considered for the potential cure of giant retroperitoneal neurilemmomas.

Schwannoma of the long thoracic nerve in the left axilla: a case report

Schwannoma, which is also known as neurilemmoma, is a type of tumor that arises from the peripheral nerve sheaths. Cases of schwannomas located in different regions have been reported. Some schwannomas present as asymptomatic masses, while others cause discomfort, such as pain and numbness. Magnetic resonance imaging (MRI) is a valuable diagnostic tool. A 23-year-old woman presented to our hospital with a mass in the left axilla that was misdiagnosed as mammae erraticae. The patient also considered the condition to be mammae erraticae for approximately 14 months because of a lack of symptoms. MRI was recommended by a surgeon from the galactophore department. A giant schwannoma was found. The mass was surgically excised, while preserving the continuity of the long thoracic nerve. Routine histopathological analysis confirmed the presence of a benign schwannoma. Schwannomas located in the axilla are rare and may be easily misdiagnosed as mammae erraticae or enlarged lymph nodes. Early investigation is necessary to make the diagnosis, and surgical excision is usually curative.