Dados do Trabalho

Título

Retroperitoneal Schwannoma treated by laparoscopic approach: a case report

Apresentação do caso

Female, 68 years old is admitted at the gynecology ward at the reference hospital after suspected finding of pedunculated subserosal nodule or expansive ovarian lesion in a transvaginal ultrasonography. The exam revealed subserosal myometrial nodule (3x2cm) in the anterior wall and heterogeneous nodular formation with irregular borders and hypoechoic surrounding area (4x3cm) in the left adnexal region, with no ovarian identification. The patient was asymptomatic, without alteration in the physical or gynecological exam. She was submitted to a pelvic RMI, discovering a nodular corporal intramural formation( anterior with 2,5x2cm and two posterior with 9mm and 6mm) suggestive of leiomyoma. It was also discovered an expansive formation of 4,3x3,3x3cm close to the left iliac vases, with areas of restricted diffusion in contact with S1. The hypothesis of gynecologic tumors was discarded by the radiology department. The patient was referred to the general surgery department to continue the investigation. The chosen surgical approach was the laparoscopy with the resection of the subjacent mass and the left iliac vases that were removed through umbilical incision. The sample was sent to histopathological studies. The microscopic examination revealed fusiform neoplastic cells with slight atypia and hyalinized center, suggesting schwannoma with hyaline degeneration. Immunohistochemical analysis was S100 positive, suggesting an old schwannoma.

Discussão

Schwannomas are encapsulated tumours in the myelin sheath of cranial and peripheral nerves that are formed from Schwann cells. Although they represent the most common myelin sheath tumours and are usually present in the root of the cranial and raquidian nerves, their incidence is extremely rare in the retroperitoneal space. They are usually benign, but can potentially become malignant, and may be associated with neurofibromatosis.

Comentários Finais

Schwannomas are slow growth tumors commonly associated with asymptomatic cases which makes it difficult to have a preoperative diagnosis, even with imaging exams. The histopathological assay is critical in the diagnosis. The case illustrated the challenge in the detection of a Schwannoma and their laparoscopic surgery therapeutic approach, mainly in an uncommon localization such as the retroperitoneal space.

Palavras Chave

{Schwannoma} {Retroperitoneal} {Laparoscopy}