Abstract
A huge schwannoma, located in the retroperitoneal space, is found very rarely. The main purpose of this paper is to present the case of a giant retroperitoneal schwannoma which partly invaded L4 vertebral body. The secondary purpose is to summarize the case-report articles on retroperitoneal schwannomas. A circumscribed heterogenic tumour was revealed on transabdominal sonography. It extended into the right retroperitoneal space. CT and MRI revealed a paravertebral tumour in the size of 11 cm × 9 cm, which is causing a partial lysis of L4 vertebral body (15% of vertebral capacity), expanding intravertebral foramen and filling the right retroperitoneal space. A preoperative core needle biopsy was performed and a benign schwannoma was diagnosed. A complete surgical excision of the tumour was achieved by a two-step operation. During the first step, the neurosurgeons made L4 hemilaminectomy, facetectomy and a transverse process resection by posterior extended approach. The general surgeons excised the residual retroperitoneal part of the tumour by midline transabdominal approach 10 days later. The diagnosis of benign schwannoma was verified histochemically. There were no sign of tumour recurrence or spine destabilization at the six-month follow-up. In conclusion, although majority of giant retroperitoneal schwannomas can be completely removed performing one-step operation, a preoperative consideration about rationality of two-step operation should be mandatory when tumour destructs a part of vertebral body. Our case shows that the combined two stage complete surgical excision of a giant retroperitoneal schwannoma, eroding 15% of L4 vertebra’s osseous capacity, is effective and does not have any negative influence on spinal stability.
[1] Singh V., Kapoor R., Atypical presentations of benign retroperitoneal schwannoma: Report of three cases with review of literature, Int Urol Nephrol, 2005, 37, 547–549 http://dx.doi.org/10.1007/s11255-004-4705-510.1007/s11255-004-4705-5Search in Google Scholar PubMed
[2] Sharma S.K., Koleski F.C., Husain A.N., Albala D.M, Turk T.M., Retroperitoneal schwannoma mimicking an adrenal lesion, World J Urol, 2002, 20, 232–233 10.1007/s00345-002-0264-5Search in Google Scholar PubMed
[3] Dede M., Yagci G., Yenen M.C., Gorgulu S., Daveci M.S., Cetiner S., et al., Retroperitoneal benign schwannoma: report of three cases and analysis of clinico-radiologic findings, Tohoku J. Exp. Med., 2003, 200, 93–97 http://dx.doi.org/10.1620/tjem.200.9310.1620/tjem.200.93Search in Google Scholar PubMed
[4] Girgin C., Ozkan U., Sezer A., Tugyan N., Large pelvic schwannoma causing bilateral hydronephrosis, Int. J. Urol., 2003, 10, 616–618 http://dx.doi.org/10.1046/j.1442-2042.2003.00702.x10.1046/j.1442-2042.2003.00702.xSearch in Google Scholar PubMed
[5] Patocskai E.J., Tabatabaian M, Thomas M.J., Cellular schwannoma: a rare presacral tumour, Can J Surg, 2002, 45, 141–144 Search in Google Scholar
[6] Palmer J.D., Manual of neurosurgery, Bell and Bain Ltd., Glasgow, 1996 Search in Google Scholar
[7] Li Q., Gao C., Juzi J.T, Hao X., Analysis of 82 cases of retroperitoneal schwannoma, ANZ J Surg, 2007, 77, 237–240 http://dx.doi.org/10.1111/j.1445-2197.2007.04025.x10.1111/j.1445-2197.2007.04025.xSearch in Google Scholar PubMed
[8] Kar M., Deo S.V., Shukla N.K., Malik A., DattaGupta S.,. Mohanti B.K et al., Malignant peripheral nerve sheath tumors (MPNST) — Clinicopathological study and treatment outcome of twenty-four cases, World J Surg Oncol, DOI:10.1186/1477-7819-4-55 10.1186/1477-7819-4-55Search in Google Scholar PubMed PubMed Central
[9] Erzen D., Sencar M., Novak J., Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana, J Surg Oncol, 2005, 91, 1–9 http://dx.doi.org/10.1002/jso.2026510.1002/jso.20265Search in Google Scholar PubMed
