Laparoscopic resection of primary retroperitoneal schwannoma: A case report

Abstract

BACKGROUND Schwannomas are rare, often benign, tumors deriving from Schwann cells that have low incidence in the retroperitoneal region (0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs, symptoms and imaging tests. Thus, it is necessary performing guided punch biopsy in order to identify it. Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy. CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure, without complications, evolved with severe pain in the lower limbs, thigh and gluteal region associated with neurogenic claudication. Persistent pain required magnetic resonance imaging (MRI) of the lumbar spine, which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion. The surgical team opted for draining the collection, as well as requested an MRI of the abdomen and pelvis, whose analysis showed expansive lesion in the retroperitoneum, in close contact with the inferior vena cava and with the right renal vein. A guided puncture was performed for diagnostic clarification, which showed immunohistochemical profile compatible with schwannoma. The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy. The patient was discharged and remained stable after 4-mo follow-up; she remains under follow-up to check the need of cancer investigations. CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection, which often presents low relapse rates and optimistic prognosis.

Robotic-Assisted Resection of a Benign Schwannoma of the Obturator Nerve: A Rare Case

“…Schwannomas are typically benign tumors of slow growth and late diagnosis. However, they can undergo malignant transformation when associated with Von Recklinghausen disease (type II neurofibromatosis) or when an epithelioid morphology of peripheral nerve sheath tumor is present [ 4 , 11 ]. They are usually large at the time of diagnosis, because they are asymptomatic or have vague symptoms, such as abdominal pain [ 3 , 4 ], and rarely neurological manifestations, such as limb pain, paresthesia, and motor weakness due to the compression of adjacent structures [ 12 ].…”

“…Schwannomas are benign with slow growth and rarely display malignancy [ 2 ]. Early diagnosis is rare, and many cases are accidentally diagnosed during imaging tests or routine physical examinations, owing to asymptomatic or nonspecific symptoms [ 3 , 4 ]. Only a histo-pathological study confers the definitive diagnosis of schwannomas [ 5 ].…”

“…Only a histo-pathological study confers the definitive diagnosis of schwannomas [ 5 ]. Treatment is done by surgical resection of the tumor, as these tumors are less sensitive to radiation and/or chemotherapy [ 4 ]. Schwannomas present a favorable prognosis when completely resected [ 6 ].…”