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Gastroenterology & Hepatology: Open Access
Presacral Schwannoma Resected Via Anterior Trans
Peritoneal Approach: A Case Report
Volume 3 Issue 2- 2015
1Department of Surgical Oncology, Kerudi Cancer Hospital and
Research Centre, Bagalkot, Karnataka, India
2Department of Radiodiagnosis, Kerudi Cancer Hospital and
Research Centre, Bagalkot, Karnataka, India
3Department of Pathology, SRL Diagnostics, Bangalore,
Karnataka, India
*Corresponding author: Vishwas D Pai, Department of
Surgical Oncology, Kerudi Cancer Hospital and Research
Centre, Bagalkot 587101, Karnataka, India, Tel: +91-
9449333502; E-mail:
Received: October 28, 2015 | Published: December 29,
2015
Submit Manuscript | http://medcraveonline.com Gastroenterol Hepatol Open Access 2015, 3(2): 00080
Abbreviations: CECT: Contrast Enhanced Computed
Tomography; MRI: Magnetic Resonance Imaging; CT: Computed
Tomography
Introduction
Schwannomas are the most common types of peripheral nerve
neoplasms arising from the Schwann cells of the neural sheath.
Although they may occur in any part of the body, only 6% are
estimate since majority of these remain asymptomatic. Because
of the location, these tumors can grow to very large size before
because of the narrow working space available and proximity to
the vital structures including external iliac vessels as well as the
ureter. In addition, abundant vascularity of the presacral plexus of
the type of the tumor on preoperative imaging studies is essential
to determine the appropriate approach for these rare tumors. We
are presenting a case of presacral schwannoma resected via an
open, intraperitoneal approach.
Case Report
A 40 year old gentleman presented with pain in the lower
abdomen of 1 year duration. On evaluation with contrast
enhanced computed tomography of abdomen (CECT), a soft
tissue mass of size 10 x 8 x 6 cm was detected in the presacral
it as dumb-bell shaped tumor with no intra spinal extension
representing a nerve sheath tumour (Figure 1a). Intra operatively,
right external iliac artery and vein. Tumor was then separated
from the sacrum by sharp and blunt dissection. Excision of the
tumor was completed after clipping the 5th lumbar nerve root
on the right side (Figure 1b). Duration of the surgery was 100
minutes and there was 100 ml of blood loss. Post operative course
was uneventful and he was discharged on 4th post operative day.
as a benign schwannoma (Figure 1c).
Discussion
Presacral schwannomas are rare accounting for 1-5% of
spinal schwannomas [2-4]. Less than 30 cases of presacral
schwannoma have been reported in English literature [5]. Klimo
sacrum but erode the wall of the sacrum and extend into the
adjacent spaces. Type 3 tumors are located predominantly in the
presacral or retro peritoneal area [6].
Most of these tumors remain asymptomatic and are detected
symptoms. Because of their slow growing nature and their
location in the presacral fossa they can reach very large size while
being asymptomatic and can even erode the sacrum. MRI is more
the tumor as well as its relationship with surrounding structures
including intra spinous extension [7].
Complete surgical resection remains the treatment of choice.
In general, posterior approach is preferable for type 1 tumors;
anterior approach is preferable for type 3 tumors and combined
anterior and posterior approach is preferable for type 2 tumors
[8]. Anterior approach may be either trans peritoneal or extra
peritoneal. Majority of the previous reports have reported trans
peritoneal approach although extra peritoneal approach has also
been reported by few authors [9,10]. The present patient had type
3 tumor and hence was resected via anterior trans peritoneal
approach.
Case Report
Abstract
Presacral tumors are rare. Neurogenic tumors in this area are even rarer with
only case report and short case series being reported in literature. Most of
these tumors remain asymptomatic till they reach size large enough to cause
pressure symptoms. Magnetic resonance imaging (MRI) of the pelvis is the
most preferred imaging modality for preoperative diagnosis as well treatment
planning. Complete surgical resection is the treatment of choice. Approach to
surgical resection depends on the type of the tumour. After complete excision
of the tumor, recurrence is rare. Up to 10-50% recurrence has been reported in
literature after incomplete resections. Adjuvant treatment is not recommended
even in incomplete resections or recurrences. We are presenting a case of type
3 presacral schwannoma resected by open, anterior, trans peritoneal approach.
Keywords: Presacral schwannoma; Neurogenic tumors; Anterior transperitoneal
approach
Presacral Schwannoma Resected Via Anterior Trans Peritoneal Approach: A Case Report 2/2
Copyright:
©2015 Pai et al.
Citation: Pai VD, Pawale A, Ravindranath S (2015) Presacral Schwannoma Resected Via Anterior Trans Peritoneal Approach: A Case Report. Gastroenterol
Hepatol Open Access 3(2): 00080. DOI: 10.15406/ghoa.2015.03.00080
Figure 1A: MRI pelvis, axial section showing soft tissue mass arising in the presacral area with no obvious
intra spinous extension.
Figure 1B: Gross picture of specimen of the presacral tumor resected.
Figure 1C: Spindle cell tumor with indented wavy nuclei revealing focal palisade.
Conclusion
Presacral schwannoma are rare nerve sheath tumors. MRI is
the most preferred imaging modality. Complete surgical resection
can be performed safely via anterior transabdominal approach.
References
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