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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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Images of HE staining showing the schwannoma undergoing malignant transformation. High-power view of the spindle cell component showing bland cytologic features with a suggestion of palisading, mitotic figures and tumor giant cells. (Original magnification 200×).
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Figure 4: Images of HE staining showing the schwannoma undergoing malignant transformation. High-power view of the spindle cell component showing bland cytologic features with a suggestion of palisading, mitotic figures and tumor giant cells. (Original magnification 200×).

Mentions: At first occurrence, the biggest primary mass had a grey fish-meat like appearance on section with major solid features. Histopathological analysis identified the tumor as a schwannoma with malignant transformation. It was not grossly clear whether the lesion was associated with a nerve trunk. Histologically, the lesion consisted of spindle cells arranged in short bundles with occasional palisading nuclei. Cytologic atypia is evident as characterized by nuclear hyperchromasia, atypical mitotic figures and tumor giant cells (Fig. 4 and Fig. 5). Seromuscular layer of sigmoid colon and renal capsule were invaded by tumor cells as shown in HE staining section (Additional file 2: Fig. S2 and Additional file 3: Fig. S3). All the smaller nodular lesions on the colon and pelvic cavity had the same histopathological characters with the largest one and the immunohistochemical profile were very similar.


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)

Images of HE staining showing the schwannoma undergoing malignant transformation. High-power view of the spindle cell component showing bland cytologic features with a suggestion of palisading, mitotic figures and tumor giant cells. (Original magnification 200×).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Images of HE staining showing the schwannoma undergoing malignant transformation. High-power view of the spindle cell component showing bland cytologic features with a suggestion of palisading, mitotic figures and tumor giant cells. (Original magnification 200×).
Mentions: At first occurrence, the biggest primary mass had a grey fish-meat like appearance on section with major solid features. Histopathological analysis identified the tumor as a schwannoma with malignant transformation. It was not grossly clear whether the lesion was associated with a nerve trunk. Histologically, the lesion consisted of spindle cells arranged in short bundles with occasional palisading nuclei. Cytologic atypia is evident as characterized by nuclear hyperchromasia, atypical mitotic figures and tumor giant cells (Fig. 4 and Fig. 5). Seromuscular layer of sigmoid colon and renal capsule were invaded by tumor cells as shown in HE staining section (Additional file 2: Fig. S2 and Additional file 3: Fig. S3). All the smaller nodular lesions on the colon and pelvic cavity had the same histopathological characters with the largest one and the immunohistochemical profile were very similar.

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