Retroperitoneal schwannoma sandwiched between abdominal aorta and inferior vena cava. A case report

Robotic-Assisted Resection of a Benign Schwannoma of the Obturator Nerve: A Rare Case

BACKGROUND Neurilemmomas are rare tumors derived from the Schwann cells that comprise the peripheral nerve sheaths. They have a slow growth and rarely display malignancy. Early diagnosis is rare, and the treatment consists by surgical resection. Although robotic-assisted surgery is commonly used for treating retroperitoneal diseases, there are few reports of resection of retroperitoneal and pelvic schwannoma through robotic-assisted surgery. In the present study, we reported a case of complete excision of a benign retroperitoneal schwannoma of the obturator nerve by robotic-assisted surgery. CASE REPORT A 51-year-old woman was referred by her gynecologist for left pelvic discomfort of a 3-month duration. The physical examination was normal, but a computerized tomography scan of the abdomen and pelvis showed an expansive pelvic lesion in the topography of the left iliac vessels, a hypodense contrast enhancement measuring 4.6×3.4 cm. Magnetic resonance imaging showed an extraperitoneal lesion located medially and inferiorly to the left external iliac vessels, with a size of 4.9×3.7 cm, and of probable neural etiology. Surgical resection of the tumor was recommended because of the diagnostic hypothesis of obturator nerve schwannoma. CONCLUSIONS This case showed that retroperitoneal neurilemmomas are difficult to diagnose owing to a lack of specific symptoms, and the best treatment is complete tumor resection. The use of robotic techniques gives greater dexterity to the surgeon, since it provides high-definition 3-dimensional vision, which can make the removal of retroperitoneal tumors susceptible to minimally invasive resection in a safe and effective way.

Two giant connected retroperitoneal schwannomas: a rare case report

Schwannoma is a type of tumor originating from Schwann cells of peripheral nerves. In this study, we report a rare case of two giant connected retroperitoneal schwannomas. The patient presented to our department with a 1-day history of abdominal pain and without other symptoms. There were no abnormalities in the patient’s tumor markers. Abdominal plain computed tomography (CT) revealed two (combined) retroperitoneal masses appearing as soft tissue-density shadows with uneven internal density, cystic low-density shadows, and patchy calcification shadows. The larger mass measured approximately 12.0 cm × 12.3 cm in size. The tumors were completely excised by a reasonable surgical approach while the surrounding organs closely related to the tumor were preserved. Postoperative pathology confirmed that the tumors were benign schwannomas. In the 18-month follow-up, the patient had no recurrences and was asymptomatic. We summarize the diagnosis and treatment of two rare combined giant retroperitoneal schwannomas in a single patient. Laparotomy for the management of retroperitoneal giant schwannomas may be safe and effective.