Presacral solitary giant neurofibroma without neurofibromatosis type 1 presenting as pelvic mass--case report

Retroperitoneal solitary neurofibroma mimicking lymph node metastasis of colon cancer: a case report

BACKGROUND

A neurofibroma is a benign tumor that arises from Schwann cells and neurofibromas occur throughout the skin of neurofibromatosis type 1 (NF-1: Von Recklinghausen's disease) patients. A retroperitoneal solitary neurofibroma without any clinical signs of NF1 has been rarely reported. Herein, we present a case of a retroperitoneal solitary neurofibroma mimicking lymph node metastasis of colon cancer as well as a literature review.

CASE PRESENTATION

An 80-year-old woman with abdominal pain and nausea was transported and diagnosed with bowel obstruction arising from sigmoid colon cancer A colonic stent was inserted to alleviate the bowel obstruction. A computed tomography scan with contrast revealed a liver tumor in segment 3, and an enlarged lymph node around the abdominal aorta. Whole-body 18F-fluorodeoxyglucose-positron emission tomography-CT (FDG-PET-CT) examine revealed increased FDG uptake in the liver tumor and enlarged lymph node. Liver and distant lymph node metastasis were diagnosed and we made a plan for a two-stage operation of the colon cancer and the metastatic lesions because laparotomy resection was needed for the retroperitoneal lymph node. Laparoscopic sigmoid colectomy was performed first. Pathological examination showed a tubular adenocarcinoma. A laparotomy for the metastatic lesions was performed to ensure complete lymph node dissection secondly. Histopathological findings of the liver tumor showed metastasis of sigmoid colon cancer. However, the tissue regarded as the enlarged lymph node was diagnosed as a neurofibroma. No metastasis and recurrence were observed.

CONCLUSION

Although most neurofibromas are benign, malignant transformation of a neurofibroma is possible. PET-CT showed our patient had a high accumulated retroperitoneal tumor co-existing with colon cancer and liver metastasis. The treatment strategy of a solitary neurofibroma must be selected carefully considering the site of occurrence and the patient's background and aggressive resection of a tumor co-existing with another malignant tumor is needed.

A solitary giant neurofibroma of the left thigh: a case report

A neurofibroma not associated with neurofibromatosis type 1 is termed solitary neurofibroma. A solitary giant neurofibroma of the thigh is an extremely rare tumor. A 44-year-old woman presented to us with a well-defined swelling on her left thigh for 10 years. On the basis of magnetic resonance image finding, we diagnosed the tumor as a neurofibroma. We excised the tumor and the pathological findings established the diagnosis of neurofibroma. There was no recurrence 8-months after surgery.

Large solitary encapsulated neurofibroma of upper arm: A case report

Introduction: Neurofibromas are benign tumors of neuronal origin, occurring most commonly in young adults, with no gender predilection. The connection of neurofibroma with disorders on a general level as von Recklinghausen's disease makes its diagnosis critical. Case report: A 32-old female patient was administered to the Clinic of Plastic surgery, Clinical Center of Montenegro in Podgorica, with a 10-year history of painless, subcutaneous tumor of the right upper arm that grew in size over the last ten years. The patient reported progressive pain and tingling in her right forearm and right hand for the last 12 months. An MRI showed a non-homogenous tumor of the middle third portion of the triceps muscle, in close contact with the humerus but without infiltrating it. The tumor was removed, with a definitive histopathological result of a solitary benign neurofibroma. Conclusions: This example of successful treatment of solitary neurofibroma may serve to increase the awareness of surgeons and radiologists in small countries regarding benign peripheral nerve sheath tumors. The patient is under observation for two years with no signs of relapse and no other features indicative of neurofibromatosis type 1.

A solitary giant neurofibroma of inguinal region: A case report

Neurofibroma is a rare nerve sheath tumor of neuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported. We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosis showed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2 years. For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians cannot rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection is excellent.

Lumbosacral plexiform neurofibroma: a rare case in an adult without neurofibromatosis type I

Plexiform neurofibromas are an uncommon variant of neurofibromas that are described as being essentially pathognomonic of neurofibromatosis type 1 (NF1). Plexiform neurofibromas in the absence of NF1 are extremely rare. We present the case of a 38-year-old woman with a large multilobulated lumbosacral mass extending into the pelvis and proximal thigh. Histopathology of a CT-guided biopsy of the mass revealed it to be a neurofibroma. The imaging findings were consistent with a plexiform subtype. Further imaging and clinical workup showed that the patient had no other identifiable neurofibromas and did not meet criteria for the diagnosis of NF1.

