Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl


Preferences help
enabled [disable] Abstract
Number of results


2008 | 3 | 2 | 233-244

Article title

Retroperitoneal giant schwannoma eroding lumbal vertebra: A case report with a literature review


Title variants

Languages of publication



A huge schwannoma, located in the retroperitoneal space, is found very rarely. The main purpose of this paper is to present the case of a giant retroperitoneal schwannoma which partly invaded L4 vertebral body. The secondary purpose is to summarize the case-report articles on retroperitoneal schwannomas. A circumscribed heterogenic tumour was revealed on transabdominal sonography. It extended into the right retroperitoneal space. CT and MRI revealed a paravertebral tumour in the size of 11 cm × 9 cm, which is causing a partial lysis of L4 vertebral body (15% of vertebral capacity), expanding intravertebral foramen and filling the right retroperitoneal space. A preoperative core needle biopsy was performed and a benign schwannoma was diagnosed. A complete surgical excision of the tumour was achieved by a two-step operation. During the first step, the neurosurgeons made L4 hemilaminectomy, facetectomy and a transverse process resection by posterior extended approach. The general surgeons excised the residual retroperitoneal part of the tumour by midline transabdominal approach 10 days later. The diagnosis of benign schwannoma was verified histochemically. There were no sign of tumour recurrence or spine destabilization at the six-month follow-up. In conclusion, although majority of giant retroperitoneal schwannomas can be completely removed performing one-step operation, a preoperative consideration about rationality of two-step operation should be mandatory when tumour destructs a part of vertebral body. Our case shows that the combined two stage complete surgical excision of a giant retroperitoneal schwannoma, eroding 15% of L4 vertebra’s osseous capacity, is effective and does not have any negative influence on spinal stability.










Physical description


1 - 6 - 2008
9 - 4 - 2008


  • Clinic of Gastroenterology, Nephrourology and Surgery, Center of General Surgery, Vilnius University, LT-04130, Vilnius, Lithuania
  • Clinic of Gastroenterology, Nephrourology and Surgery, Center of General Surgery, Vilnius University, LT-04130, Vilnius, Lithuania
  • Clinic of Neurology and Neurosurgery, Vilnius University, LT-04130, Vilnius, Lithuania
  • Department of Pathology, Vilnius University Emergency Hospital, LT-04130, Vilnius, Lithuania
  • Clinic of Gastroenterology, Nephrourology and Surgery, Center of General Surgery, Vilnius University, LT-04130, Vilnius, Lithuania