[10] Heaton N.D., Page A.C., Howard E.R., Malignant retroperitoneal schwannoma, J R Soc Med, 1991, 84, 308–309 10.1177/014107689108400521Search in Google Scholar
[11] Ogose A., Hotta T., Morita T., Higuchi T., Umezu H., Imaizumi S., et al., Diagnosis of peripheral nerve sheath tumors around the pelvis, Jpn. J. Clin. Oncol., 2004, 34, 405–413 http://dx.doi.org/10.1093/jjco/hyh07210.1093/jjco/hyh072Search in Google Scholar PubMed
[12] Rousseau M.A., Pascal-Mousselard H., Lazennec J.Y., Saillant G, The mini-invasive anterior extra peritoneal approach to the pelvis, Eur J Surg Oncol, 2005, 31, 924–926 http://dx.doi.org/10.1016/j.ejso.2005.05.00610.1016/j.ejso.2005.05.006Search in Google Scholar PubMed
[13] Kishi Y., Kajiwara S., Seta S., Kawauchi N., Suzuki T., Sasaki K., Retroperitoneal schwannoma misdiagnosed as a psoas abscess: report of a case, Surg. Today, 2002, 32, 849–852 http://dx.doi.org/10.1007/s00595020016610.1007/s005950200166Search in Google Scholar
[14] Facciorusso D., Federici T., Giacobbe A.,. Niro Grazia A, Piermanni V., Andriulli A., Retroperitoneal neurilemoma diagnosed by endosonographically guided fine needle aspiration, J Clin Ultrasound, 2006, 34, 241–243 http://dx.doi.org/10.1002/jcu.2021110.1002/jcu.20211Search in Google Scholar
[15] Cotran R.S., Kumar V., Collins T., Robbins S.L., Robbins Pathologic basis of disease, 6th ed, W.B. Saunders Company, USA, 1999 Search in Google Scholar
[16] Kleihues P., Cavenee W.K., Pathology and Genetics of Tumours of the Nervous System, IARC Press, France, 2000 Search in Google Scholar
[17] Rosai J., Rosai and Ackerman’s surgical pathology, 9th ed., Mosby, USA, 2004 Search in Google Scholar
[18] Schindler O.S., Dixon J.H., Retroperitoneal giant schwannomas: report on two cases and review of the literature, J Orthop Surg (Honk Kong), 2002, 10, 77–84 10.1177/230949900201000114Search in Google Scholar
[19] Lalloo S.T., Mayat A.G., Nadvi S.S., Landers A.T., Clinics in diagnostic imaging (68), Singapore Med J, 2001, 42, 592–595 Search in Google Scholar
[20] Klimo P., Rao G., Schmidt R.H., Schmidt M.H., Nerve sheath tumors involving the sacrum. Case report and classification scheme, Neurosurg Focus, 2003, 15, 12 10.3171/foc.2003.15.2.12Search in Google Scholar
[21] Goh B.K., Tan Y.M., Chung Y.F., Chow P.K., Ooi L.L., Wong W.K., Retroperitoneal schwannoma, Am. J. Surg., 2006, 192, 14–18 http://dx.doi.org/10.1016/j.amjsurg.2005.12.01010.1016/j.amjsurg.2005.12.010Search in Google Scholar
[22] Hayasaka K., Tanaka Y., Soeda S., Huppert P., Claussen C.D., MR findings in primary retroperitoneal schwannoma, Acta Radiol, 1999, 40, 78–82 http://dx.doi.org/10.3109/0284185990917440810.3109/02841859909174408Search in Google Scholar
[23] Kono K., Inoue Y., Nakamura H., Shakudo M., Nakayama K., MR imaging of a case of a dumbbellshaped spinal schwannoma with intramedullary and intradural-extramedullary components, Neuroradiology, 2001, 43, 864–867 http://dx.doi.org/10.1007/s00234010059910.1007/s002340100599Search in Google Scholar
[24] Pollo C., Richard A., De Preux J., Resection of a retroperitoneal schwannoma by a combined approach, Neurochirurgie, 2004, 50, 53–56 (in French) http://dx.doi.org/10.1016/S0028-3770(04)98306-310.1016/S0028-3770(04)98306-3Search in Google Scholar
[25] Paderni S., Boriani S., Schwannoma of L3, Chir Organi Mov, 2002, 87, 133–139 Search in Google Scholar
[26] Tsukigi M., Kubota Y., Iijima Y., Yaguchi H., Tateno T., Suzuku T., et al., Retroperitoneal schwannoma extending into intravertebral foramen, Urol. Int., 2002, 69, 75–77 http://dx.doi.org/10.1159/00006436610.1159/000064366Search in Google Scholar PubMed
[27] Napolitano C., Mutter D., Steib I.P., Christmann D., Marescaux J., A benign retroperitoneal schwannoma with vertebral lysis. A case report, Ann Ital Chir, 1998, 69, 815–817 (in Italian) Search in Google Scholar
