An interdisciplinary approach for laparoscopic removal of a large retroperitoneal pelvic schwannoma attached to vital vessels

Abstract

Rationale: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. Patient concerns: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. Diagnoses: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. Interventions: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. Outcomes: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. Lessons: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.

Two giant connected retroperitoneal schwannomas: A rare case report

“…Retroperitoneal schwannomas are generally solitary masses with well-de ned and intact envelopments [1], most of which are located near the great vessels [2,4]. The tumor may be solid or multilocular cystic with hemorrhage and necrosis.…”

“…The other is the sparsely cellular Antoni B region, in which the cells are loosely arranged in the mucoid matrix and pathological variations are seen as epithelioid or calci ed [5]. The typical immunohistochemical features of schwannomas are S100 protein and SOX10 positive but Desmin negative [2,[9][10][11]. In our case, the expression of S100 protein and SOX10 in the tumor cells was positive, while Desmin was negative, which was consistent with the immunohistochemical characteristics of schwannoma.…”

“…Schwannoma is a kind of tumor originating from Schwann cells of peripheral nerve. It is the most common peripheral nerve tumor and is usually benign [1,2],and some of the tumors have neuroendocrine functions [3]. Schwannoma usually occurs in patients of 20-50 years old, with no signi cant gender difference.…”

Two giant connected retroperitoneal schwannomas: A rare case report

“…It is common in the head, neck and limbs [4], and can also occur in the larynx, liver, mediastinum, and retroperitoneal space [5]. Retroperitoneal schwannomas account for 0.3% ~ 3.0% of all schwannomas [2,6], and schwannomas account for 1% of all retroperitoneal tumors [7]. Herein, we report a case of giant retroperitoneal schwannoma, which received satisfactory treatment results by complete resection of the tumor and preservation of surrounding organs.…”

“…Schwannoma is a kind of tumor originating from Schwann cells of peripheral nerve. It is the most common peripheral nerve tumor and is usually benign [1,2],and some of the tumors have neuroendocrine functions [3]. Schwannoma usually occurs in patients of 20-50 years old, with no signi cant gender difference.…”