Laparoscopic resection of a retroperitoneal schwannoma

Although laparoscopic surgery for retroperitoneal diseases has been widely performed, there are few reports of laparoscopic resection for retroperitoneal tumors. We present the case of a 5-cm retroperitoneal tumor compressing the right common iliac vein and inferior vena cava that was successfully resected using a laparoscopic technique. Dissection between the tumor and the large vessels was performed safely using a harmonic scalpel and an ultrasonic surgical aspirator. Histopathology of the resected tumor showed a benign schwannoma. Laparoscopic surgical techniques should be considered for treatment of selected retroperitoneal tumors.     

Laparoscopic resection of a retroperitoneal schwannoma

Schwannomas or neurilemomas are rare, benign tumors that originate from the neural sheath. A 54-year-old man presented with left flank discomfort and lumbar pain for 6 months. A computed tomographic scan confirmed the existence of a 12 × 9 cm heterogeneous retroperitoneal mass adherent to the left psoas muscle that displaced the left kidney anteriorly. Total laparoscopic removal of the tumor was performed and pathologic examination revealed a benign schwannoma.     

Laparoscopic resection of a retroperitoneal schwannoma

We report a case of a successfully resected retroperitoneal benign schwannoma using laparoscopic surgery. A 62-year-old woman presented with an asymptomatic retroperitoneal mass. Computed tomography (CT) scan revealed a solid tumor compressing the inferior vena cava (IVC). First, we performed an intraoperative biopsy analysis, which revealed a benign neurologic tumor. We then proceeded with the complete laparoscopic resection of the tumor. Pathology revealed a benign schwannoma 8 x 5 cm in size. To our knowledge, only three other cases of the laparoscopic resection of retroperitoneal schwannoma have been reported. In our case, despite the large size of the tumor and the high level of compression of the IVC, a totally laparoscopic resection was feasible.     

Laparoscopic resection of retroperitoneal schwannoma : report of three cases and review of 22 cases in Japanese literature

Retroperitoneal schwannoma is a rare tumor. Only 19 cases have been reported to be treated by laparoscopic surgery. We performed successful laparoscopic excision of retroperitoneal schwannoma using the four-trocar in three patients who had a left retroperitoneal mass. The patients were two women and one man. They were 62, 60 and 57 years old. The tumor was 70, 45 and 50 mm in greatest diameter and operative time was 204, 243 and 254 min. respectively. The pathological diagnosis of the tumor was schwannoma. There was no morbidity or mortality. Preoperative diagnosis of schwannoma is very difficult. However schwannoma is a benign tumor with a good prognosis. This laparoscopic excision for retroperitoneal schwannoma is effective and rather safe.     

Laparoscopic resection of retroperitoneal benign schwannoma

Schwannomas are particularly rare neoplasms among tumors of the retroperitoneal space. Only 0.3-3.2% of benign schwannomas are found in retroperitoneal locations. As these tumors are usually asymptomatic and discovered by chance or in the course of the evaluation of an unrelated health problem, they may cause the delay of early diagnosis and treatment. With recent advances in the field of minimally invasive surgery, several laparoscopic approaches to retroperitoneal schwannomas have been reported. In this paper, we present the case of a 59-year-old female patient with an asymptomatic retroperitoneal mass that was found during a regular medical checkup. The mass was located between the inferior vena cava (IVC) and aorta under the pancreaticoduodenal unit (site of lymph node 16b1), compressing the IVC. She underwent successful laparoscopic surgery for retroperitoneal schwannoma. In addition, we summarized the literature on cases regarding the laparoscopic management of the retroperitoneal schwannoma.     

腹膜后神经鞘瘤1例报告并文献复习

目的报告1例腹膜后神经鞘瘤,并复习相关文献,分析其临床诊治现状。方法通过对1例腹膜后神经鞘瘤的诊断、治疗方法及术后病理、随访的回顾,结合国内外有关文献报道,综合分析腹膜后神经鞘瘤的诊断及治疗状况。结果本例行手术治疗,术后病理证实为腹膜后神经鞘瘤,随访半年无复发。结论腹膜后神经鞘瘤诊断困难,影像学检查无特异性,确诊依靠病理检查,理想的治疗方法是通过外科手术完整切除肿瘤,其预后良好,早期复发率低。     

原发性膀胱神经鞘瘤1例报告并文献复习

目的 探讨原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤在组织病理学、临床表现、治疗和预后上的特点,确立两者的鉴别诊断思路.方法 回顾1例原发于膀胱的神经鞘瘤的临床诊疗过程,结合有关膀胱神经鞘瘤及膀胱恶性周围神经鞘瘤的文献资料进行分析.结果 在组织病理和免疫组化方面,原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤有明显差异.结论 原发于膀胱的神经鞘瘤临床极其少见,易与膀胱常见肿瘤混淆,造成误诊,免疫组化为重要的确诊依据.膀胱恶性周围神经鞘瘤应以高度恶性的软组织肉瘤进行处理.临床上应重视两种疾病的鉴别,以正确地指导临床诊疗.     