18F-NaF Uptake in Retroperitoneal Neurofibroma and Uterine Leiomyoma Calcifications

A 48-year-old woman with intermittent lower back pain for 9 months and known retroperitoneal neurofibroma underwent F-NaF PET/CT scan to assess possible bony lesions causing the pain. Incidentally, the images showed elevated NaF activity in the retroperitoneal neurofibroma. In addition, uterine leiomyoma with heterogeneous calcifications revealed increased NaF activity.

Neurofibroma involving obturator nerve mimicking an adnexal mass: a rare case report and PRISMA-driven systematic review

Background

Pelvic masses are a common gynecologic problem, and majority of them are diagnosed as ovarian tumors finally. Sometimes, it is hard to distinguish the origin of these pelvic masses. The following case is a solitary neurofibroma arising from the right-side obturator nerve, which was impressed as a right-side ovarian tumor initially. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes image, molecular and pathological findings and outcome of neurofibroma.

Case presentation

A 33-year-old woman with a regular menstrual period denied any symptoms or signs. During her physical check-up, image examination revealed a right-side heterogeneous pelvic mass; it was suggestive of a complex of right-side ovarian tumor. A provisional diagnosis of retroperitoneal pelvic mass, probably a benign ovarian tumor, was made.

Excision of the right-side pelvic mass was performed. We sent the specimens for frozen pathology, which indicated neurofibroma and lipomatous tumor and that the possibility of liposarcoma cannot be excluded. A segment of the obturator nerve was attached to the tumor and was severed. A right-side obturator nerve tear during tumor excision was observed, and a neurosurgeon was consulted for obturator nerve grafting and repair. The patient complained of mild weakness and paresthesia affecting the right leg, and we consulted a rehabilitation doctor for neuron injury. The patient’s recovery was uneventful, and she was discharged eight days after the drain was removed. Further rehabilitation treatment was arranged.

Conclusion

A neurofibroma is an uncommon pelvic retroperitoneal tumor, and it can be misdiagnosed as an adnexal mass. To our knowledge, this is a rare case of a solitary neurofibroma arising from the obturator nerve. It usually does not have any neurological deficit. We present this case to demonstrate that pelvic neurofibroma can be mistaken for an adnexal mass. This fact should be borne in mind during the diagnosis process.

[Presacral giant solitary neurofibroma: a rare cause of pelvic mass in women]

Le neurofibrome présacré solitaire est une tumeur ectodermiquetrès rare tant par sa fréquence que par sa localisation, souvent pauci-symptomatiquejusqu’à l'atteinte de taille importante, d'accès difficile et de diagnostic erroné. L'imagerie préopératoirejoue un rôle essentieldans la prise en charge. Son diagnostic est immuno-histologique. Son traitement chirurgical est basé sur l'exérèse complète à marges saines. Nous rapportons l'observation d'une patiente de 46 ans, ayant été opérée pour suspicion de fibrome utérin sous séreux, dont l'exploration chirurgicale a confirméune tumeur rétropéritonéale et présacrée. L'IRM post opératoire a précisé ses rapports anatomiques. La reprise chirurgicalea permis l'exérèse complète de la tumeur sans lésions des organes adjacents. L'histologie et l’étude immuno-histochimique ont conclu à un neurofibrome.

Chronic suppurative inflammatory cyst in the sacrum

Sacral bone remodeling with abnormal dilatation of intervertebral foramina is usually associated with Tarlov's perineurial cysts but can also be caused by slow-growth lesions. In this case report, an atypical inflammatory sacral cyst with bone scalloping was found and some possible causes are suggested. A 77-year-old woman complained of severe back pain and claudication with anal tone weakness. A plain roentgenogram and CT showed spinal canal expansion and characteristic border scalloping of the sacrum. MRI showed septated cystic content with peripheral enhancement. Laminectomy was performed. The cyst contained yellowish viscous material that was easily removed. The neurological symptoms improved after surgery. The cystic wall was composed of dense fibrous tissue without epithelial cell lining; the cystic content was, on histology, inflammatory cells including neutrophils and lymphocytes. Patients who have sacral intraspinal cysts should be identified before doing the treatment such as acupuncture and epidural steroid injection to avoid infection to those cysts.

