Preoperative management of giant retroperitoneal schwannoma: A case report and review of the literature

Abstract

Schwannomas rarely occur in the retroperitoneum, and are normally not aggressive. Preoperative diagnosis is difficult and the surgeon may confront blood vessels, nerves or organs damage, since the intra-operative findings are various. The diagnosis and treatment of malignant schwannomas in the retroperitoneum are even more challenging. In addition, the prognosis of malignant schwannomas is extremely poor. The present study reports the case of a 52-year-old woman who presented with a 6-month history of an abdominal mass in the left lower quadrant. The local doctor determined a preliminary diagnosis of abdominal giant tumor and referred the patient to the First Affiliated Hospital, Medical School of Xi'an Jiaotong University, (Xi'an, China). Following discussion, the patient underwent a surgical resection. Low-grade malignant schwannoma was diagnosed following histological examination. No evidence of recurrence or any other complication was observed at the 18-month follow-up examination. The present study reports a case of giant retroperitoneal schwannoma (RS), and includes a literature review in order to provide an overview of the diagnosis, treatment and prognosis of RS and discuss preoperative management strategies for the disease.

Large retroperitoneal schwannoma: a rare cause of chronic back pain

“…A strong diffuse expression of S100 protein is a distinct immunohistochemical feature of schwannoma. 16 Additionally, although positive cytoplasmic reactivity for vimentin may identify all mesenchymal cells, it is more consistently expressed in Schwann cells. 17 Furthermore, unlike neurofibromas, most schwannomas do not demonstrate major CD34 immunoreactivity.…”

Retroperitoneal malignant schwannoma in a child

“… 9 , 10 The symptoms of retroperitoneal schwannomas are variable due to the flexibility of the retroperitoneal cavity, and most affected patients are asymptomatic; this often results in the discovery of a substantially large tumor at the time of consultation. 11 Preoperative diagnosis mainly depends on radiological examinations, such as CT and magnetic resonance imaging (MRI). 1 , 12 , 13 CT scans often show cystic changes, which are more common in retroperitoneal schwannomas (about 66%) and rare in other retroperitoneal tumors.…”

“… 5 , 16 Immunohistochemistry is of significant importance to the final diagnosis, and the most accurate positive markers mainly consist of S100, vimentin, GFAP, SOX10, and a few others. 11 , 17 , 18…”

“…The prognosis of retroperitoneal malignant schwannomas is not optimistic. Factors influencing the prognosis may include incomplete excision, 11 association with NF-1, 8 and hypoxia-inducible factor 1 alpha. 24 The most common problem is recurrence, which is much higher for malignant than benign tumors.…”

Retroperitoneal Schwannoma: A Case Report

“…It is considered that malign schwannomas have irregular external surfaces and tendency to invade neighbor structures [11].…”