Retroperitoneal giant schwannoma: a case report and review of the literature

Schwannomas are rare tumours that originate in the neural sheath and account for only a small percentage of all retroperitoneal tumours. They are usually solitary, circumscribed and encapsulated lesions eccentrically located on proximal nerves or spinal nerve roots. Presentation is typically varied and non-specific, ranging from abdominal pain, an abdominal mass or an incidental finding. The preoperative diagnosis is difficult and laboratory tests are usually unremarkable. We report the case of a 66-year-old female presenting with abdominal pain in her left flank and with an ultrasonographic diagnosis of a left kidney mass. She was diagnosed as suffering from a giant retroperitoneal schwannoma after surgical exploration and complete excision. The role of CT scan and CT-guided needle biopsy is emphasised, in that ultrasonography and fine needle aspiration alone do not provide sufficient information regarding aetiology and malignancy. Radical surgical excision is curative but recurrences may occur. Careful follow-up is needed.     

Abducens nerve schwannoma: a case report and review of the literature

BACKGROUND: Schwannomas of the abducens nerve are extremely rare tumors; only 10 cases have been reported so far. The tumor may be located within the cavernous sinus (CS) or more commonly at the prepontine region. Patients usually present with VIth cranial nerve paresis. CASE DESCRIPTION: We report a case of a 42-year-old male patient who presented with headache, vertigo, and hearing deficit, but no symptoms or signs related to a VIth cranial nerve impairment. Computed tomography and magnetic resonance imaging showed a large mass with a ring-like contrast enhancement in the prepontine area. Surgical treatment, via a simple retrosigmoid suboccipital approach, revealed a schwannoma originating from the VIth cranial nerve at its prepontine portion. Postoperative histological examination confirmed the diagnosis of schwannoma, and the patient had only a VIth cranial nerve palsy, which resolved during long-term follow-up. CONCLUSIONS: Abducens schwannomas are rare tumors, representing less than 1% of all intracranial schwannomas in our clinic and about 13% of oculomotor nerve schwannomas reported in the literature. These lesions can be mainly divided into tumors originating from the intracavernous portion of the VIth cranial nerve or more commonly from the cisternal part of the nerve, leading to a lesion in the prepontine region. In such cases, with no invasion of the cavernous sinus, radical tumor resection with preservation of the abducens nerve can be performed via a simple suboccipital retrosigmoid approach.     

Laparoscopic resection of a retroperitoneal schwannoma behind the lesser omental sac

Most schwannomas occur in the head, neck, or limbs with a few cases occurring in the retroperitoneal space. In benign schwannoma occurring in the retroperitoneal space, tumors are most commonly located near the adrenal gland. Herein, we report on a 55-year-old Japanese man with benign schwannoma (6x4 cm) behind the lesser omental sac, which was removed under laparoscopy. Non-functioning neurogenic tumor was suspected as a differential diagnosis by computed tomography, ultrasonography, and magnetic resonance imaging, and the patient underwent laparoscopic resection of the tumor. Histologically, the resected tumor was diagnosed as benign schwannoma. The patient was discharged from our hospital on the tenth postoperative day without any complications. A laparoscopic surgical technique is safe and feasible for the diagnosis and treatment of retroperitoneal benign tumors such as schwannoma.     

腹膜后肾外错构瘤1例报告并文献复习

目的：提高对腹膜后肾外错构瘤(AML)的认识及诊疗水平。方法：报告1例并发肾上腺皮质髓质增生的腹膜后肾外AML,并结合文献复习就其诊疗问题予以讨论。结果：施行右侧腹膜后肿瘤切除术的患者术后随访2年,未见肿瘤复发及转移;施行左侧肾上腺切除术的患者术后随访10个月,阵发性高血压及相关症状消失,生化检查结果正常。结论：腹膜后肾外AML是一种罕见的有潜在恶性的间叶瘤,结合CT及MRI可作出较为准确的术前诊断,但确诊有待于病理检查结果。治疗方法应尽量采取保留肾脏的单纯性肿瘤切除术。     