Intravascular embolisation and surgical resection of a giant neurofibroma with intratumoural haemorrhage

The use of pre-operative embolisation has been described for small neurofibromas, but not for giant lesions. Advances in embolisation techniques are extending the indications for this procedure, in particular to assist with operative intervention on a range of lesions. This case report describes a 45-year-old male with a giant neurofibroma who underwent embolisation to stabilise intratumoural haemorrhage and to assist with haemostasis during the subsequent surgical resection. Minimal transfusion was required and the patient has made a good recovery. This case demonstrates that pre-operative embolisation of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity.

An unusual presentation of a solitary benign giant neurofibroma. Case report

The authors report on a 34-year-old man who presented with acute enlargement of an extraspinal mass secondary to a hemorrhage following minor trauma. The mass had been present from birth, had slowly enlarged over time, and previous imaging had suggested an extraspinal fibrolipoma measuring 10 x 6 x 4 cm. Following minor trauma (scratching the skin overlying the tumor), the mass rapidly enlarged to approximately double in size over a period of 4 hours. A CT scan and MR imaging confirmed an extraspinal tumor that was 15 x 11 x 11 cm, with an associated acute hematoma of similar dimensions. The patient was taken to the operating room for hematoma evacuation and tumor resection. Histopathological investigation identified a benign, diffuse neurofibroma with associated dysplastic blood vessels exhibiting irregular areas of tunica media and sinusoidal-like vascular channels. To the authors' knowledge, a solitary giant neurofibroma in a patient without neurofibromatosis presenting with acute enlargement secondary to hemorrhage following minor trauma has not been previously described. The authors suggest that the source of the acute hemorrhage may be related to the neurofibroma-associated vascular dysplasia and the resultant increased vascular fragility.

[Voluminous mediastinal neurofibroma in a child]

INTRODUCTION

Neurogenic tumors account for 30% of mediastinal tumors in children. The thoracic region is the most common site for neurofibromas. We report a case of a voluminous neurofibroma in a small girl.

CASE

After 8 months of paraplegia, a 4-year-old girl underwent thoracic radiography and computed tomography as well as magnetic resonance imaging of the spine. These revealed a huge mediastinal mass continuing into the vertebral canal and compressing the cord. Histological examination after surgery confirmed the diagnosis of neurofibroma. At the follow-up examination a month later, the paraplegia had resolved.

DISCUSSION

Neurofibromas may manifest as solitary tumors or may be one manifestation of neurofibromatosis. In mediastinal neurofibroma, thoracic radiography, and computed tomography can show the tumor, posterior vertebral scalloping, and enlarged neural foramina. MR imaging provides the exact anatomic location, as well as any compression and displacement caused by the tumor. This information is essential for deciding the exact extent of resection. MRI may also be helpful in postoperative management.

Pelvic plexus tumors

Object

Pelvic plexus tumors are unusual entities. These lesions often reach significant size prior to clinical presentation due to vague lower extremity or other symptoms refractory to exhaustive workup and the potential space of the retroperitoneum.

Methods

The authors retrospectively reviewed the charts of 44 patients who presented to Louisiana State University Health Sciences Center with pelvic plexus tumors. All such patients were included in the present study if there was at least 12 months of follow-up. Clinical evaluations were examined, including typical clinical presentation, imaging studies, and other preoperative evaluations. These tumors include 38 peripheral neural sheath tumors (86%), two malignant neural sheath tumors (5%), and four nonneural sheath tumors (9%). The authors also examined the relation of pelvic neural sheath tumors to neurofibromatosis Type 1 (NF1).

Results

Histopathological examination confirmed 18 solitary neurofibromas (41%), 12 NF1-associated neurofibromas (27%), eight schwannomas (18%), two malignant nerve sheath tumors (5%), and four other nonneural sheath tumors (9%). The other nonneural sheath tumors consisted of one each of desmoid, ganglioma, lipoma, and an unspecified calcified mass.

Conclusions

The optimal treatment for retroperitoneal lesions remains operative excision with adjunctive therapy specific to the lesion encountered.

MR imaging of abdominopelvic involvement in neurofibromatosis type 1: a review of 43 patients

BACKGROUND

Plexiform neurofibromas are a frequent complication of neurofibromatosis type 1. This article discusses MR imaging findings and distribution of plexiform neurofibromas in the abdomen and pelvis.

