Presacral schwannoma: a bizarre presentation in the Pandora’s box of abdomen and pelvis

Schwannomas are benign tumors arising from the Schwann cells of nerve fibers. They are extremely rare in the pelvis accounting for only 1-3% of all schwannomas. These tumors are nonaggressive, slow growing, solitary neoplasms with an extremely low possibility of malignant transformation or recurrence after excision. We present a case of a 19 years old male with complaints of radiating pain from lower back to the left thigh associated with altered bowel and bladder habits. Following a detailed work up he underwent laparotomy and mass excision. Histopathological report revealed presacral schwannoma. Post-surgery patient improved symptomatically and is on regular follow up. There are a smaller number of cases of presacral schwannoma reported in the literature. Due to its outlandish striking presentation, diagnosis is very challenging. Although presacral schwannoma is rare, it should be considered as a differential diagnosis in the back of the mind of a surgeon while dealing a case of pelvic mass. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors.

Unusually large quiescent ancient schwannoma of hypoglossal nerve.

Ancient schwannoma is considered as a variant of schwannoma, comprising about 10% of all schwanommas. Schwannoma is a benign neoplasm derived from the nerve sheath of peripheral motor, sensory and sympathetic nerves and from the cranial nerve pairs. It usually presents as a solitary soft‑tissue lesion which is slow growing, encapsulated and is often associated with nerve attached peripherally. Diagnosis is often confirmed with the microscopic examination. The long standing schwannoma attributes to degenerative changes and is termed “ancient” schwannoma. Present case is of a 68‑year‑old female patient who reported with an asymptomatic large swelling below mandible on the left side since last 23 years. The lesion was surgically excised under general anesthesia.

Solitary Ancient Schwannoma in Upper Arm: A Case Report / 대한골관절종양학회지

Ancient schwannoma is a variant of schwannoma and is characterized slowly growing tumor with degenerative change. And it is reported that schwannoma is relatively rare in extensor area. As a rare cause of solitary ancient schwannoma in extensor area of upper arm, we report it.

A Case of Ancient Schwannoma in Retromaxillary Area Removed with Le Fort I Osteotomy Approach

Schwannoma, which manifests as a smooth and solitary, encapsulated lesion, originates from the nerve sheaths of Schwann cells. Ancient schwannoma, a rare histologic variant of schwannoma, characterized by its distinctive degenerative changes. Basically, treatment entails complete removal of the mass, with maximal safeguarding of the nerve. However, depending on tumor size and extent, complete removal can be problematic. Le Fort I osteotomy in orthognathic surgery is widely utilized and can be effective to remove the skull base tumors. A 25-year-old woman presented with stabbing pain of 1-2 seconds duration occurring every two hours in the interior of the right face, which condition had persisted for one year. Magnetic resonance imaging showed mass lesion in the right retromaxillary area. Mass in retromaxillary area was removed by Le Fort I osteotomy. Pathologic examination confirmed the diagnosis of ancient schwannoma. In the course of a six-month follow-up, neither recurrence nor malocclusion was observed.

Ancient Schwannoma Misdiagnosed as a Hemangioma in the Ventral Tongue

Cervical Intramedullary Ancient Schwannoma

A young male of 24 years was presented with a history of gradually progressive spastic quadriparesis for long four years. He was investigated and MRI revealed a neoplastic lesion in the cervical cord at the level of C4, C5 with perilesional edema and tumour syrinx formation, suggestive of astrocytoma. After total removal histopathology proved it to be an ancient schwannoma.

Ancient Schwannoma of the cervical sympathetic chain: A case report

Schwannoma of the cervical sympathetic chain is an extremely rare nerve tumour. We report an unusual swelling in a 41-year-old female who presented with an asymptomatic solitary mass in the right parapharyngeal space. Clinical examination and computed tomography showed displaced carotid artery in an antero-medial direction. Surgical excision of the lesion was carried out and histological examination revealed an Ancient Schwannoma.

