Benign retroperitoneal schwannoma presenting as colitis: A case report

Paravertebral retroperitoneal ancient schwannoma mimicking irritable bowel syndrome

We report a case of paravertebral retroperitoneal ancient schwannoma (RPAS) with symptoms suggestive of irritable bowel syndrome that was relieved after resection. Very few cases have been reported of RPAS with gastrointestinal symptoms. Increased bowel activity associated with RPAS has not been reported. Our case report suggests that RPAS may present with increased bowel frequency that could be relieved after surgical resection.

Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report

Background

The occurrence of schwannomas in the hepatoduodenal ligament is rare, and its preoperative accurate diagnosis is difficult. Only few cases have been treated with laparoscopic surgery.

Case presentation

A 54-year-old man visited our hospital following abnormal abdominal computed tomography findings. He had no complaints, and his laboratory investigations were normal. Abdominal contrast-enhanced computed tomography revealed a tumor with enhancement at the margin of the hepatoduodenal ligament. The abdominal magnetic resonance imaging findings of the tumor showed hypointensity on the T1-weighted images and mixed hypointensity and hyperintensity on the T2-weighted fat-suppression images. Positron emission tomography showed localized accumulation of fludeoxyglucose only in the hepatoduodenal ligament tumor. The patient underwent laparoscopic tumor resection for accurate diagnosis. Histopathologically, the tumor was mainly composed of spindle cells, which were strongly positive for S-100 protein on immunohistochemical staining. The patient was discharged without any postoperative complications on day 5.

Conclusions

Complete tumor resection is essential for schwannomas to avoid recurrence. Laparoscopic surgery is useful for schwannomas occurring in the hepatoduodenal ligament and can be performed safely by devising an appropriate surgical method.

Clinical Characteristics and Treatment Strategy of Retroperitoneal Schwannoma Adjacent to Important Abdominal Vessels: Three Case Reports and Literature Review

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.

The effect of ozone injection within a common peroneal nerve schwannoma: A mistreatment due to a misdiagnosis

Background:

Peripheral schwannomas can be misdiagnosed or mistreated as they can mimic other subcutaneous lesions, leading to wrong diagnosis and, therefore, to improper treatment.

Case Description:

A 23-years-old male presented a painful growing nodule at the left popliteal fossa, with distally irradiated pain. A first magnetic resonance imaging depicted a heterogeneous lesion between common peroneal and sural nerves but, surprisingly, the patient was submitted to perilesional injection of ozone-oxygen mixture, causing the onset of intense neuropathic pain. A second MRI showed a morphological change of tumor characteristics. He finally underwent surgery but, intraoperatively, inter-fascicular fibrous adherences were noticed, making the tumor removal more difficult and riskier. The histopathological diagnosis was of schwannoma with areas of foreign body reaction.

Conclusion:

The injection of ozone or other substances within a subcutaneous swelling should be avoided, before a complete imaging assessment; because of such swelling could be a peripheral nerve schwannoma. The correct assessment of a lesion of the limbs determining radiating pain should be carefully demanded to a thorough history, clinical examination, and appropriate imaging technique. To avoid incorrect management, the treatment of such tumors should be performed in the first place by dedicated equips with proven expertise in this field.

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 in the hepatoduodenal ligament with portal vein invasion: A case report

RATIONALE

Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature.

PATIENT CONCERNS

Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area.

DIAGNOSES

Schwannoma in the hepatoduodenal ligament with portal vein invasion.

INTERVENTIONS

Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein.

OUTCOMES

The patient had a good prognosis and had no recurrence after 37 months of follow-up.

LESSONS

Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.

Juxta-adrenal schwannoma presenting as a giant adrenal tumor: A case report and a literature review

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Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath.

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RS can be misdiagnosed preoperatively, especially when they stick to other structures (the adrenal in our case).

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Complete surgical resection is the treatment of choice and open surgery is the safest option when we have big tumors.

