後腹腔神經鞘瘤於腎上腺偶見瘤之個案報告及系列

蔡勝閔¹、謝昆霖¹、曾文歆¹、劉建良^1.2、黃冠華¹

奇美醫療財團法人奇美醫院 外科部 泌尿科

Retroperitoneal Schwannoma of Adrenal Incidentaloma: A Case report and series review

Sheng-Min Tsai¹、Kun-Lin Hsieh¹、Wen-Hsin Tseng¹、Chien-Liang Liu^1,2、Steven K. Huang¹

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

Introduction:

Retroperitoneal schwannoma is a tumor that originates from schwann cells in the myelinated neural sheath, and is quite rare, accounting for only 0.5% to 5% of all schwannomas. Typically, these tumors are asymptomatic and only discovered incidentally, unless they have grown to a significant size and are causing mass effect. Unfortunately, it is challenging to make a definitive preoperative diagnosis of retroperitoneal schwannoma. Surgical excision is the preferred treatment for these tumors, and the traditional approach has been an open procedure. Retroperitoneal schwannomas are usually well-defined and do not invade nearby organs or large vessels, so laparoscopic surgery can be a safe alternative to the open approach.

Case presentation:

The illustrated case is a 50-year-old female patient with history of uterine myoma and endometrioma. She received follow up in out-patient department of gynecology. She has been suffered from right lower quadrant pain for 1 month. Transvaginal sonography and transabdominal ultrasound revealed an intramural myoma and a right ovarian complex cyst. Further tumor marker work-up are within normal range; whereas abdominal CT scan showed a heterogeneous enhanced mass with central necrosis at left adrenal gland, about 7x6x4 cm in size. The patient was transferred to urology department for evaluation. Hormone survey showed normal Vanillylmandelic acid, aldosterone, renin, and urine catecholamine level. The patient denied hypertensive event or headache. The patient received laparoscopic retroperitoneal tumor resection with adrenalectomy. There was no postoperative complication, and the patient was discharged at third day post operation. The pathologic report revealed left adrenal tissue within normal limit and an encapsulated spindle cell tumor composed by well-differentiated Schwann cells. The patient received regular follow up in urology out-patient department.

Discussion:

We retrospectively reviewed the cases with pathologic report of retroperitoneal schwannomas. In our case series, the patients received laparoscopic retroperitoneal tumor resection has low post-operative complications.