Haruna Takahiro, Takata Hideyuki, Mizutani Satoshi, Katsuno Akira, Nakata Ryosuke, Motoda Norio, Taniai Nobuhiko, Yoshida Hiroshi
Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383, Kosugimachi Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan.
Department of Diagnostic Pathology, Nippon Medical School Musashikosugi Hospital, 1-383, Kosugimachi Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan.
Surg Case Rep. 2023 Mar 27;9(1):48. doi: 10.1186/s40792-023-01617-8.
A neurofibroma is a benign tumor that arises from Schwann cells and neurofibromas occur throughout the skin of neurofibromatosis type 1 (NF-1: Von Recklinghausen's disease) patients. A retroperitoneal solitary neurofibroma without any clinical signs of NF1 has been rarely reported. Herein, we present a case of a retroperitoneal solitary neurofibroma mimicking lymph node metastasis of colon cancer as well as a literature review.
An 80-year-old woman with abdominal pain and nausea was transported and diagnosed with bowel obstruction arising from sigmoid colon cancer A colonic stent was inserted to alleviate the bowel obstruction. A computed tomography scan with contrast revealed a liver tumor in segment 3, and an enlarged lymph node around the abdominal aorta. Whole-body 18F-fluorodeoxyglucose-positron emission tomography-CT (FDG-PET-CT) examine revealed increased FDG uptake in the liver tumor and enlarged lymph node. Liver and distant lymph node metastasis were diagnosed and we made a plan for a two-stage operation of the colon cancer and the metastatic lesions because laparotomy resection was needed for the retroperitoneal lymph node. Laparoscopic sigmoid colectomy was performed first. Pathological examination showed a tubular adenocarcinoma. A laparotomy for the metastatic lesions was performed to ensure complete lymph node dissection secondly. Histopathological findings of the liver tumor showed metastasis of sigmoid colon cancer. However, the tissue regarded as the enlarged lymph node was diagnosed as a neurofibroma. No metastasis and recurrence were observed.
Although most neurofibromas are benign, malignant transformation of a neurofibroma is possible. PET-CT showed our patient had a high accumulated retroperitoneal tumor co-existing with colon cancer and liver metastasis. The treatment strategy of a solitary neurofibroma must be selected carefully considering the site of occurrence and the patient's background and aggressive resection of a tumor co-existing with another malignant tumor is needed.
神经纤维瘤是一种起源于施万细胞的良性肿瘤，在1型神经纤维瘤病（NF-1：冯雷克林霍增氏病）患者的皮肤中各处均可发生。腹膜后孤立性神经纤维瘤且无任何NF1临床体征的情况鲜有报道。在此，我们报告一例腹膜后孤立性神经纤维瘤病例，其酷似结肠癌的淋巴结转移，并进行文献复习。
一名80岁女性因腹痛和恶心入院，被诊断为乙状结肠癌引起的肠梗阻。插入结肠支架以缓解肠梗阻。增强计算机断层扫描显示肝3段有一个肝肿瘤，腹主动脉周围有一个肿大淋巴结。全身18F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG-PET-CT）检查显示肝肿瘤和肿大淋巴结的FDG摄取增加。诊断为肝和远处淋巴结转移，由于腹膜后淋巴结需要开腹切除，我们制定了针对结肠癌和转移灶的两阶段手术计划。首先进行腹腔镜乙状结肠切除术。病理检查显示为管状腺癌。其次进行开腹手术切除转移灶以确保彻底清扫淋巴结。肝肿瘤的组织病理学检查结果显示为乙状结肠癌转移。然而，被视为肿大淋巴结的组织被诊断为神经纤维瘤。未观察到转移和复发。
尽管大多数神经纤维瘤是良性的，但神经纤维瘤有可能发生恶变。PET-CT显示我们的患者有一个高摄取的腹膜后肿瘤与结肠癌和肝转移共存。对于孤立性神经纤维瘤的治疗策略必须根据发生部位和患者背景仔细选择，并且需要积极切除与另一种恶性肿瘤共存的肿瘤。
