Karamat Riyan Imtiaz, Singh Ajeet, Anwaar Adeel, Malik Zaka Ullah, Hashmi Javaid, Haseeb Muhammad Talha, Akilimali Aymar
Department of Internal Medicine Rahbar Medical and Dental College Lahore Pakistan.
Department of General Surgery Punjab Rangers Teaching Hospital (PRTH) Lahore Pakistan.
Clin Case Rep. 2024 Oct 21;12(10):e9485. doi: 10.1002/ccr3.9485. eCollection 2024 Oct.
Benign ancient retroperitoneal schwannomas (BARS) exhibit abdominal masses and flank pain to incidental findings at more advanced stages. Histopathological and immunohistochemical analysis is essential for confirmation of benign nature. Our patient was misdiagnosed as ureteric colic, highlighting the need to consider BARS in differential diagnosis to prevent complications like hydronephrosis.
Ancient schwannomas are usually benign neoplasms that originate from Schwann cells of peripheral nerves. We present a novel case of a 24-year-old young male with left flank pain and nausea which was initially thought to be left ureteric colic. However, in-depth imaging and biopsy revealed a retroperitoneal mass. The definitive diagnosis was narrowed down to Benign Retroperitoneal Ancient Schwannoma (BARS) via immunohistochemistry and histopathological analysis. This often marble-shaped S100 protein-positive tumor is an under-recognized and potential cause of hydronephrosis if localized near the renal structures. In addition, the retroperitoneal location with infrarenal abdominal aortic adherence is another rare peculiarity in the present case that demands prompt diagnosis and surgical excision to avoid any cardiovascular sequelae such as hypotension and abdominal pain, as indicated by the natural history of growth of this benign tumor. Therefore, timely excision of this benign tumor prior to its further proliferation is paramount. We initially planned laparoscopic removal but adopted excision via laparotomy because of the proximity of the vital structures. The postoperative course of the patient was uneventful and subsequently the patient's presenting complaint of left abdominal flank pain greatly improved. The patient was advised to undergo follow-up computed tomography scan of kidney ureter bladder and RFT evaluation 6 months postsurgery which indicated no evidence of recurrence or iatrogenic complications. The diagnosis and management of the present case share valuable experiences for similar future cases worldwide.
良性陈旧性腹膜后神经鞘瘤（BARS）在更晚期阶段表现为腹部肿块和侧腹疼痛，多为偶然发现。组织病理学和免疫组化分析对于确认其良性性质至关重要。我们的患者最初被误诊为输尿管绞痛，这凸显了在鉴别诊断中考虑BARS以预防诸如肾积水等并发症的必要性。
陈旧性神经鞘瘤通常是起源于周围神经施万细胞的良性肿瘤。我们报告一例新病例，一名24岁年轻男性，有左侧腹疼痛和恶心症状，最初被认为是左侧输尿管绞痛。然而，深入的影像学检查和活检发现了一个腹膜后肿块。通过免疫组化和组织病理学分析，最终诊断为良性腹膜后陈旧性神经鞘瘤（BARS）。这种通常呈大理石状的S100蛋白阳性肿瘤是一种未被充分认识的疾病，如果位于肾结构附近，可能是肾积水的潜在原因。此外，本病例中肿瘤位于腹膜后且与肾下腹主动脉粘连，这是另一个罕见的特殊情况，需要及时诊断并手术切除，以避免该良性肿瘤自然生长过程中出现的任何心血管后遗症，如低血压和腹痛。因此，在该良性肿瘤进一步增殖之前及时切除至关重要。我们最初计划腹腔镜切除，但由于重要结构距离较近，改为剖腹手术切除。患者术后恢复顺利，其最初的左侧腹疼痛主诉明显改善。建议患者在术后6个月进行肾脏输尿管膀胱的计算机断层扫描随访及肾功能评估，结果显示无复发或医源性并发症迹象。本病例的诊断和治疗为全球类似的未来病例提供了宝贵经验。