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Histology and Immunohistochemistry confirm the diagnosis.

Introduction

Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. Juxta-adrenal schwannomas may be misdiagnosed with giant adrenal tumors. This article reports the case of a RS that presented as an asymptomatic adrenal mass in a 50 Y.O female.

Presentation of case

An abdominal ultrasound of our asymptomatic patient showed right adrenal lesion of 9 cm of diameter. Endocrinological evaluation was negative. The patient was considered to have a non-secreting right adrenal mass confirmed by adrenal scan. We began a right laparoscopic trans peritoneal adrenalectomy, but when we discovered intra operatively that the wall of the IVC and the renal vein were very adherent to the mass which had a lot of small vessels that were bleeding, we converted to open surgery that allowed us to remove the mass safely. The operative time was 200 min, the blood loss was 850 cc and the patient was discharged uneventfully on the sixth day after surgery.

Discussion

Although we thought that we removed a huge adrenal tumor from the retroperitoneum of our patient, the pathological exam revealed a RS that comprises the adrenal gland which was normal. Preoperative establishment of diagnosis is difficult in case of RS that can be misdiagnosed, especially when they stick to other structures (the adrenal in our case).

Conclusion

Complete surgical resection is the treatment of choice for RS and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirms the diagnosis that can be easily missed preoperatively.

Large retroperitoneal schwannoma: a rare cause of chronic back pain

Schwannomas are tumours that arise from Schwann cells of the peripheral nerve sheath and rarely occur in the retroperitoneum. We report a 45-year-old woman who presented with a 2-year history of continuous progressive right-sided lower back and dull flank pain radiating into her posterolateral thigh. Abdominal magnetic resonance imaging showed a homogenous soft-tissue tumour with thick capsular lining, which lay in the right retroperitoneum. The tumour was removed at surgery. A histological examination confirmed the diagnosis of benign encapsulated cellular schwannoma. Complete tumour excision should be regarded as the treatment of choice for benign retroperitoneal schwannomas. Successful treatment of these tumours requires thorough preoperative planning and a multidisciplinary approach.

Detection and management of retroperitoneal cystic lesions: A case report and review of the literature

The identification of cystic lesions within the retroperitoneal space is a rare event that poses clinicians the challenge of a difficult diagnosis and disease management. Retroperitoneal cystic lesions account for a group of lesions that range from common benign lesions (e.g., lymphoceles developing as a surgical complication) to rare aggressive malignant neoplasms. Currently, in the majority of cases, image-guided procedures allow for a pathological diagnosis to be achieved in these challenging lesions, thus offering the chance of an appropriate treatment; however, the overall clinical assessment of retroperitoneal cysts is highly demanding. The present study reports the management of a representative clinical case, presenting with a voluminous cystic mass able to dislocate cave vein, whose diagnosis was preceded by a deep vein thrombosis. Computed tomography-scan and ultrasound guided percutaneous drainage were performed to achieve the diagnosis. Following the discussion of the current case report, a review of the pathological and radiological characteristics of retroperitoneal cystic lesions is presented.

Hemorrhagic, calcified, and ossified benign retroperitoneal schwannoma: First case report

BACKGROUND

Schwannomas are mesenchymal tumors arising from the neural sheaths of peripheral nerves. They can almost develop in any part of the body, while head, neck and extremities are the most common sites. Occurrence in the retroperitoneum is rare. Schwannomas can show secondary degenerative changes including cyst formation, hyalinization, hemorrhage, and calcification, whereas the ossified retroperitoneal schwannoma was only reported in a malignant one.

