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CASE REPORT
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 58-59

Retroperitoneal schwannoma


Department of Surgery, Dr. Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India

Date of Web Publication21-Mar-2012

Correspondence Address:
T Karthik
Department of Surgery, Dr. Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Chinnaoutpalli, Gannavaram, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.94179

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  Abstract 

Retroperitoneal schwannomas are rare tumors originating from Schwann cells of peripheral nerve ending and are uncommon (0.5-1.2%). Absence of typical clinical picture and lack of specific signs make preoperative diagnosis hard to ascertain. We report a case of a 45-year-old male who presented with constipation and difficulty in micturition for 5 days. Ultrasound abdomen showed a large mass of 13 cm × 10 cm with internal echoes posterior to urinary bladder and was confirmed by contrast enhanced computed tomography abdomen. A complete resection of mass without injuring the adjacent structures was carried out through a midline laparotomy. Histopathological evaluation and immunohistochemistry documented a benign retroperitoneal schwannoma.Retroperitoneal schwannomas are rare tumors originating from Schwann cells of peripheral nerve ending and are uncommon (0.5-1.2%). Absence of typical clinical picture and lack of specific signs make preoperative diagnosis hard to ascertain. We report a case of a 45-year-old male who presented with constipation and difficulty in micturition for 5 days. Ultrasound abdomen showed a large mass of 13 cm × 10 cm with internal echoes posterior to urinary bladder and was confirmed by contrast enhanced computed tomography abdomen. A complete resection of mass without injuring the adjacent structures was carried out through a midline laparotomy. Histopathological evaluation and immunohistochemistry documented a benign retroperitoneal schwannoma.

Keywords: Schwannoma, retroperitoneal, S-100


How to cite this article:
Karthik T, Devanandam K, Shastri R K, Ramesh K. Retroperitoneal schwannoma. J NTR Univ Health Sci 2012;1:58-9

How to cite this URL:
Karthik T, Devanandam K, Shastri R K, Ramesh K. Retroperitoneal schwannoma. J NTR Univ Health Sci [serial online] 2012 [cited 2019 Nov 11];1:58-9. Available from: http://www.jdrntruhs.org/text.asp?2012/1/1/58/94179


  Introduction Top


Schwannomas are usually well encapsulated tumors seen commonly in the head and neck, extremities and mediastinum, between the ages of 20 and 50. Schwannoma in retroperitoneum is a rare presentation. [1] Its symptoms depend on the size and area of tumor and are mainly due to compression of adjacent structures. Diagnosis depends on ultrasound, contrast enhanced computed tomography (CECT) and MRI and is aided by guided biopsy. Confirmation is by histopathology and immunohistochemistry. [2] We report one such case.


  Case Report Top


A 45 year old man presented with constipation and difficulty in micturition for 5 days. He had discomfort in lower abdomen but no history of fever, hematuria, protrusion of mass or bleeding per rectum. On abdominal examination, a retroperitoneal mass measuring approximately 13 cm × 10 cm was found. Rectal examination revealed a soft mass on the right side projecting into the lumen. Prostate was not palpable separately. Rest of the examination and laboratory parameters were with in normal limits.

Ultrasonography of abdomen and pelvis showed a mass of 13 cm × 10 cm with cystic changes posterior to urinary bladder. On CECT a lesion with peripheral rim enhancement was seen posterior to bladder, not separately visualized from prostate. A preoperative diagnosis of retroperitoneal cystic tumor, probably teratoma was made and a complete excision of a well-defined mass without injuring any adjacent structures was carried out though a midline laparotomy [Figure 1]. Postoperative period was uneventful. Histopathology being suspicious, immunohistochemistry was done, which was positive for S-100, thus confirming a diagnosis of schwannoma. There was no evidence of malignancy.
Figure 1: Intra-op picture showing the mass

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  Discussion Top


Schwannomas are usually located in head, neck and flexor surface of extremities. Only 0.7% are seen in retroperitoneum and are usually benign (only 1.7% being malignant). Primary retroperitoneal tumors are themselves rare and schwannomas comprise only 0.5-1.2%. [1] Presentation of retroperitoneal schwannoma is non-specific and in most of the cases is due to compression of the adjacent structures. Abdominal ultrasonogram is a simple and non-invasive method for early detection of these tumors. On CECT, these tumors appear as heterogeneous masses with ring enhancement. MRI is the gold standard. [3] Image-guided needle biopsy is also useful. [2],[4]

Histopathology reveals two types of patterns - Antoni A and Antoni B. Cystic changes occur in 66% [4] and commonly in malignancy. [3] Immunohistochemistry is needed to confirm the diagnosis. [2] Resection of the tumor is the only appropriate treatment. Prognosis is quite good and recurrences are unusual. [5]

 
  References Top

1.Wong CS, Chu TY, Tam KF. Retroperitoneal schwannoma: A common tumour in an uncommon site. Hong Kong Med J 2010;16:66-8.  Back to cited text no. 1
    
2.Kudo T, Kawakami H, Kuwatani M. Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA. World J Gastroenterol 2011;7:3459-64.  Back to cited text no. 2
    
3.Schindler O, Dixon J, Case P. Retroperitoneal giant schwannomas: Report on two cases and review of the literature. J Orthop Surg (Hong Kong) 2002;10:77-84.  Back to cited text no. 3
    
4.Narasimha A, Kumar MH, Kalyani R, Madan M. Retroperitoneal cystic schwannoma: A case report with review of literature. J Cytol 2010;27:136-9.  Back to cited text no. 4
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5.Ben Moualli S, Hajri M, Ben Amna M, Kolsi K, Chebil M, Ben Jilani S, et al. Retroperitoneal schwannoma. Case Report. Ann Urol (Paris) 2001;35:270-2.  Back to cited text no. 5
    


    Figures

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