OBJECTIVE

To define the most prevalent patterns of involvement and MR imaging findings in abdominopelvic neurofibromatosis type 1.

MATERIALS AND METHODS

We reviewed the MR appearance of abdominopelvic lesions in 23 male and 20 female patients (median age: 16 years) with type 1 neurofibromatosis. The patients were part of a multi-institutional study of 300 patients. Imaging included coronal or sagittal, and axial short tau inversion recovery images.

RESULTS

The most common abdominopelvic involvement was in the abdominopelvic wall (n=28, 65%) and lumbosacral plexus (n=27, 63%). Retroperitoneal involvement was frequent (n=15, 35%). Lesions were less often intraperitoneal (21%) (P=0.001). Pelvic disease (n=27, 63%), neural canal involvement (n=18, 42%), and hydronephrosis (n=4, 9%) were also noted. Target-like appearance of plexiform lesions was noted in more than half the patients.

CONCLUSION

Abdominopelvic involvement in neurofibromatosis type 1 is primarily extraperitoneal. Although lesions are most prevalent in the abdominopelvic wall and lumbosacral plexus, retroperitoneal and pelvic involvement is common and usually affects important organs. MR imaging added information in the initial and follow-up clinical evaluation of these patients.

Benign intradural extramedullary masses in children of northern India

Twenty-five children with benign intradural extramedullary tumors/lesions were retrospectively analyzed to see the frequency of different histotypes in this location and their variation from the Western world. The duration of symptoms, clinical profile and surgical outcome of these cases were evaluated. The age of children ranged from 1.5 to 18 years, with a mean age of 7.5 years. Thirteen amongst them were male. Follow-up ranged from 3 months to 5 years with a mean of 19 months. McCormick functional grading was used retrospectively to find out the functional outcome in these children. Sixty-eight percent of these cases presented with functional grade IV or V. The mean duration from the appearance of the first symptoms to admission to our hospital in these children was 13 months. Improvement in the functional grade following surgical excision was noted amongst all, except one, who presented with schwannoma, and did not improve from grade III even after a 14-month follow-up. Reoperation/two-staged operation was required in 3 children. The following conclusions were drawn from this study: (1) approximately half (48%) of intradural extramedullary benign tumors are nerve sheath tumors, i.e. neurofibromas, neurilemomas and schwannomas. Giant neurofibromas with giant extraforaminal extension may rarely manifest with a large extraspinal mass; (2) meningioma is an infrequent tumor in this location; (3) developmental cystic dysraphic lesions (neurenteric cyst, arachnoid cysts), unassociated with the stigmata of spinal dysraphism, are significantly more frequent (28%) than reported in the literature; (4) the possibility of infective lesions (granuloma, abscess) causing compressive features cannot be denied even in intradural extramedullary tumors; (5) long-standing lesions, with a long segment involvement, also have a good outcome following a good microsurgical excision, and (6) more than half of the children (68%) present with a severe neurological compromise, either because of ignorance and poor education or due to the scanty diagnostic facilities available at the peripheral hospitals of the developing milieu.

Synchronously diagnosed pre-sacral neurofibroma and cutaneous spitzoid melanoma: a fortuitous association?

BACKGROUND

At a U.S prevalence of 1 in 3000, Neurofibromatosis type-1 (NF-1) is a relatively common disorder. Amongst a variety of others, occurrence of 2 or more neurofibromas in the same patient represents one of the major diagnostic criteria for this disorder. Rarely, ocular, cutaneous or anorectal malignant melanomas may be identified in patients with NF-1, This rare association has caused controversy as to whether patients with NF-1 have an inherently higher risk for melanomas or whether the associations can be explained by chance alone.

CASE PRESENTATION

The purpose of this report is to highlight the unusual confluence of rare clinicopathologic features in a patient without NF-1. The patient was diagnosed with an 8.5 cm pre-sacral neurofibroma and was shortly thereafter diagnosed with a cutaneous malignant melanoma showing spitzoid features. Pre-sacral neurofibromas are rare in patients without NF-1; likewise, malignant spitzoid melanoma, a controversial histopathological entity, is distinctly uncommon.

CONCLUSIONS

The synchronous diagnoses of these neural crest derived tumor entities in a patient without neurofibromatosis lends credence to the view that when these two lesions occur in patients with NF-1, the association is coincidental.

Nerve sheath tumors involving the sacrum. Case report and classification scheme

Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.