Abducens nerve schwannoma: case report and review of the literature

Schwannomas of the abducens nerve are extremely rare. The authors report a case with this tumor and discuss its clinical and radiographic characteristics. A 36-year-old man presented with 6-month history of diplopia. Right abducens nerve paresis was noted on neurologic examination. Magnetic resonance imaging revealed a 4-cm sized heterogeneously enhancing mass in the right cerebellopontine angle. Although schwannoma was suggested, no direct radiographic evidences regarding its origin were identified. Instead, the facial and vestibulocochlear nerve complex was found to be displaced posteriorly by the tumor on MR three-dimensional T2-weighted driven equilibrium sequence. Resection of the tumor was carried out via retrosigmoid approach. As the encapsulated partially suckable yellowish tumor was debulked and dissected, the abducens nerve was found to fan along and be attached to the medial surface of the tumor, which was cut at this point. Complete excision of the tumor was accomplished, and reanimation of the nerve was done by end-to-end anastomosis. Histologic feature was typical of schwannoma. Abducens schwannoma, although rare, should be taken into account for differential diagnosis of the cerebellopontine angle tumors. Appreciation of the characteristic clinical and radiographic features may provide an accurate preoperative diagnosis.     

Laparoscopic resection for nonfunctioning small glucagon-producing tumor: report of a case and review of the literature

Glucagonoma is a relatively rare type of pancreatic endocrine tumor, and is often well-developed and malignant at detection. We report a case of nonfunctioning small glucagon-producing tumor that was successfully resected by laparoscopic surgery. A 63-year-old woman was admitted to our hospital for further examination of a pancreatic tumor that had been detected incidentally. Hematological data and hormone concentrations were within normal ranges. Abdominal ultrasonography and computed tomography showed a small mass in the body of the pancreas. Laparoscopic distal pancreatectomy was done. Macroscopically, the resected tumor was a yellowish-white, solid mass measuring 8 x 8 x 7 mm. The tumor cells showed positive immunohistochemical staining for chromogranin A and glucagon. The postoperative course was uneventful. To the best of our knowledge, this is the first report of laparoscopic surgery for a nonfunctioning small glucagon-producing tumor. Because of recent improvements in laparoscopic surgery technique, use of this approach for resection of pancreatic benign small endocrine tumors will likely increase in the future.     

Laparoscopic resection of ectopic pancreas in the gastric antrum: case report and literature review

We report a case of ectopic pancreas tissue in the gastric wall that was removed using a minimally invasive approach. The patient was a 46-year-old obese woman who presented with fatigue, weakness, abdominal discomfort, and guaiac-positive stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the gastric antrum. Intraoperative upper endoscopy clearly located the lesion at the antrum. The lesion was marked with India ink, allowing it to be identified easily at laparoscopy. A laparoscopic wedge resection of the gastric antrum was performed. The patient had an uneventful recovery. We believe that this is a valid treatment option for this benign condition.     

Giant retroperitoneal schwannoma from the fifth lumbar nerve root with vertebral body osteolysis: a case report and literature review

Study design  To report a rare case of retroperitoneal schwannoma from lumbar nerve root with difficult surgery and potential vascular complication. Objective  We report a rare case of giant schwannoma which arises from fifth lumbar root with L5 vertebral body destruction. Summary of background data  Retroperitoneal schwannomas are rare, and those with bony involvement are even rarer and may be mimicking malignant tumors. Methods  Retroperitoneal removal of the tumor with partial killing of right L5 nerve root and allograft of L5 vertebral body defect were performed. Incidental injury of common iliac vein was encountered due to adhesion of the vein to tumor capsule. The laceration was repaired by cardiovascular surgeon. Results  At final follow-up, the patient had mild weakness of dorsi-flexion of right ankle and mild right L5 dermatome numbness. No walking difficulty and no sign of local recurrence in the image studies. Conclusions  Retroperitoneal schwannomas are rare, and they can become very large when diagnosed. Major vessels impingement and adhesion can occur which make the surgery difficult. Careful pre-operative evaluation and explanation is very important.     

Laparoscopic vasectomy: case report and review of the literature

A 42-year-old man undergoing bilateral laparoscopic hernia repair requested vasectomy for family planning purposes. Bilateral vasectomy was done by a laparoscopic approach at the time of extraperitoneal hernia repair, and a separate scrotal incision was avoided. In addition to reporting a case of laparoscopic vasectomy, we review the published literature on this topic.