Recurred Giant Sacral Schwannoma: Report of a Case and Review of the Literature

Oh, Kyung Joon; Kim, Jae Won; Sung, Hyo Sook; Park, Noh Hyun; Song, Yong Sang; Kang, Soon Beom; Lee, Hyo Pyo

Abstract

Retroperitoneal Schwannomas are mostly benign encapsulated neoplasms originating from the Schwann cells of the retroperitoneal peripheral nervous systems. They are rare, but when the tumors occur, they can be large and difficult to diagnose because of a wide variety of nonspecific symptoms and findings on radiologic studies. The treatment of choice is a simple enucleation but sometimes conservative approach is inevitable. There are some discrepancies of the prognosis of conservative approach. A 54-year-old woman presented with a 4 month history of voiding difficulty and abdominal palpable mass. She had a history of partial resection of mass which was diagnosed as a retropretoneal schwannoma nine years ago. Computerized tomography revealed bilateral hydronephrosis and a increased presacral mass that destructed sacrum. Left percutaneous nephrostomy was performed preoperatively. We performed a conservative core resection and ultrasonic aspiration of the mass because of its dense adherence to major nerves and iliac vessels. After operation, percutaneous nephrostomy were removed. Voiding difficulty and left hydronephrosis were disappeared but right hydronephrosis was remained with improvement. Double J catheter was inserted to right ureter. Five months after surgery, the size of remained mass is reduced and bilateral hydronephrosis were disappeared.