Retroperitoneal Neural Sheath Tumors: Cleveland Clinic Experience

Abstract

Retroperitoneal neural sheath tumors are a rare clinical entity with a variable and nonspecific presentation, whose accurate preoperative diagnosis often can be difficult. Since July 1984, 9 retroperitoneal neural sheath tumors, including 3 benign schwannomas, 3 malignant schwannomas and 3 neurofibromas, were evaluated at our institution. Preoperative evaluation included a computerized tomography scan in all patients and magnetic resonance imaging in 4. Magnetic resonance imaging offered better resolution and anatomical definition in certain cases. Preoperative computerized tomography-guided needle biopsy, performed in 3 patients, yielded inaccurate or inconclusive results. The 6 patients with surgically resected benign schwannomas and neurofibromas had no local recurrences and all 6 had no evidence of disease (mean followup 17.3 and 14 months, respectively). Malignant tumors, especially when associated with von Recklinghausen's disease, offered a poor prognosis. Surgical considerations include complete tumor excision with free margins of resection and proper pathological evaluation to determine biological potential.

Laparoscopic treatment of retroperitoneal benign schwannoma

“…4 Guz et al also reported that CT-guided biopsy is inaccurate and sometimes misleading. 15 Therefore, surgical operations have been used for pathologic evaluation to enable diagnosis.…”

A Giant Guteal Schwannoma with extension into the Pelvis: A case report

“…[1][2][3][4][5][6] In our case an incisional biopsy provided enough material for a definitive diagnosis complete with immunohistochemical studies. The typical biphasic pattern microscopic features of Schwannomas ( Figure 2 ) coupled with the characteristic areas of degeneration produces the stromal heterogeneity typical of CT and MRI images of Schwannomas.…”

“…12 Wide local excision of retroperitoneal schwannomas has been advocated by some surgeons and pathologists who manage these tumours on the basis that malignancy can never be totally excluded. 6,13 However tumour recurrence or malignant transformation almost never occurs in benign schwannomas. [14][15] Provided the diagnosis of a benign schwannoma is established preoperatively, local excision or in difficult cases simple enucleation is adequate as no tumour enlargement has been observed.…”

“…5 Complete local excision is the treatment of choice, and once excised completely local recurrence is not expected. 6 Further adjuvant treatment is usually not required.…”

Schwanoma retroperitoneal maligno

“…La intervención quirúrgica completa suele ser el tratamiento más correcto, siendo necesaria la extirpación de algunos órganos vecinos en ciertas ocasiones, así como la resección de adecuados márgenes quirúrgicos 1,10 . Posteriormente al tratamiento han sido probados fármacos quimioterápicos sin conseguirse con ello mejoría en la supervivencia 3 .…”