Ribeiro Marcelo Af, Elias Yasmin Gb, Augusto Samara de S, Néder Paola R, Costa Cássia Tk, Maurício Andressa D, Sampaio Adriano P, Fonseca Alexandre Z
General Surgery and Trauma Department, Catholic University of São Paulo - PUC-Sorocaba and Moriah Hospital, São Paulo 04083-002, São Paulo CEP, Brazil.
Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil.
World J Clin Cases. 2020 Sep 26;8(18):4114-4121. doi: 10.12998/wjcc.v8.i18.4114.
Schwannomas are rare, often benign, tumors deriving from Schwann cells that have low incidence in the retroperitoneal region (0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs, symptoms and imaging tests. Thus, it is necessary performing guided punch biopsy in order to identify it. Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.
Forty-seven years old female patient who was hospitalized for elective orthopedic procedure, without complications, evolved with severe pain in the lower limbs, thigh and gluteal region associated with neurogenic claudication. Persistent pain required magnetic resonance imaging (MRI) of the lumbar spine, which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion. The surgical team opted for draining the collection, as well as requested an MRI of the abdomen and pelvis, whose analysis showed expansive lesion in the retroperitoneum, in close contact with the inferior vena cava and with the right renal vein. A guided puncture was performed for diagnostic clarification, which showed immunohistochemical profile compatible with schwannoma. The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy. The patient was discharged and remained stable after 4-mo follow-up; she remains under follow-up to check the need of cancer investigations.
Schwannoma features requires surgical treatment based on laparoscopic resection, which often presents low relapse rates and optimistic prognosis.
施万细胞瘤罕见，通常为良性，起源于施万细胞，在腹膜后区域发病率较低（0.5%至5%）。由于其体征、症状及影像学检查缺乏特异性特征，早期很难确诊。因此，有必要进行引导下穿刺活检以明确诊断。因其对放疗和化疗不敏感，手术切除是首选治疗方法。
一名47岁女性患者因择期骨科手术入院，无并发症，术后出现下肢、大腿及臀部剧痛并伴有神经源性间歇性跛行。持续性疼痛需要进行腰椎磁共振成像（MRI）检查，结果显示硬膜外积液伴硬膜受压以及肝脏周围巨大的异质性结节性病变。手术团队选择引流积液，并要求进行腹部和骨盆MRI检查，检查结果显示腹膜后有占位性病变，与下腔静脉及右肾静脉紧密相连。为明确诊断进行了引导下穿刺，结果显示免疫组化特征与施万细胞瘤相符。所选治疗方案包括腹膜后肿瘤切除联合腹腔镜胆囊切除术。患者出院，4个月随访后病情稳定；她仍在接受随访，以检查是否需要进行癌症相关检查。
施万细胞瘤的特点需要基于腹腔镜切除的手术治疗，该方法通常复发率低，预后乐观。
