Ohsawa Manato, Miguchi Masashi, Yoshimitsu Masanori, Oishi Koichi, Kohashi Toshihiko, Hihara Jun, Mukaida Hidenori, Kaneko Mayumi, Egi Hiroyuki, Ohdan Hideki, Hirabayashi Naoki
Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Asian J Endosc Surg. 2019 Apr;12(2):192-196. doi: 10.1111/ases.12607. Epub 2018 May 28.
Schwannomas are tumors originating from the Schwann cells of the peripheral nerve sheath. Only 1%-3% of schwannomas reportedly occur in the pelvis. In a 67-year-old man, a pelvic mass that was 52 mm in diameter was incidentally diagnosed during a preoperative CT evaluation for prostate cancer. Preoperative 3-D reconstruction CT showed that the feeding artery to the tumor originated from the internal iliac artery and the drainage vein from the internal iliac vein. Each vessel could be isolated, clipped, and cut with minimal bleeding. The tumor was easily dissected from adjacent structures and was completely resected via laparoscopic surgery. Histopathology and immunohistochemistry of the excised specimen revealed a benign schwannoma. Using 3-D reconstruction to recognize a tumor's positional relation with the supplying vessels is important for avoiding complications during laparoscopic resection in the narrow pelvis. Laparoscopic resection is safe, feasible, and effective for retroperitoneal schwannoma.
施万细胞瘤是起源于周围神经鞘雪旺细胞的肿瘤。据报道，只有1%-3%的施万细胞瘤发生在骨盆。在一名67岁男性中，在前列腺癌术前CT评估时偶然诊断出一个直径为52毫米的盆腔肿块。术前三维重建CT显示，肿瘤的供血动脉起源于髂内动脉，引流静脉来自髂内静脉。每条血管都可以被分离、夹闭并切断，出血极少。肿瘤很容易从相邻结构中分离出来，并通过腹腔镜手术完全切除。切除标本的组织病理学和免疫组化显示为良性施万细胞瘤。利用三维重建来识别肿瘤与供血血管的位置关系，对于避免在狭窄骨盆中进行腹腔镜切除时出现并发症很重要。腹腔镜切除对于腹膜后施万细胞瘤是安全、可行且有效的。
