Retroperitoneal schwannoma: an unusual cause of abdominal distention

Abstract

DescriptionA 54-year-old Caucasian woman with no significant medical history presented to her primary care physician with chief complaints of right-sided abdominal dull pain and distension. There were no constitutional symptoms or other complaints such as nausea, vomiting, constipation, diarrhoea, melena or hematochezia. She was a non-smoker with no significant family history. Vital signs were stable and physical exam was insignificant except for dull pain on deep palpation of the right mid-abdomen. Laboratory studies including complete blood count, basic metabolic panel, liver function tests, serum amylase and serum lipase were all within normal range. CT of the abdomen revealed a large retroperitoneal mass which was concerning for a malignant sarcoma (figures 1 and 2). Positron emission tomography scan confirmed increased metabolic Learning points► Schwannomas are mesenchymal tumours that arise from Schwann cells of peripheral nerve sheaths and can occur in all age groups. More than 90% of schwannomas are benign, and the most commonly involved sites are the head, neck and extremities. Only 1%-3% of schwannomas are found in the retroperitoneal space.

Retroperitoneal schwannoma masquerading as an ovarian cyst

“…Schwannomas are mesenchymal tumours that arise from Schwann cells of peripheral nerve sheath. Most commonly benign, they are usually found in the extremities – the head, neck and limbs with only less than 3% of schwannomas reported to be in the retroperitoneal space . To our knowledge, this is the first case of retroperitoneal schwannoma reported as a cause of pelvic pain.…”

“…Treatment wise, surgical resection is the recommended treatment for retroperitoneal schwannomas, both to resolve the compressive symptoms as well as to provide a definite histological diagnosis after histopathological and immunohistochemical staining analyses . Characteristic histopathological and immunohistochemical features include Antoni areas, S‐100 and CD‐34 staining .…”

Retroperitoneal schwannoma mimicking a pancreatic cystic neoplasm: a case report

“…Retroperitoneal schwannomas (RPS) pose significant diagnostic challenges as they are frequently elusive and lack specific signs and symptoms. They have been associated with atypical presentations such as abdominal distension, hypertension, hematuria and hydronephrosis in several previously published reports (3)(4)(5). Although preoperative computed tomography (CT) and magnetic resonance imaging (MRI) may help establish the diagnosis, RPS lack specific imaging features which makes definitive diagnosis inevitably based on post-resection histopathologic evaluation and immunohistochemical labeling (5).…”

Surgical management of retroperitoneal schwannoma complicated with severe hydronephrosis

“…At the advanced stage, the main presentations of the retroperitoneal schwannomas includes abdominal pain and palpable abdominal mass, other atypical presentations such as secondary hypertension, hematuria, and renal colic were also reported in the literatures. [ 3 , 4 ]…”