Seminal vesicle schwannoma presenting as rectal pain: successful robotic-assisted excision

Laparoscopic surgery combined with the double-J tube implantation for the rare cystic-solid schwannoma of seminal vesicle: A Case Report and Literature Review

RATIONALE

Schwannoma is common in young and middle-aged people and occurs in the head, neck, posterior mediastinum, and retroperitoneal. Schwannoma, on the other hand, is a rare occurrence in the seminal vesicle. Early diagnosis and treatment are crucial since the disease can cause lower abdominal pain, nocturia, frequent urination, blood sperm, and other symptoms. There is no standard diagnostic or treatment guideline for seminal vesicle schwannomas currently. Therefore, the treatment experience relies on the few cases reported throughout the world.

PATIENT CONCERNS

A 45-year-old male patient discovered that the tumor beside the right side spermatophore is bigger than 3 years ago.

DIAGNOSIS

Schwannoma of seminal vesicle.

INTERVENTIONS

Ureter double-J tube implantation and laparoscopic surgery for schwannoma of seminal vesicle.

OUTCOMES

The operation process went smoothly. And the patient was no discomfort after half a year.

CONCLUSION

Schwannoma of the seminal vesicle is very rare in the clinic, and the imaging examination was not conclusive. The diagnosis mainly depends on pathological results. Surgical resection is the best treatment method for schwannoma. In surgery for schwannoma of seminal vesicle, combined with the ureter double-J tube implantation are many benefits. This case is an excellent example of the seminal vesicle schwannomas.

Robotic Nerve Sheath Tumor Resection With Intraoperative Neuromonitoring: Case Series and Systematic Review

BACKGROUND

Retroperitoneal nerve sheath tumors present a surgical challenge. Despite potential advantages, robotic surgery for these tumors has been limited. Identifying and sparing functional nerve fascicles during resection can be difficult, increasing the risk of neurological morbidity.

OBJECTIVE

To review the literature regarding robotic resection of retroperitoneal nerve sheath tumors and retrospectively analyze our experience with robotic resection of these tumors using a manual electromyographic probe to identify and preserve functional nerve fascicles.

METHODS

We retrospectively analyzed the clinical courses of 3 patients with retroperitoneal tumors treated at the National Institutes of Health by a multidisciplinary team using the da Vinci Xi system. Parent motor nerve fascicles were identified intraoperatively with a bipolar neurostimulation probe inserted through a manual port, permitting tumor resection with motor fascicle preservation.

RESULTS

Two patients with neurofibromatosis type 1 underwent surgery for retroperitoneal neurofibromas located within the iliopsoas muscle, and 1 patient underwent surgery for a pelvic sporadic schwannoma. All tumors were successfully resected, with no complications or postoperative neurological deficits. Preoperative symptoms were improved or resolved in all patients.

CONCLUSION

Resection of retroperitoneal nerve sheath tumors confers an excellent prognosis, although their deep location and proximity to vital structures present unique challenges. Robotic surgery with intraoperative neurostimulation mapping is safe and effective for marginal resection of histologically benign or atypical retroperitoneal nerve sheath tumors, providing excellent visibility, increased dexterity and precision, and reduced risk of neurological morbidity.

Two cases of pelvic schwannomas simultaneously resected with the prostate by robot-assisted surgery

INTRODUCTION

Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. The operative steps and technical aspects of robotic resection of pelvic schwannoma are described herein.

CASE PRESENTATION

We describe two patients with pelvic tumors simultaneously resected with the prostate by robot-assisted surgery: a 69-year-old man with schwannoma of the right side of the pelvic floor and a 68-year-old man with schwannoma in the left pelvis. As metastasis of prostate cancer could not be ruled out, tumorectomy was performed using robotic-associated prostatectomy. Malignancy was absent in the two pelvic tumors, and the patients were diagnosed with schwannoma.

CONCLUSION

For surgery in a narrow deep pelvis, robot-assisted surgery is minimally invasive, offers excellent mobility of robotic instruments and visibility of three-dimensional view, and is a useful approach.

Case report of seminal vesical schwannoma treated with conservative strategy

RATIONALE

Schwannoma is a benign peripheral nerve sheath tumor composed of Schwann cells and caused by genetic mutation or deletion. It rarely occurs in seminal vesicles. The optimal therapic strategy for asymptomatic cases is still unclear.

PATIENT CONCERNS

A 42-year-old man presented no clinical symptoms. A mass in his left seminal vesicle was found incidentally in a computed tomography scan and transrectal ultrasound-guided biopsy revealed the mass was schwannoma.

DIAGNOSIS

The patient was diagnosed as schwannoma of the seminal vesicle with no significant extension to the surrounding tissues.

INTERVENTIONS

The patient underwent computed tomography or magnetic resonance imaging scans periodically to estimate the alteration of the lesion and further strategy.

OUTCOMES

After 20-month follow-up, computed tomography scans showed no significant alteration to the lesion and no clinical symptoms were reported by the patient.

LESSONS

Conservative strategy might be an effective treatment option for asymptomatic patients with seminal vesical schwannoma. The period of follow-up depends on the size of the tumor.

Multiple schwannoma of the seminal vesicle: A case report

RATIONALE

Schwannomas of the seminal vesicles are extremely rare, and only cases of single seminal vesicle schwannomas have been reported. Here, we report a case of multiple schwannoma of the seminal vesicle.

PATIENT CONCERNS

We report a rare case of multiple schwannoma of the seminal vesicle that occurred in a 48-year-old man during physical examination. Multiple mixed masses in the left region of the seminal vesicle were documented with transrectal ultrasonography and magnetic resonance imaging. The patient presented no clinical symptoms, no family history of the disease and no history of genetic disease.

DIAGNOSIS

Postoperative pathology revealed a diagnosis of seminal vesical schwannoma.

INTERVENTIONS

The patient underwent robotic-assisted laparoscopic surgery to remove the mass.

OUTCOMES

The patient recovered rapidly and the length of hospitalization was 6 days after operation. At present, there is no recurrence in 10 month follow up.

LESSONS

Whether benign or malignant, single or multiple, schwannomas still need to be diagnosed by pathology because of the limitations of examination methods. Surgical resection is still the preferred treatment.

Leiomyoma arising from the right seminal duct/seminal vesicle-Report of a rare case and review of the literature

We present a case of a patient with a large, symptomatic abdominal tumour, which finally could be classified as a leiomyoma arising from the right seminal duct/seminal vesicle. In computed tomography (CT) scan, it appeared as a 7.5 × 6.5 cm solid, supravesical mass. A cystoscopy as well as bilateral retrograde studies was normal, a transrectal ultrasound-guided biopsy and an ultrasound-guided transabdominal biopsy of the mass were inconclusive. Subsequently, we performed a tumour extirpation through a lower midline laparotomy. Histological examination showed a leiomyoma arising from the right seminal duct or seminal vesicle. In this article, we discuss clinical presentation, findings on imaging and management of this rare benign tumour and review the relevant literature where only 13 similar cases could be identified.