Skip to main content
SpringerLink
Log in

Retroperitoneal giant schwannoma eroding lumbal vertebra: A case report with a literature review

  • Case Report
  • Published:
Central European Journal of Medicine

Abstract

A huge schwannoma, located in the retroperitoneal space, is found very rarely. The main purpose of this paper is to present the case of a giant retroperitoneal schwannoma which partly invaded L4 vertebral body. The secondary purpose is to summarize the case-report articles on retroperitoneal schwannomas. A circumscribed heterogenic tumour was revealed on transabdominal sonography. It extended into the right retroperitoneal space. CT and MRI revealed a paravertebral tumour in the size of 11 cm × 9 cm, which is causing a partial lysis of L4 vertebral body (15% of vertebral capacity), expanding intravertebral foramen and filling the right retroperitoneal space. A preoperative core needle biopsy was performed and a benign schwannoma was diagnosed. A complete surgical excision of the tumour was achieved by a two-step operation. During the first step, the neurosurgeons made L4 hemilaminectomy, facetectomy and a transverse process resection by posterior extended approach. The general surgeons excised the residual retroperitoneal part of the tumour by midline transabdominal approach 10 days later. The diagnosis of benign schwannoma was verified histochemically. There were no sign of tumour recurrence or spine destabilization at the six-month follow-up. In conclusion, although majority of giant retroperitoneal schwannomas can be completely removed performing one-step operation, a preoperative consideration about rationality of two-step operation should be mandatory when tumour destructs a part of vertebral body. Our case shows that the combined two stage complete surgical excision of a giant retroperitoneal schwannoma, eroding 15% of L4 vertebra’s osseous capacity, is effective and does not have any negative influence on spinal stability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Singh V., Kapoor R., Atypical presentations of benign retroperitoneal schwannoma: Report of three cases with review of literature, Int Urol Nephrol, 2005, 37, 547–549

    Article  PubMed  Google Scholar 

  2. Sharma S.K., Koleski F.C., Husain A.N., Albala D.M, Turk T.M., Retroperitoneal schwannoma mimicking an adrenal lesion, World J Urol, 2002, 20, 232–233

    PubMed  Google Scholar 

  3. Dede M., Yagci G., Yenen M.C., Gorgulu S., Daveci M.S., Cetiner S., et al., Retroperitoneal benign schwannoma: report of three cases and analysis of clinico-radiologic findings, Tohoku J. Exp. Med., 2003, 200, 93–97

    Article  PubMed  Google Scholar 

  4. Girgin C., Ozkan U., Sezer A., Tugyan N., Large pelvic schwannoma causing bilateral hydronephrosis, Int. J. Urol., 2003, 10, 616–618

    Article  PubMed  Google Scholar 

  5. Patocskai E.J., Tabatabaian M, Thomas M.J., Cellular schwannoma: a rare presacral tumour, Can J Surg, 2002, 45, 141–144

    PubMed  Google Scholar 

  6. Palmer J.D., Manual of neurosurgery, Bell and Bain Ltd., Glasgow, 1996

    Google Scholar 

  7. Li Q., Gao C., Juzi J.T, Hao X., Analysis of 82 cases of retroperitoneal schwannoma, ANZ J Surg, 2007, 77, 237–240

    Article  PubMed  Google Scholar 

  8. Kar M., Deo S.V., Shukla N.K., Malik A., DattaGupta S.,. Mohanti B.K et al., Malignant peripheral nerve sheath tumors (MPNST) — Clinicopathological study and treatment outcome of twenty-four cases, World J Surg Oncol, DOI:10.1186/1477-7819-4-55

  9. Erzen D., Sencar M., Novak J., Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana, J Surg Oncol, 2005, 91, 1–9

    Article  PubMed  Google Scholar 

  10. Heaton N.D., Page A.C., Howard E.R., Malignant retroperitoneal schwannoma, J R Soc Med, 1991, 84, 308–309

    PubMed  CAS  Google Scholar 

  11. Ogose A., Hotta T., Morita T., Higuchi T., Umezu H., Imaizumi S., et al., Diagnosis of peripheral nerve sheath tumors around the pelvis, Jpn. J. Clin. Oncol., 2004, 34, 405–413

