Alsahwan Abdullah G, Felemban Jomana M, Al-Othman Anas, Assiri Shahad Y, Alzahir Ali A
Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
Department of General Surgery, Surgical Oncology Section, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
Int J Surg Case Rep. 2021 Apr;81:105751. doi: 10.1016/j.ijscr.2021.105751. Epub 2021 Mar 11.
Schwannomas are benign tumors of the nerve sheath, they do not typically present on the abdominal wall and cause symptoms. To the best of our knowledge, this is the second symptomatic case of schwannoma in upper abdominal wall reported according to the reviewed English medical literature.
A 25-year-old man post renal transplant two year ago. He presented with left hypochondrial painfull swelling, and redness. On examination, local examination revealed a lesion located in the anterior abdominal wall swelling, 3 × 3 cm, tender with minimal erythema and hotness but no discharge. An ultrasound showed superficial oval shaped with thick wall and mildly increased peripheral vascularity without internal vascularity. He underwent surgical excision and the histopathology result was schwannoma.
Usually, a patient presents asymptomatic with a slow growing mass. However, the symptoms can vary and depending on the location. Furthermore, a growing lump can start putting pressure on the nerves around the area, and patients can show symptoms accordingly. The likability of ultrasound to pick up a well-circumscribed mass and reaching a definitive diagnosis without histopathology is nearly impossible. Therefore, a complete excision and histopathology confirmed the presence of schwannoma.
Upon the rarity of schwannomas presenting in atypical regions, such as the abdominal wall. A painful mass on the abdominal wall should raise the suspicion of benign schwannoma. The recurrence rate after the treatment of choice is unusual. Moreover, complete surgical excision of the mass is the definitive treatment.
施万细胞瘤是神经鞘的良性肿瘤，通常不会出现在腹壁并引起症状。据我们所知，根据检索到的英文医学文献，这是第二例报道的上腹壁有症状的施万细胞瘤病例。
一名25岁男性，两年前接受肾移植。他出现左季肋部疼痛性肿胀和发红。检查时，局部检查发现前腹壁有一肿物，大小为3×3厘米，有压痛，轻度红斑和发热，但无分泌物。超声显示为浅表椭圆形，壁增厚，周边血管轻度增多，内部无血管。他接受了手术切除，组织病理学结果为施万细胞瘤。
通常，患者表现为无症状的缓慢生长肿块。然而，症状可能因人而异，取决于肿块位置。此外，不断增大的肿块会开始压迫周围区域的神经，患者会相应地出现症状。超声几乎不可能检测到边界清晰的肿块并在没有组织病理学检查的情况下做出明确诊断。因此，完整切除并经组织病理学检查证实为施万细胞瘤。
鉴于施万细胞瘤在非典型区域（如腹壁）出现的罕见性，腹壁上的疼痛性肿块应怀疑为良性施万细胞瘤。选择治疗后的复发率不常见。此外，完整手术切除肿块是确定性治疗方法。
