Singh Mahendra, Kumar Lovekesh, Chejara Rajkumar, Prasad Om Prakash, Kolhe Yuvraj, Saxena Ashish
Department of Surgery, AIIMS, Basni, Jodhpur, Rajasthan 342001, India.
Department of Surgery, Hindu Rao Hospital, New Delhi, India.
Case Rep Oncol Med. 2014;2014:628538. doi: 10.1155/2014/628538. Epub 2014 Aug 27.
Schwannoma is a benign tumour of peripheral nerve sheath. It usually arises from head, neck, and trunk. Retroperitoneal schwannoma is a rare entity, accounting for only 0.3-3% of total schwannomas. Majority of retroperitoneal schwannomas reported in literature have a diameter of 5 to 15 cm. Preoperative diagnosis is difficult due to low frequency, nonspecific clinical course, and nonspecific imaging features. Histology usually provides definitive diagnosis. Schwannomas are solitary, well-circumscribed, and noninvasive, so complete surgical excision provides good result. We report a case of a 23-year-old male, who presented with progressive abdominal distension and intermittent episodes of intestinal obstruction. CECT was suggestive of huge solid-cystic mass in abdominopelvic region. Image guided percutaneous aspiration revealed around 1 litre of frank pus and FNAC was suggestive of abscess. Exploratory laparotomy revealed a large 32 × 28 × 26 cm mass with solid and cystic components containing 1 litre of pus. Histological features of tumour were suggestive of benign schwannoma and immunohistochemistry for S-100 was positive. Postoperative recovery was uneventful. We report this case of a retroperitoneal schwannoma because of giant size, rare location, unusual presentation, and diagnostic dilemma.
神经鞘瘤是一种周围神经鞘的良性肿瘤。它通常起源于头、颈和躯干。腹膜后神经鞘瘤是一种罕见的实体，仅占神经鞘瘤总数的0.3%至3%。文献报道的大多数腹膜后神经鞘瘤直径为5至15厘米。由于其发病率低、临床过程无特异性以及影像学特征不特异，术前诊断困难。组织学检查通常能提供明确诊断。神经鞘瘤为单发、边界清楚且无侵袭性，因此完整的手术切除效果良好。我们报告一例23岁男性患者，他表现为进行性腹胀和间歇性肠梗阻发作。CT增强扫描提示腹盆腔区域有巨大的实性囊性肿块。影像引导下经皮穿刺抽出约1升脓性液体，细针穿刺抽吸活检提示为脓肿。剖腹探查发现一个32×28×26厘米的巨大肿块，有实性和囊性成分，内含1升脓液。肿瘤的组织学特征提示为良性神经鞘瘤，S-100免疫组化呈阳性。术后恢复顺利。我们报告这例腹膜后神经鞘瘤病例，原因在于其巨大的尺寸、罕见的位置、不寻常的表现以及诊断上的困境。