    Article  PubMed  Google Scholar 

  12. Rousseau M.A., Pascal-Mousselard H., Lazennec J.Y., Saillant G, The mini-invasive anterior extra peritoneal approach to the pelvis, Eur J Surg Oncol, 2005, 31, 924–926

    Article  PubMed  CAS  Google Scholar 

  13. Kishi Y., Kajiwara S., Seta S., Kawauchi N., Suzuki T., Sasaki K., Retroperitoneal schwannoma misdiagnosed as a psoas abscess: report of a case, Surg. Today, 2002, 32, 849–852

    Article  PubMed  Google Scholar 

  14. Facciorusso D., Federici T., Giacobbe A.,. Niro Grazia A, Piermanni V., Andriulli A., Retroperitoneal neurilemoma diagnosed by endosonographically guided fine needle aspiration, J Clin Ultrasound, 2006, 34, 241–243

    Article  PubMed  Google Scholar 

  15. Cotran R.S., Kumar V., Collins T., Robbins S.L., Robbins Pathologic basis of disease, 6th ed, W.B. Saunders Company, USA, 1999

    Google Scholar 

  16. Kleihues P., Cavenee W.K., Pathology and Genetics of Tumours of the Nervous System, IARC Press, France, 2000

    Google Scholar 

  17. Rosai J., Rosai and Ackerman’s surgical pathology, 9th ed., Mosby, USA, 2004

  18. Schindler O.S., Dixon J.H., Retroperitoneal giant schwannomas: report on two cases and review of the literature, J Orthop Surg (Honk Kong), 2002, 10, 77–84

    Google Scholar 

  19. Lalloo S.T., Mayat A.G., Nadvi S.S., Landers A.T., Clinics in diagnostic imaging (68), Singapore Med J, 2001, 42, 592–595

    PubMed  CAS  Google Scholar 

  20. Klimo P., Rao G., Schmidt R.H., Schmidt M.H., Nerve sheath tumors involving the sacrum. Case report and classification scheme, Neurosurg Focus, 2003, 15, 12

    Google Scholar 

  21. Goh B.K., Tan Y.M., Chung Y.F., Chow P.K., Ooi L.L., Wong W.K., Retroperitoneal schwannoma, Am. J. Surg., 2006, 192, 14–18

    Article  PubMed  Google Scholar 

  22. Hayasaka K., Tanaka Y., Soeda S., Huppert P., Claussen C.D., MR findings in primary retroperitoneal schwannoma, Acta Radiol, 1999, 40, 78–82

    Article  PubMed  CAS  Google Scholar 

  23. Kono K., Inoue Y., Nakamura H., Shakudo M., Nakayama K., MR imaging of a case of a dumbbellshaped spinal schwannoma with intramedullary and intradural-extramedullary components, Neuroradiology, 2001, 43, 864–867

    Article  PubMed  CAS  Google Scholar 

  24. Pollo C., Richard A., De Preux J., Resection of a retroperitoneal schwannoma by a combined approach, Neurochirurgie, 2004, 50, 53–56 (in French)

    Article  PubMed  CAS  Google Scholar 

  25. Paderni S., Boriani S., Schwannoma of L3, Chir Organi Mov, 2002, 87, 133–139

    PubMed  CAS  Google Scholar 

  26. Tsukigi M., Kubota Y., Iijima Y., Yaguchi H., Tateno T., Suzuku T., et al., Retroperitoneal schwannoma extending into intravertebral foramen, Urol. Int., 2002, 69, 75–77

    Article  PubMed  Google Scholar 

  27. Napolitano C., Mutter D., Steib I.P., Christmann D., Marescaux J., A benign retroperitoneal schwannoma with vertebral lysis. A case report, Ann Ital Chir, 1998, 69, 815–817 (in Italian)

    PubMed  CAS  Google Scholar 

  28. Kadar E., Kisfaludi N., Czirjak S., Jakab F., Resection of giant schwannoma by combined surgical exposure, Acta Chir Hung, 1997, 36, 158–159

    PubMed  CAS  Google Scholar 

  29. Kageyama Y., Kihara K., Ishizaka K., Okuno T., Kawakami S., Fujii Y., et al., Endoscope-assisted Minilaparotomy (endoscopic minilaparotomy) for retroperitoneal schwannoma: experience with three cases, Jpn. J. Clin. Oncol., 2002, 32, 177–180