  • [1] Singh V., Kapoor R., Atypical presentations of benign retroperitoneal schwannoma: Report of three cases with review of literature, Int Urol Nephrol, 2005, 37, 547–549 http://dx.doi.org/10.1007/s11255-004-4705-5[Crossref]
  • [2] Sharma S.K., Koleski F.C., Husain A.N., Albala D.M, Turk T.M., Retroperitoneal schwannoma mimicking an adrenal lesion, World J Urol, 2002, 20, 232–233
  • [3] Dede M., Yagci G., Yenen M.C., Gorgulu S., Daveci M.S., Cetiner S., et al., Retroperitoneal benign schwannoma: report of three cases and analysis of clinico-radiologic findings, Tohoku J. Exp. Med., 2003, 200, 93–97 http://dx.doi.org/10.1620/tjem.200.93[Crossref]
  • [4] Girgin C., Ozkan U., Sezer A., Tugyan N., Large pelvic schwannoma causing bilateral hydronephrosis, Int. J. Urol., 2003, 10, 616–618 http://dx.doi.org/10.1046/j.1442-2042.2003.00702.x[Crossref]
  • [5] Patocskai E.J., Tabatabaian M, Thomas M.J., Cellular schwannoma: a rare presacral tumour, Can J Surg, 2002, 45, 141–144
  • [6] Palmer J.D., Manual of neurosurgery, Bell and Bain Ltd., Glasgow, 1996
  • [7] Li Q., Gao C., Juzi J.T, Hao X., Analysis of 82 cases of retroperitoneal schwannoma, ANZ J Surg, 2007, 77, 237–240 http://dx.doi.org/10.1111/j.1445-2197.2007.04025.x[Crossref]
  • [8] Kar M., Deo S.V., Shukla N.K., Malik A., DattaGupta S.,. Mohanti B.K et al., Malignant peripheral nerve sheath tumors (MPNST) - Clinicopathological study and treatment outcome of twenty-four cases, World J Surg Oncol, DOI:10.1186/1477-7819-4-55 [Crossref]
  • [9] Erzen D., Sencar M., Novak J., Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana, J Surg Oncol, 2005, 91, 1–9 http://dx.doi.org/10.1002/jso.20265[Crossref]
  • [10] Heaton N.D., Page A.C., Howard E.R., Malignant retroperitoneal schwannoma, J R Soc Med, 1991, 84, 308–309
  • [11] Ogose A., Hotta T., Morita T., Higuchi T., Umezu H., Imaizumi S., et al., Diagnosis of peripheral nerve sheath tumors around the pelvis, Jpn. J. Clin. Oncol., 2004, 34, 405–413 http://dx.doi.org/10.1093/jjco/hyh072[Crossref]
  • [12] Rousseau M.A., Pascal-Mousselard H., Lazennec J.Y., Saillant G, The mini-invasive anterior extra peritoneal approach to the pelvis, Eur J Surg Oncol, 2005, 31, 924–926 http://dx.doi.org/10.1016/j.ejso.2005.05.006[Crossref]
  • [13] Kishi Y., Kajiwara S., Seta S., Kawauchi N., Suzuki T., Sasaki K., Retroperitoneal schwannoma misdiagnosed as a psoas abscess: report of a case, Surg. Today, 2002, 32, 849–852 http://dx.doi.org/10.1007/s005950200166[Crossref]
  • [14] Facciorusso D., Federici T., Giacobbe A.,. Niro Grazia A, Piermanni V., Andriulli A., Retroperitoneal neurilemoma diagnosed by endosonographically guided fine needle aspiration, J Clin Ultrasound, 2006, 34, 241–243 http://dx.doi.org/10.1002/jcu.20211[Crossref]
  • [15] Cotran R.S., Kumar V., Collins T., Robbins S.L., Robbins Pathologic basis of disease, 6th ed, W.B. Saunders Company, USA, 1999
  • [16] Kleihues P., Cavenee W.K., Pathology and Genetics of Tumours of the Nervous System, IARC Press, France, 2000
  • [17] Rosai J., Rosai and Ackerman’s surgical pathology, 9th ed., Mosby, USA, 2004
  • [18] Schindler O.S., Dixon J.H., Retroperitoneal giant schwannomas: report on two cases and review of the literature, J Orthop Surg (Honk Kong), 2002, 10, 77–84
  • [19] Lalloo S.T., Mayat A.G., Nadvi S.S., Landers A.T., Clinics in diagnostic imaging (68), Singapore Med J, 2001, 42, 592–595
  • [20] Klimo P., Rao G., Schmidt R.H., Schmidt M.H., Nerve sheath tumors involving the sacrum. Case report and classification scheme, Neurosurg Focus, 2003, 15, 12
  • [21] Goh B.K., Tan Y.M., Chung Y.F., Chow P.K., Ooi L.L., Wong W.K., Retroperitoneal schwannoma, Am. J. Surg., 2006, 192, 14–18 http://dx.doi.org/10.1016/j.amjsurg.2005.12.010[Crossref]
  • [22] Hayasaka K., Tanaka Y., Soeda S., Huppert P., Claussen C.D., MR findings in primary retroperitoneal schwannoma, Acta Radiol, 1999, 40, 78–82 http://dx.doi.org/10.3109/02841859909174408[Crossref]
