Benign Retroperitoneal Schwannoma

L. Bouhajja, M. Bel Haj Salah, O. Khayat, N. Abdessayed, W. Koubâa, R. Jouini, N. Labbène, A. Chadly-Debbiche


Schwannomas are benign tumors mostly arising from the head and neck. Retroperitoneal schwannomas are rare as only 0.7–2.6% of schwannomas occur in the retroperitoneal space, and approximately 1–6% of retroperitoneal tumors are schwannomas. Most retroperitoneal schwannomas are benign; approximately 1.2% of cases are malignant. They are diagnosed in patients with an average age of 48 years with mild female predominance. Given the large loose areolar space available in the retroperitoneum, tumors in this location often present late with vague complaints related to compression of surrounding structures and often develop degenerative changes inside them. Size at diagnosis is usually large with a median of 9cm. Imaging is not specific and diagnosis remains histological. In lights of the two observations, we will discuss the clinical, radiological and pathological features of this tumor.
We report two cases of retroperitoneal schwannoma in a 17 year-old man and a 39 year-old woman. In the first case, the patient had a two years lasting mass of the left flank. The second patient consulted for a lower back pain. The radiological examination showed a retroperitoneal mass.
Macroscopically, these masses were nodular, well defined, measuring respectively 8.5 and 12 cm with a firm, yellowishcut-section. Histological examination showed, in both cases, fusocellular, encapsulated proliferation made of a compact spindle cells component with focal nuclear palisadingwhich was altering with a loosely textured, histiocyte-rich component. There were numerous thick-walled vessels with fibrinoid and hyaline changes as well as a marked lymphoid infiltrate. Foci of ischemic necrosis were noted in the first case but without atypia or increased mitotic activity. Both tumors were stained positively and strongly with S100 protein. Diagnosis of benign retroperitoneal schwannomas was made.
Retroperitoneal schwannoma was rare and preoperative diagnosis was difficult. Most of retroperitoneal schwannoma were benign and the surgical treatment was the first choice.

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