CASE SUMMARY

We first present a benign ossified retroperitoneal schwannoma in a 61-year-old female. The mass was found by a routine health examination. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well-defined mass in the area among duodenum, right liver, and kidney. Definitive preoperative diagnosis of the mass was difficult. By laparotomy, the mass was found in the retroperitoneum. We completely removed the tumor and gross specimen showed a mass with a capsule and 6 × 6 × 4.8 cm in size. Microscopic examination showed the tumor is composed of spindle-shaped cells with degenerative changes of hemorrhage, calcification, and ossification. Immunohistochemically, S-100 protein was strongly positive. Finally, the mass was diagnosed as a hemorrhagic, calcified, and ossified benign schwannoma in the retroperitoneum. The patient was followed up for a period of 21 months, during which she was well with no evidence of recurrence.

CONCLUSION

We report the first case of a benign retroperitoneal schwannoma with secondary degenerative changes including hemorrhage, calcification, and ossification. Precise preoperative diagnosis of the tumor is challenging even with multiple preoperative imaging modalities. After complete resection, patients with benign retroperitoneal schwanommas generally have good prognosis.

Giant retroperitoneal schwannoma: a case report

Schwannomas are rare tumors originating from the Schwann sheath of the peripheral or cranial nerves. They are usually benign tumors and in 95% of the cases they originate from the peripheral nerves. Occurrence in the retroperitoneum is rare. We report a case of giant retroperitoneal schwannoma. The patient was a 71-year old female. She was admitted in with the complaints of finding abdominal mass for 8 years and emaciation for 1 year. CT scan showed a 15 cm × 11 cm mass located between the liver and the upper pole of the right kidney. After adequate preparation, the patient underwent surgery. During the procedure, we found a 15 cm × 11 cm × 6 cm mass located between the right liver, right kidney, adrenal gland and vena cava and adhered to them. The pathologic diagnosis was schwannoma.

Rare presentation of retroperitoneal schwannoma: a case report

The deadly Schwannomas, as uncommon subtype of soft tissue tumors originate from peripheral nerve sheaths. Retro peritoneum is an uncommon site for these tumors. Here we present the clinical feature and therapeutic implication of a 38-year-old man affected by recurrent retroperitoneal schwannoma who admitted to emergency ward following abdominal pain. Computed Tomorgraphic Scan showed a solid well-differentiated heterogeneous mass, 8.5x6 cm size in portahepatis beneath liver and right periumbilical .On laboratory tests Cancer Antigen 19-9 and Cancer Embryonic Antigen were in normal range. In surgery, a 7x8cm round mass was discovered at juxta renal juxta duodenal retro peritoneum, It was completely adhered to second part of duodenum with no signs of infiltration of the liver and right kidney, unable to simply being enucleated, curative resection was performed by classical whipple procedure. The patient`s hospitalization course was uneventful and on the second week he was discharged from the hospital with complete recovery. Due to the high recurrent rate of retroperitoneal Schwannomas even in benign circumstances, radical resection would be the treatment of choice.

Cellular schwannoma arising from sigmoid mesocolon presenting as torsion

Schwannomas are a type of peripheral nerve sheath tumors with clinically indolent behavior. Though, they can occur anywhere in body, the incidence in retroperitoneum, mediastinum, and pelvis is exceedingly rare. We present a case of a 58-year-old female with a massive twisted tumor arising from sigmoid mesocolon. The tumor was diagnosed to be a case of cellular schwannoma, an exceedingly rare tumor in this location with rare presentation.

Lumbar plexus schwannoma causing recurrent syncope

Retroperitoneal schwannomas are rare and present non-specifically. They usually manifest secondary to their compressive effects on adjacent structures. We describe a patient who presented with recurrent syncope resulting from a large retroperitoneal schwannoma stretching the inferior vena cava and compromising venous return. We also discuss the salient aspects of preoperative investigations leading to definitive diagnosis and surgery.

Retroperitoneal schwannoma

Retroperitoneal schwannomas are rare tumors and a correct pre-operative diagnosis is often not possible. They are usually identified incidentally via cross-sectional imaging. Diagnosis is based on histopathologic examination and immunohistochemistry. A 57-year-old man with a retroperitoneal schwannoma, as an unusual localisation, is presented.

Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA

Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects were two males and one female, ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors. However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes. Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 indexes were 3%-15%, 2%-3%, and 3%, respectively. No case showed any signs of malignancy. As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated no enlargement and no change in characteristics. Schwannomas are almost always benign and can be observed following diagnosis by EUS-FNA.

Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up

Giant sacral tumors present unique challenges to surgeons because there is no established consensus regarding the best treatment options. The authors report on the care of and outcome in a patient presenting with low-back pain only, who underwent preoperative biopsy sampling and subsequent embolization of the feeding vessels of a giant, sacral cellular schwannoma. The main procedure was performed via a combined posterior-anterior approach with complete microsurgical removal of the tumor, without the use of instrumentation, bracing, or adjuvant radio- and chemotherapy. At the 10-year follow-up, no evidence of residual tumor, recurrence, or instability was recognizable. Giant, sacral cellular schwannomas can be aggressively completely removed without any significant morbidity, achieving long-term control of the disease.

Gastrointestinal schwannoma: an unusual colonic lesion mimicking adenocarcinoma

Gastrointestinal schwannoma is a rare, benign pathological entity that can mimic colonic adenocarcinoma and cause diagnostic dilemmas for treatment. A case of a 68-year-old woman with colonic adenocarcinoma who was discovered to have an incidental synchronous bowel lesion that proved to be a gastrointestinal schwannoma and not a synchronous adenocarcinoma is described. Gastrointestinal schwannomas are uncommon in the colorectal region; they are most often located in the stomach. These spindle cell lesions are distinct from gastrointestinal stromal tumours because the tumour cells have a distinct immunophenotype, with strong diffuse positivity for S-100, glial fibrillary acidic protein and vimentin, and corroborative negative staining of CD34, CD117 and smooth muscle markers. Accurate diagnosis and recognition of this benign entity is, therefore, of immense clinicopathological value for accurate planning of therapeutic strategies.

A rare retroperitoneal schwannoma in a patient with neurofibromatosis Type 2

Neurofibromatosis Type 2 (NF2) is a dominantly inherited tumour-prone disorder, characterized by the development of multiple schwannomas, meningiomas and ependymomas. Its prevalence is around 1:60 000. Vestibular schwannoma (VS) is the hallmark of NF2. Retroperitoneal schwannomas are expected to occur in only 3% of cases. We present the case of a large retroperitoneal schwannoma in a patient with NF2. A well-circumscribed heterogenic mass (9.5 × 4 × 4 cm) behind and under the left kidney and extending into the left retroperitoneal space was revealed during a lumbar and retroperitoneal space magnetic resonance imaging (MRI). Brain, orbits, cervical, thoracic and lumbar MRI revealed bilateral VS, multiple meningiomas as well as multiple schwannomas and ependymomas in the cervical, thoracic and lumbar spine. The retroperitoneal mass represents a schwannoma probably derived from an intercostal nerve. The patient underwent neurosurgical excision of the VS, and 3 months later, the patient's condition remained stable.

Pain images: hip pain--wrong diagnosis, wrong operation

OBJECTIVE

The clinical presentation of retroperitoneal schwannoma with neuropathic pain and its subsequent management is presented.

DESIGN AND SETTING

This is a case report of a 67-year-old woman who developed left hip pain radiating into the postero-lateral portion of her left thigh and extending to the knee.

INTERVENTION

The patient underwent a left hip replacement for suspected pain from osteoarthritis of the hip joint.

OUTCOME MEASURE

The location of her pain was unchanged from the initial presentation, and more extensive investigations were carried out.

RESULT

The pain was found to be neuropathic in nature caused by a 54 mm retroperitoneal schwannoma.

CONCLUSION

Our case demonstrates the principle that unless the diagnosis is very clear (based on history, examination and diagnostic local anaesthetic injection, and confirmed by special investigations), surgery should not be considered. Where doubt exists, further assessment and investigation is required.