Andrej Omejc, Lucija Vegan, Mirko Omejc
Medical Faculty, University of Ljubljana, Slovenia.
Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska c.7, 1000 Ljubljana, Slovenia.
Int J Surg Case Rep. 2022 Apr;93:106934. doi: 10.1016/j.ijscr.2022.106934. Epub 2022 Mar 10.
Schwannoma is a relatively slow-growing and usually benign tumor that consists of myelin-producing Schwann cells. It is most often associated with 8th cranial nerve (vestibular schwanomma) and only rarely presents outside the head and neck. Extremely rarely it occurs as a retroperitoneal mass that can remain asymptomatic until it reaches a size so big that it compresses the adjacent organs and therefore requires surgical intervention.
We present a case of 58 years old male with a benign pelvic schwannoma, adherent to S1-S2 intervertebral foramen, presenting with increased urinary frequency and treated with surgical en block excision.
Diagnostic procedure and surgical treatment of giant pelvic schwanomma could be both challenging. Radiologic investigation is essential for preoperative planning and helpful in diagnosis but does not offer a definitive diagnosis of pelvic schwannoma. Definitive diagnosis is therefore based on histological and immunohistochemical analysis of surgically removed specimens. Possible surgical interventions include complete or partial resection, both bearing its risks and advantages in terms of postoperative morbidity.
Although sometimes challenging, complete surgical resection remains the mainstay of treatment. If possible, it should be performed by en block resection since it provides the best short and long term prognosis for the patient.
施万细胞瘤是一种生长相对缓慢且通常为良性的肿瘤,由产生髓磷脂的施万细胞组成。它最常与第8对脑神经相关(前庭神经鞘瘤),极少出现在头颈部以外的部位。极其罕见的情况下,它会以腹膜后肿块的形式出现,在肿块大到压迫相邻器官从而需要手术干预之前可能一直无症状。
我们报告一例58岁男性,患有良性盆腔施万细胞瘤,附着于S1 - S2椎间孔,表现为尿频,并接受了手术整块切除治疗。
巨大盆腔施万细胞瘤的诊断程序和手术治疗都可能具有挑战性。影像学检查对于术前规划至关重要且有助于诊断,但不能对盆腔施万细胞瘤做出明确诊断。因此,明确诊断基于手术切除标本的组织学和免疫组化分析。可能的手术干预包括完整或部分切除,两者在术后发病率方面都有其风险和益处。
尽管有时具有挑战性,但完整的手术切除仍然是主要的治疗方法。如果可能,应进行整块切除,因为这为患者提供了最佳的短期和长期预后。