Autieri Domenico, Pastore Antonio Luigi, Silvestri Luigi, Leto Antonino, Ripoli Andrea, Palleschi Giovanni, Porta Natale, Petrozza Vincenzo, Carbone Antonio
Dept. of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Urology Unit - ICOT, Latina - Italy.
Urologia. 2012 Dec 30;79 Suppl 19:1-3. doi: 10.5301/RU.2012.9376.
We present a case of retroperitoneal schwannoma incidentally diagnosed in a patient undergoing surgical drainage of a pelvic abscess as a complication of a prostatic biopsy. A 50-year-old male, suffering from lymphatic leukemia, came to our observation due to lichen ruber planus and ejaculatory pain. The patient underwent a trans-perineal ultrasound-guided biopsy of the right seminal vesicle and of a hypoechoic area documented by ultrasonography. 48 hours after the procedure, the patient had developed: cold sores, shortness of breath with dyspnea, and high fever (40°C). The patient was hospitalized, underwent an emergency CT which documented a right presacral and pararectal liquid mass (abscess). The patient underwent emergency laparotomy and drainage of the abscess. The lesion histological examination revealed a retroperitoneal schwannoma with inflammatory phenomena and hyperplasic lymphadenitis. The retroperitoneal schwannoma is a silent disease whose only clinical manifestation coincides with the compression of adjacent anatomical structures. In many cases, the symptoms, even if present, as in this case (ejaculatory pain with compression of the seminal vesicle), are non-specific, thus delaying diagnosis and the therapeutic approach.
我们报告一例腹膜后神经鞘瘤，该病例是在一名因前列腺活检并发症而行盆腔脓肿手术引流的患者中偶然诊断出来的。一名50岁男性，患有淋巴白血病，因扁平苔藓和射精疼痛前来就诊。患者接受了经会阴超声引导下对右侧精囊及超声检查发现的低回声区的活检。术后48小时，患者出现：唇疱疹、呼吸急促伴呼吸困难以及高热（40°C）。患者住院治疗，接受了急诊CT检查，结果显示右侧骶前和直肠旁液性肿块（脓肿）。患者接受了急诊剖腹手术及脓肿引流。病变组织学检查显示为伴有炎症现象和增生性淋巴结炎的腹膜后神经鞘瘤。腹膜后神经鞘瘤是一种隐匿性疾病，其唯一的临床表现与相邻解剖结构受压相符。在许多情况下，症状即使存在，如本例（精囊受压导致射精疼痛），也是非特异性的，从而延误了诊断和治疗方法。
