Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2020; 8(18): 4114-4121
Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.4114
Laparoscopic resection of primary retroperitoneal schwannoma: A case report
Marcelo AF Ribeiro Jr, Yasmin GB Elias, Samara de S Augusto, Paola R Néder, Cássia TK Costa, Andressa D Maurício, Adriano P Sampaio, Alexandre Z Fonseca
Marcelo AF Ribeiro Jr, General Surgery and Trauma Department, Catholic University of São Paulo – PUC-Sorocaba and Moriah Hospital, São Paulo 04083-002, São Paulo CEP, Brazil
Yasmin GB Elias, Samara de S Augusto, Paola R Néder, Cássia TK Costa, Andressa D Maurício, Department of Surgery, Medical School, Santo Amaro University, São Paulo 04743-030, São Paulo State, Brazil
Adriano P Sampaio, Alexandre Z Fonseca, General Surgery and Trauma Department, Moriah Hospital, São Paulo 04083-002, São Paulo State, Brazil
Author contributions: Ribeiro Jr MAF was the patient’s surgeon and reviewed the literature and supervised the manuscript writing; Elias YGB, Augusto SS, Néder PR, Costa CTK and Maurício AD reviewed the literature and contributed to manuscript writing; Fonseca AZ and Sampaio AP were patient’s auxiliary surgeons and contributed to manuscript writing.
Informed consent statement: The patient has provided a written Informed Consent, which authorized the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marcelo AF Ribeiro Jr, FACS, MD, MSc, PhD, Chairman, Full Professor, General Surgery and Trauma Department, Catholic University of São Paulo – PUC-Sorocaba and Moriah Hospital, Avenida Moaci 974, São Paulo 04083-002, São Paulo CEP, Brazil. drmribeiro@gmail.com
Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: June 15, 2020
Revised: July 7, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: September 26, 2020
Processing time: 116 Days and 9.7 Hours
Abstract
BACKGROUND

Schwannomas are rare, often benign, tumors deriving from Schwann cells that have low incidence in the retroperitoneal region (0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs, symptoms and imaging tests. Thus, it is necessary performing guided punch biopsy in order to identify it. Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.

CASE SUMMARY

Forty-seven years old female patient who was hospitalized for elective orthopedic procedure, without complications, evolved with severe pain in the lower limbs, thigh and gluteal region associated with neurogenic claudication. Persistent pain required magnetic resonance imaging (MRI) of the lumbar spine, which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion. The surgical team opted for draining the collection, as well as requested an MRI of the abdomen and pelvis, whose analysis showed expansive lesion in the retroperitoneum, in close contact with the inferior vena cava and with the right renal vein. A guided puncture was performed for diagnostic clarification, which showed immunohistochemical profile compatible with schwannoma. The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy. The patient was discharged and remained stable after 4-mo follow-up; she remains under follow-up to check the need of cancer investigations.

CONCLUSION

Schwannoma features requires surgical treatment based on laparoscopic resection, which often presents low relapse rates and optimistic prognosis.

Keywords: Neurilemmoma; Neoplasms; Retroperitoneal space; Laparoscopy; Case report

Core Tip: Schwannomas are rare tumors deriving from Schwann cells, whose incidence in the retroperitoneal region is remarkably unusual (approximately 0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to the lack of specific features in signs, symptoms and imaging tests. The diagnosis of primary retroperitoneal schwannoma in the herein reported case was incidental; it happened during the postoperative follow-up of a patient who had been subjected to an orthopedic procedure in the lumbosacral spine. Laparoscopic resection of the tumor was the treatment of choice; the patient did not present complications and remains under oncological follow-up.