    Article  PubMed  Google Scholar 

  30. Hori T., Yamagiwa K., Yagi S., Iida T., Taniguchi K., Yamamoto C., et al., Noradrenalin-secreting retroperitoneal schwannoma resected by handassisted laparoscopic surgery: report of a case, Surg. Today, 2006, 36, 1108–1113

    Article  PubMed  Google Scholar 

  31. Hide I.G., Baudouin C.J., Murray S.A., Malcolm A.J., Giant ancient schwannoma of the pelvis, Skeletal Radiol., 2000, 29, 538–542

    Article  PubMed  CAS  Google Scholar 

  32. Sridhar K., Ramamurthi R., Vasudevan M.C., Ramamurthi B., Vasudevan M.C., Giant invasive spinal schwannomas: definition and surgical management, J. Neurosurg., 2001, 94, 210–215

    PubMed  CAS  Google Scholar 

  33. Descazeaud A., Coggia M., Bourriez A., Goëau-Brissonnière O., Laparoscopic resection of a retroperitoneal schwannoma, Surg Endosc., DOI:10.1007/s00464-002-4251-0

  34. Caddedu M.O., Mamazza J., Schlachta C.M., Seshadri P.A., Poulin E.C., Laparoscopic excision of retroperitoneal tumours: technique and review of the laparoscopic experience, Surg Laparosc Endosc Percutan Tech, 2001, 11, 144–147

    Article  Google Scholar 

  35. Ohta I., Lin P.H., Rau C.L., Wang K.C., Evaluation of perinephric, retroperitoneal schwannomas: case report and review of the literature, South Med J, 2007, 100, 80–82

    PubMed  Google Scholar 

  36. Hardisson D., Picazo M.L., Nuñez C., Jimenez-Heffernan J.A., De la Peña J., Retroperitoneal melanocytic schwannoma, Br J Urol, 1997, 79, 1003–1004

    PubMed  CAS  Google Scholar 

  37. Nakamura M., Takayama T., Takayasu K., Shimada K., Yamamoto J., Kosuge T., et al., Retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe, Jpn. J. Clin. Oncol., 1997, 27, 282–284

    Article  PubMed  CAS  Google Scholar 

  38. Rajab K.E., Issa A.A., Skerman J.H., Unusual presentation of an abdominoinguinal schwannoma, Obstet Gynecol, 2003, 102, 1158–1160

    Article  PubMed  Google Scholar 

  39. Acciarri N., Staffa G., Poppi M., Giant sacral schwannoma: removal by anterior, transabdominal approach, Br J Neurosurg, 1996, 10, 489–492

    Article  PubMed  CAS  Google Scholar 

  40. Ohigashi T., Nonaka S., Nakanoma T., Ueno M., Deguchi N., Laparoscopic treatment of retroperitoneal benign schwannoma, Int. J. Urol., 1999, 6, 100–103

    Article  PubMed  CAS  Google Scholar 

  41. Celli P., Trillo G., Ferrante L., Spinal extradural schwannoma, J Neurosurg Spine, 2005, 2, 447–456

    PubMed  Google Scholar 

  42. Khouni H., Andrianne R., Nidhal H., Badreddine S., De Leval J., Faouzi M.A., Benign schwannoma a rare retroperitoneal tumour, Prog. Urol., 2005, 15, 78–80

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic of Gastroenterology, Nephrourology and Surgery, Center of General Surgery, Vilnius University, LT-04130, Vilnius, Lithuania

    Marija Sakalauskaite, Juozas Stanaitis & Raimundas Lunevicius

  2. Clinic of Neurology and Neurosurgery, Vilnius University, LT-04130, Vilnius, Lithuania

    Saulius Cepkus

  3. Department of Pathology, Vilnius University Emergency Hospital, LT-04130, Vilnius, Lithuania

    Mindaugas Pleckaitis

Authors
  1. Marija Sakalauskaite
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juozas Stanaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saulius Cepkus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mindaugas Pleckaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raimundas Lunevicius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marija Sakalauskaite.

About this article

Cite this article

Sakalauskaite, M., Stanaitis, J., Cepkus, S. et al. Retroperitoneal giant schwannoma eroding lumbal vertebra: A case report with a literature review. cent.eur.j.med 3, 233–244 (2008). https://doi.org/10.2478/s11536-008-0006-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s11536-008-0006-1

Keywords

Search

Navigation