Maidarti Mila, Wibawa Yohanes Satrya, Garinasih Prini Diandara, Hellyanti Tantri, Harzif Achmad Kemal, Nuryanto Kartiwa Hadi
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Human Reproductive, Infertility and Family Planning Research Centre, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
Int J Surg Case Rep. 2022 Jul;96:107327. doi: 10.1016/j.ijscr.2022.107327. Epub 2022 Jun 20.
Schwannomas are benign tumors originating from Schwann cells of nerve fibers. Pelvic schwannomas are extremely rare. Here, we present a case of a 48-year-old woman with a pelvic schwannoma imitating degenerating cystic leiomyoma.
A 48-year-old woman presented with brown-yellowish bloody vaginal discharge, fever, abdominal enlargement, and pain. Abdominal ultrasound showed a homogeneous solid mass with a clear border separated from the uterus and left ovary. Computed tomography (CT) scan revealed a multilocular cystic mass with thick septa and solid enhancing component. Histopathological examination showed a mesenchymal tumor composed of cells with fine chromatin. The nuclei were oval or round, and some cells exhibited spindle and cigar-shaped nuclei. Tumor cells had an abundant amount of eosinophilic cytoplasm. Immunohistochemical examination demonstrated positive expression for S100 as specific staining for schwannomas. Mitosis was not found, and hyalinized blood vessels were observed.
Compression by the tumor into the surrounding organs, such as the bladder and intestines, could cause difficulty with defecation and urination in patients. The absence of specific signs and symptoms can lead to a misdiagnosis of pelvic schwannoma. Surgery is the treatment of choice. It is difficult to establish a definitive diagnosis before surgery. Laparotomy approach was taken and a histopathological examination was completed to confirm the diagnosis.
Unspecified pelvic pain with abdominal mass may suggest a rare tumor such as schwannoma. Transvaginal ultrasonography is incapable of reliably distinguishing between schwannoma and other tumors.
施万细胞瘤是起源于神经纤维施万细胞的良性肿瘤。盆腔施万细胞瘤极为罕见。在此，我们报告一例48岁女性盆腔施万细胞瘤，其表现类似退变的囊性平滑肌瘤。
一名48岁女性出现棕黄色血性阴道分泌物、发热、腹部增大及疼痛。腹部超声显示一个边界清晰的均匀实性肿块，与子宫和左侧卵巢分离。计算机断层扫描（CT）显示一个多房囊性肿块，有厚分隔及实性强化成分。组织病理学检查显示为一种间叶性肿瘤，由染色质细腻的细胞组成。细胞核呈椭圆形或圆形，部分细胞呈梭形和雪茄形核。肿瘤细胞有丰富的嗜酸性细胞质。免疫组织化学检查显示S100呈阳性表达，这是施万细胞瘤的特异性染色。未见核分裂象，可见玻璃样变的血管。
肿瘤对周围器官如膀胱和肠道的压迫可导致患者排便和排尿困难。缺乏特异性体征和症状可导致盆腔施万细胞瘤误诊。手术是首选治疗方法。术前很难做出明确诊断。采用剖腹手术方法并完成组织病理学检查以确诊。
伴有腹部肿块的不明原因盆腔疼痛可能提示存在如施万细胞瘤等罕见肿瘤。经阴道超声检查无法可靠地区分施万细胞瘤与其他肿瘤。