  • [23] Kono K., Inoue Y., Nakamura H., Shakudo M., Nakayama K., MR imaging of a case of a dumbbellshaped spinal schwannoma with intramedullary and intradural-extramedullary components, Neuroradiology, 2001, 43, 864–867 http://dx.doi.org/10.1007/s002340100599[Crossref]
  • [24] Pollo C., Richard A., De Preux J., Resection of a retroperitoneal schwannoma by a combined approach, Neurochirurgie, 2004, 50, 53–56 (in French) http://dx.doi.org/10.1016/S0028-3770(04)98306-3[Crossref]
  • [25] Paderni S., Boriani S., Schwannoma of L3, Chir Organi Mov, 2002, 87, 133–139
  • [26] Tsukigi M., Kubota Y., Iijima Y., Yaguchi H., Tateno T., Suzuku T., et al., Retroperitoneal schwannoma extending into intravertebral foramen, Urol. Int., 2002, 69, 75–77 http://dx.doi.org/10.1159/000064366[Crossref]
  • [27] Napolitano C., Mutter D., Steib I.P., Christmann D., Marescaux J., A benign retroperitoneal schwannoma with vertebral lysis. A case report, Ann Ital Chir, 1998, 69, 815–817 (in Italian)
  • [28] Kadar E., Kisfaludi N., Czirjak S., Jakab F., Resection of giant schwannoma by combined surgical exposure, Acta Chir Hung, 1997, 36, 158–159
  • [29] Kageyama Y., Kihara K., Ishizaka K., Okuno T., Kawakami S., Fujii Y., et al., Endoscope-assisted Minilaparotomy (endoscopic minilaparotomy) for retroperitoneal schwannoma: experience with three cases, Jpn. J. Clin. Oncol., 2002, 32, 177–180 http://dx.doi.org/10.1093/jjco/hyf038[Crossref]
  • [30] Hori T., Yamagiwa K., Yagi S., Iida T., Taniguchi K., Yamamoto C., et al., Noradrenalin-secreting retroperitoneal schwannoma resected by handassisted laparoscopic surgery: report of a case, Surg. Today, 2006, 36, 1108–1113 http://dx.doi.org/10.1007/s00595-006-3304-8[Crossref]
  • [31] Hide I.G., Baudouin C.J., Murray S.A., Malcolm A.J., Giant ancient schwannoma of the pelvis, Skeletal Radiol., 2000, 29, 538–542 http://dx.doi.org/10.1007/s002560000266[Crossref]
  • [32] Sridhar K., Ramamurthi R., Vasudevan M.C., Ramamurthi B., Vasudevan M.C., Giant invasive spinal schwannomas: definition and surgical management, J. Neurosurg., 2001, 94, 210–215
  • [33] Descazeaud A., Coggia M., Bourriez A., Goëau-Brissonnière O., Laparoscopic resection of a retroperitoneal schwannoma, Surg Endosc., DOI:10.1007/s00464-002-4251-0 [WoS][Crossref]
  • [34] Caddedu M.O., Mamazza J., Schlachta C.M., Seshadri P.A., Poulin E.C., Laparoscopic excision of retroperitoneal tumours: technique and review of the laparoscopic experience, Surg Laparosc Endosc Percutan Tech, 2001, 11, 144–147 http://dx.doi.org/10.1097/00019509-200104000-00017[Crossref]
  • [35] Ohta I., Lin P.H., Rau C.L., Wang K.C., Evaluation of perinephric, retroperitoneal schwannomas: case report and review of the literature, South Med J, 2007, 100, 80–82 [Crossref][WoS]
  • [36] Hardisson D., Picazo M.L., Nuñez C., Jimenez-Heffernan J.A., De la Peña J., Retroperitoneal melanocytic schwannoma, Br J Urol, 1997, 79, 1003–1004 [Crossref]
  • [37] Nakamura M., Takayama T., Takayasu K., Shimada K., Yamamoto J., Kosuge T., et al., Retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe, Jpn. J. Clin. Oncol., 1997, 27, 282–284 http://dx.doi.org/10.1093/jjco/27.4.282[Crossref]
  • [38] Rajab K.E., Issa A.A., Skerman J.H., Unusual presentation of an abdominoinguinal schwannoma, Obstet Gynecol, 2003, 102, 1158–1160 http://dx.doi.org/10.1016/S0029-7844(03)00677-X[Crossref]
  • [39] Acciarri N., Staffa G., Poppi M., Giant sacral schwannoma: removal by anterior, transabdominal approach, Br J Neurosurg, 1996, 10, 489–492 http://dx.doi.org/10.1080/02688699647131[Crossref]
  • [40] Ohigashi T., Nonaka S., Nakanoma T., Ueno M., Deguchi N., Laparoscopic treatment of retroperitoneal benign schwannoma, Int. J. Urol., 1999, 6, 100–103 http://dx.doi.org/10.1046/j.1442-2042.1999.06222.x[Crossref]
  • [41] Celli P., Trillo G., Ferrante L., Spinal extradural schwannoma, J Neurosurg Spine, 2005, 2, 447–456 [Crossref]
  • [42] Khouni H., Andrianne R., Nidhal H., Badreddine S., De Leval J., Faouzi M.A., Benign schwannoma a rare retroperitoneal tumour, Prog. Urol., 2005, 15, 78–80

Document Type

Publication order reference


YADDA identifier

JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.