Retroperitoneal schwannoma is a rare, usually benign tumour originating from cells of peripheal nerve sheath and account for only a small percentage of retroperitoneal tumours. It is usually asymptomatic and discovered occassionally. Because of the large space in witch they grow, they are often discovered lately when they are large. CT and MR are the imaging techniques of choice. We report a case of laparoscopic resection of this tumour.
An asymptomatic 64-year-old man was admitted to our surgical department for a incidentally discovered retropertineal mass during a screening ultrasonography that revealed a 8x6 cm heterogeneous mass.
The CT and RM scan confirmed a low-density mass with cystic and necrotic central areas located in para-aortic left space. Despite the large size of the tumor and the contact with aorta and inferior mesenteric artery, a totally laparoscopic resection was feasible. The postoperative course was favourable and the patient was discharged on IV postoperative day. Pathology revealed a benign capsulated schwannoma. Immunohistochemical staining for S100 protein was positive. There wasn’t any recurrence after one year of follow-up.
Preoperative dignosis is difficult, however close relationship of retroperitoneal tumors with adjacent neural structures in imaging studies should raise a suspiction. Complete surgical resection is the treatment of choice. In our case, despite the large size of the tumor and the contact with aorta and superior mesenteric artery, a totally laparoscopic resection was feasible and useful because a retroperitoneal schwannoma was easily dissected from the adjacent tissues.
