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Case Reports
. 2014 Jan 14;2014(1):rjt122.
doi: 10.1093/jscr/rjt122.

Laparoscopic resection of a retroperitoneal pelvic schwannoma

Takashi Okuyama  1 , Nobumi Tagaya  2 , Kazuyuki Saito  2 , Shuhei Takahashi  3 , Hiroyuki Shibusawa  3 , Masatoshi Oya  2
Affiliations
Case Reports

Laparoscopic resection of a retroperitoneal pelvic schwannoma

Takashi Okuyama et al. J Surg Case Rep. .

Abstract

Schwannomas are rarely located in the pelvis. A 54-year-old woman was found incidentally to have a tumor in the abdomen. Abdominal computed tomography and magnetic resonance imaging revealed a well-defined, heterogeneous tumor, 5 cm in diameter, in the pelvic cavity. With a diagnosis of a mesenteric tumor, a laparoscopic procedure was performed. Intra-operatively, an elastic tumor was identified in the pelvis adjacent to the right internal iliac vein and ureter. The tumor was dissected free from adjacent structures using Liga-Sure and blunt maneuvers. A complete laparoscopic excision was performed. Histopathological examination revealed a benign schwannoma. The patient had an uneventful post-operative course, and was discharged on the fourth post-operative day. Laparoscopic treatment is useful and feasible for retroperitoneal pelvic schwannoma, with minimal invasiveness and an early post-operative recovery. Thus, this procedure may be the first-choice surgical procedure for retroperitoneal pelvic schwannomas.

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Figures

Figure 1:
Figure 1:
Ultrasonography of the pelvis shows a 5 × 4.3 cm solid and an iso-echoic mass.
Figure 2:
Figure 2:
Contrast enhanced-CT shows a 5 × 4 cm solid, well-defined, heterogeneous mass in the right side of the pelvic cavity.
Figure 3:
Figure 3:
MRI shows that the tumor is a homogeneous hypointensity on T1-weighted images (A) and a heterogeneous slight hyperintensity on T2-weighted images (B) in a right side of the pelvic cavity.
Figure 4:
Figure 4:
Sagittal MRI sections show the mass to be intricately related to the anterior presacral fascia.
Figure 5:
Figure 5:
Laparoscopic findings of schwannoma in the pelvis. 1, schwannoma 2, right ureter 3, rectum 4, right iliac vessel.
Figure 6:
Figure 6:
The specimen is an elastic hard, 5 × 4 cm mass with an integral envelope. On sectioning, it is yellow and white in color, predominantly solid with cystic change.
Figure 7:
Figure 7:
Histologic findings of schwannoma in the pelvis (hematoxylin and eosin, ×200). (A) The Antoni A pattern is composed of spindle cells arranged in intersection fascicles. Nuclear palisades are seen and mitoses are rarely observed. (B) The Antoni B pattern is composed of loose hypocellular tissue.
See this image and copyright information in PMC

References

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