Niebisch S, Staab H, Ullrich S, Hoffmann KT, Sabri O, Thieme R, Schierle K, Wittekind C, Gockel I. Retroperitoneal space-occupying lesion with displacement of the inferior vena cava.
Int J Surg Case Rep 2019;
57:170-4. [PMID:
30981070 DOI:
10.1016/j.ijscr.2019.03.037]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 01/19/2023] Open
Abstract
Exact preoperative diagnosis and surgery of retroperitoneal schwannoma (RS) is sophisticated.
Due to heterogeneity of the entity, preoperative negative biopsy does not exclude malignancy.
A curative (R0) resection must be achieved in order to avoid local recurrence, always under consideration of multivisceral resections.
Introduction
The differential diagnosis and therapy of retroperitoneal masses suspicious for soft tissue tumors remains difficult and needs individual decisions as to the best management of patients. We report an unusual case of retroperitoneal schwannoma (RS).
Presentation of case
We report on a 57-year-old female patient with a retroperitoneal space-occupying lesion with displacement, but no infiltration of surrounding vessels, especially the inferior vena cava. As presence of malignancy could not be completely excluded by imaging and biopsy, we performed an open resection of the tumor with plastic reconstruction of the right renal vein. Curative resection of the tumor could be achieved and benign RS verified.
Discussion
Preoperative work-up, including a broad spectrum of differential diagnoses, and consecutive appropriate surgical resection are challenging. Characteristic features of the pre-therapeutic diagnostics of retroperitoneal schwannomas are discussed and differential diagnostic considerations as well as surgical therapeutic options are outlined.
Conclusion
Deeper understanding of retroperitoneal schwannomas gained from preoperative radiologic diagnostics may serve to underline the need for targeted biopsy. This and its histopathological examination necessitate expert interventional radiologists and pathologists. Thus, even the pre-therapeutic diagnostic management should be performed in a specialized center. If doubts remain regarding the entity of the retroperitoneal lesion and findings are still controversial after thorough assessment, surgical oncologic resection represents the therapy of choice, if the surgical risk is adequate.
Collapse