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Recurrent retroperitoneal Schwannomas displaying different differentiation from primary tumor: case report and literature review.

Li ZQ, Wang HY, Li J, Teng L - World J Surg Oncol (2010)

Bottom Line: Radical dissection of the tumors along with the sacrifice of adjacent sigmoid colon and left kidney failed to provide a cure for this patient.Distinct immunohistochemical staining results of the tumors at recurrence indicate their potential of smooth-muscle like differentiation.Radical excision of the tumors may provide benefit for their local recurrences.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cancer Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

ABSTRACT

Background: Retroperitoneal Schwannomas are uncommonly found in the retroperitoneum and few of them show malignant transformation and invasion. Local recurrence are common in malignant Schwannomas with very few reports of tumor distinct differentiation at recurrences.

Case presentation: We report here a rare case of retroperitoneal schwannoma with multiple origins from retroperitoneum and pelvic wall. Pathological examination confirmed the case as a schwannoma with malignant transformation. Radical dissection of the tumors along with the sacrifice of adjacent sigmoid colon and left kidney failed to provide a cure for this patient. Due to tumor recurrence, a second and a third surgery of radical excision were performed 6 months and 17 months later after the first surgery, respectively. Histopathologic analysis identified that the recurrent tumors were different from the original schwannoma because of their smooth muscle-like differentiation.

Conclusion: Malignant schwannomas are uncommon sarcomas with a high incidence of local recurrence. Distinct immunohistochemical staining results of the tumors at recurrence indicate their potential of smooth-muscle like differentiation. Radical excision of the tumors may provide benefit for their local recurrences.

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Related in: MedlinePlus

CT scan showing tumors involved the sigmoid flexure.
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Figure 2: CT scan showing tumors involved the sigmoid flexure.

Mentions: A large mass in the left lower quadrant of the abdomen was found in a 51 year old male patient during physical examination and confirmed by computer tomography. The patient has no history of any cancer and no family history of neurofibromatosis. Lab tests results including blood routine, urine routine, serum chemistry, as well as examinations of several serum tumor markers such as Carcinoembryonic antigen (CEA), α-fetoprotin (AFP) and Carbohydrate antigen 19.9 (CA19.9) were all within normal ranges. Computed tomography scan confirmed a 15.0 × 12.3 × 10.0-cm enhancing heterogeneous mass with left kidney invasion arising from retroperitoneal space (Fig. 1). As shown in the CT scan, we could identify several smaller nodular lesions around the main tumor, locating in the soft tissues of the pelvic wall and sigmoid colon (Fig. 2 and Fig. 3). A presumptive diagnosis of retroperitoneal sarcoma or possible pancreatic neoplasm was suspected. The patient underwent surgical excision of the masses. The largest retroperitoneal mass was speculated to be the original site upon examinations during the operation. The nodules found on the sigmoid colon were most likely "satellite" lesions, for it was confined in the colon wall but did not protrude into the colon cavity, which may due to direct spread of tumor cells from the primary tumor. However, the pelvic masses rooted from the pelvic wall but not from pelvic peritoneum indicated they may have independent origins. The left kidney and sigmoid flexure were extirpated together with the tumors for the negative soft tissue margins. No further anti-tumor therapy was administrated after the surgery, and CT scan of the abdomen and pelvic cavity was performed every three months as follow-up. In the follow-up examination 6 months post surgery, a mass 7-cm in diameter was discovered at the retroperitoneal site (Additional file 1: Fig. S1). The mass was revealed to be well-circumscribed and complete excision was performed. The patient was doing well after the second surgery till 11 months after, the second surgery, when a recurrent mass involving the splenic hilum and cauda pancreatic was revealed by CT. A third surgery was performed to resect the tumor together with the spleen and distal pancreas. All of the three surgeries were performed to obtain macroscopic clearance at resection.


Recurrent retroperitoneal Schwannomas displaying different differentiation from primary tumor: case report and literature review.

Li ZQ, Wang HY, Li J, Teng L - World J Surg Oncol (2010)

CT scan showing tumors involved the sigmoid flexure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2927596&req=5

Figure 2: CT scan showing tumors involved the sigmoid flexure.
Mentions: A large mass in the left lower quadrant of the abdomen was found in a 51 year old male patient during physical examination and confirmed by computer tomography. The patient has no history of any cancer and no family history of neurofibromatosis. Lab tests results including blood routine, urine routine, serum chemistry, as well as examinations of several serum tumor markers such as Carcinoembryonic antigen (CEA), α-fetoprotin (AFP) and Carbohydrate antigen 19.9 (CA19.9) were all within normal ranges. Computed tomography scan confirmed a 15.0 × 12.3 × 10.0-cm enhancing heterogeneous mass with left kidney invasion arising from retroperitoneal space (Fig. 1). As shown in the CT scan, we could identify several smaller nodular lesions around the main tumor, locating in the soft tissues of the pelvic wall and sigmoid colon (Fig. 2 and Fig. 3). A presumptive diagnosis of retroperitoneal sarcoma or possible pancreatic neoplasm was suspected. The patient underwent surgical excision of the masses. The largest retroperitoneal mass was speculated to be the original site upon examinations during the operation. The nodules found on the sigmoid colon were most likely "satellite" lesions, for it was confined in the colon wall but did not protrude into the colon cavity, which may due to direct spread of tumor cells from the primary tumor. However, the pelvic masses rooted from the pelvic wall but not from pelvic peritoneum indicated they may have independent origins. The left kidney and sigmoid flexure were extirpated together with the tumors for the negative soft tissue margins. No further anti-tumor therapy was administrated after the surgery, and CT scan of the abdomen and pelvic cavity was performed every three months as follow-up. In the follow-up examination 6 months post surgery, a mass 7-cm in diameter was discovered at the retroperitoneal site (Additional file 1: Fig. S1). The mass was revealed to be well-circumscribed and complete excision was performed. The patient was doing well after the second surgery till 11 months after, the second surgery, when a recurrent mass involving the splenic hilum and cauda pancreatic was revealed by CT. A third surgery was performed to resect the tumor together with the spleen and distal pancreas. All of the three surgeries were performed to obtain macroscopic clearance at resection.

Bottom Line: Radical dissection of the tumors along with the sacrifice of adjacent sigmoid colon and left kidney failed to provide a cure for this patient.Distinct immunohistochemical staining results of the tumors at recurrence indicate their potential of smooth-muscle like differentiation.Radical excision of the tumors may provide benefit for their local recurrences.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cancer Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

ABSTRACT

Background: Retroperitoneal Schwannomas are uncommonly found in the retroperitoneum and few of them show malignant transformation and invasion. Local recurrence are common in malignant Schwannomas with very few reports of tumor distinct differentiation at recurrences.

Case presentation: We report here a rare case of retroperitoneal schwannoma with multiple origins from retroperitoneum and pelvic wall. Pathological examination confirmed the case as a schwannoma with malignant transformation. Radical dissection of the tumors along with the sacrifice of adjacent sigmoid colon and left kidney failed to provide a cure for this patient. Due to tumor recurrence, a second and a third surgery of radical excision were performed 6 months and 17 months later after the first surgery, respectively. Histopathologic analysis identified that the recurrent tumors were different from the original schwannoma because of their smooth muscle-like differentiation.

Conclusion: Malignant schwannomas are uncommon sarcomas with a high incidence of local recurrence. Distinct immunohistochemical staining results of the tumors at recurrence indicate their potential of smooth-muscle like differentiation. Radical excision of the tumors may provide benefit for their local recurrences.

Show MeSH
Related in: MedlinePlus