[28] Kadar E., Kisfaludi N., Czirjak S., Jakab F., Resection of giant schwannoma by combined surgical exposure, Acta Chir Hung, 1997, 36, 158–159 Search in Google Scholar
[29] Kageyama Y., Kihara K., Ishizaka K., Okuno T., Kawakami S., Fujii Y., et al., Endoscope-assisted Minilaparotomy (endoscopic minilaparotomy) for retroperitoneal schwannoma: experience with three cases, Jpn. J. Clin. Oncol., 2002, 32, 177–180 http://dx.doi.org/10.1093/jjco/hyf03810.1093/jjco/hyf038Search in Google Scholar PubMed
[30] Hori T., Yamagiwa K., Yagi S., Iida T., Taniguchi K., Yamamoto C., et al., Noradrenalin-secreting retroperitoneal schwannoma resected by handassisted laparoscopic surgery: report of a case, Surg. Today, 2006, 36, 1108–1113 http://dx.doi.org/10.1007/s00595-006-3304-810.1007/s00595-006-3304-8Search in Google Scholar
[31] Hide I.G., Baudouin C.J., Murray S.A., Malcolm A.J., Giant ancient schwannoma of the pelvis, Skeletal Radiol., 2000, 29, 538–542 http://dx.doi.org/10.1007/s00256000026610.1007/s002560000266Search in Google Scholar
[32] Sridhar K., Ramamurthi R., Vasudevan M.C., Ramamurthi B., Vasudevan M.C., Giant invasive spinal schwannomas: definition and surgical management, J. Neurosurg., 2001, 94, 210–215 10.3171/spi.2001.94.2.0210Search in Google Scholar
[33] Descazeaud A., Coggia M., Bourriez A., Goëau-Brissonnière O., Laparoscopic resection of a retroperitoneal schwannoma, Surg Endosc., DOI:10.1007/s00464-002-4251-0 10.1007/s00464-002-4251-0Search in Google Scholar
[34] Caddedu M.O., Mamazza J., Schlachta C.M., Seshadri P.A., Poulin E.C., Laparoscopic excision of retroperitoneal tumours: technique and review of the laparoscopic experience, Surg Laparosc Endosc Percutan Tech, 2001, 11, 144–147 http://dx.doi.org/10.1097/00019509-200104000-0001710.1097/00019509-200104000-00017Search in Google Scholar
[35] Ohta I., Lin P.H., Rau C.L., Wang K.C., Evaluation of perinephric, retroperitoneal schwannomas: case report and review of the literature, South Med J, 2007, 100, 80–82 10.1097/01.smj.0000242339.38934.09Search in Google Scholar
[36] Hardisson D., Picazo M.L., Nuñez C., Jimenez-Heffernan J.A., De la Peña J., Retroperitoneal melanocytic schwannoma, Br J Urol, 1997, 79, 1003–1004 10.1046/j.1464-410X.1997.00272.xSearch in Google Scholar
[37] Nakamura M., Takayama T., Takayasu K., Shimada K., Yamamoto J., Kosuge T., et al., Retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe, Jpn. J. Clin. Oncol., 1997, 27, 282–284 http://dx.doi.org/10.1093/jjco/27.4.28210.1093/jjco/27.4.282Search in Google Scholar
[38] Rajab K.E., Issa A.A., Skerman J.H., Unusual presentation of an abdominoinguinal schwannoma, Obstet Gynecol, 2003, 102, 1158–1160 http://dx.doi.org/10.1016/S0029-7844(03)00677-X10.1016/S0029-7844(03)00677-XSearch in Google Scholar
[39] Acciarri N., Staffa G., Poppi M., Giant sacral schwannoma: removal by anterior, transabdominal approach, Br J Neurosurg, 1996, 10, 489–492 http://dx.doi.org/10.1080/0268869964713110.1080/02688699647131Search in Google Scholar PubMed
[40] Ohigashi T., Nonaka S., Nakanoma T., Ueno M., Deguchi N., Laparoscopic treatment of retroperitoneal benign schwannoma, Int. J. Urol., 1999, 6, 100–103 http://dx.doi.org/10.1046/j.1442-2042.1999.06222.x10.1046/j.1442-2042.1999.06222.xSearch in Google Scholar PubMed
[41] Celli P., Trillo G., Ferrante L., Spinal extradural schwannoma, J Neurosurg Spine, 2005, 2, 447–456 10.3171/spi.2005.2.4.0447Search in Google Scholar PubMed
[42] Khouni H., Andrianne R., Nidhal H., Badreddine S., De Leval J., Faouzi M.A., Benign schwannoma a rare retroperitoneal tumour, Prog. Urol., 2005, 15, 78–80 Search in Google Scholar
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