Laparoscopic Resection of Ancient Shwannoma of Vagus Nerve in the Lesser Sac

Schwannomas are benign schwann cell tumors arising from peripheral nerves or spinal roots. Most schwannomas occur in the cephalocervical region and limbs with a few cases occurring in the intraabdominal space especially in the lesser sac. Among them. ancient schwannomas are benign schwannomas with degenerative changes such as cyst formation, calcification, hemorrhage and hyalinizaion. Histologically ancient schwannomas show degenerative changes with marked nuclear atypia and both cinical and radiologic features specific to schwannoma are usually absent. So it is difficult to diagnose ancient schwannoma preoperatively and distinguish it from malignant tumors. We describe herein a very rare case of benign ancient schwannoma of vagus nerve in the lesser omentum. A 31-year-old male patient underwent laparosocpic resection and discharged on the second postoperative day without any complications. Laparoscopic surgical technique is safe and feasible for the diagnosis and treatment of benign solid tumors in the lesser omentum such as schwannoma.

Retroperitoneal Ancient Schwannoma / 대한비뇨기과학회지

The term 'ancient' schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. The findings from abdominal ultrasound and computed tomography, in a patient with a retroperitoneal ancient schwannoma, are presented, and the histological features of this unusual type of tumor are reviewed. The presence of a large, well-delineated complex cystic mass in the deep soft tissues should raise the possibility of an ancient schwannoma. The treatment of choice for an ancient schwannoma is complete excision. It is important to recognize these tumors as benign, with excellent prognosis, so as to avoid unnecessary radical surgery. A recurrence, or persistence, seems to be associated with incomplete resection, which occurred in 10% of the reported cases.

A Case of Ancient Schwannoma of the Lingual Nerve / 대한이비인후과학회지

Schwannomas are neurogenic tumors that arise from Schwann cells of the neural sheath. They are most often benign and solitary. Ancient schwannoma is a rare variant of schwannoma with a typical characteristics of a slow growing benign tumor. A case of ancient schwannoma which originated from the lingual nerve has not been reported in the literature yet. The clinical and histological aspects of this tumor are discussed and the literature regarding this rare entity is reviewed.

The Effect of Methylprednisolone ulse Therapy against Steroid Resistant Nephrotic Syndrome in Children

Ancient (degenerated) schwannomas are benign tumors that display pronounced degenerative changes including cyst formation, calcification, hemorrhage, and hyaliniz ation. The tumors are usually infiltrated by large numbers of inflammatory cells such as neutrophils, lymphocytes, siderophages, and histiocytes. They are located in deep locations such as the retroperitoneum and must be differentiated from malignant soft tissue tumors because spindle cells with nuclear atypia may be present in the fine needle aspiration biopsy. The cytologic findings of two cases of ancient schwannoma occurring in posterior mediastinum and retroperitoneum, respectively, are described. Computerized tomographic findings of both cases showed changes of cystic degeneration or necrosis. A case occurred in retroperitoneum revealed features of destruction of vertebral body to suggest a malignant soft tussue tumor radiologically. The cytologic findings of aspiration biopsy of both tumors revealed that the tumor cells were spindle in shape with elongated nuclei. Some of tumor cells were arranged in a palisading fashion. Cell structures that resemble the Verocay bodies were observed. Some of the tumor cells showed pleomorphic bizarre nuclei, but no mitotic activity or chromatin clumping was seen. Inflammatory cells, siderophages and histiocytes were scattered in fibrillar material. These cytologic findings are important in the diagnosis of ancient schwannoma and in the differentiation of this tumor from the malignant spindle cell tumor.

Cytologic Findings of Fine Needle Aspiration Biopsy of Ancient Schwannoma / 대한세포병리학회지

Ancient (degenerated) schwannomas are benign tumors that display pronounced degenerative changes including cyst formation, calcification, hemorrhage, and hyalinization. The tumors are usually infiltrated by large numbers of inflammatory cells such as neutrophils, lymphocytes, siderophages, and histiocytes. They are located in deep locations such as the retroperitoneum and must be differentiated from malignant soft tissue tumors because spindle cells with nuclear atypia may be present in the fine needle aspiration biopsy. The cytologic findings of two cases of ancient schwannoma occurring in posterior mediastinum and retroperitoneum, respectively, are described. Computerized tomographic findings of both cases showed changes of cystic degeneration or necrosis. A case occurred in retroperitoneum revealed features of destruction of vertebral body to suggest a malignant soft tussue tumor radiologically. The cytologic findings of aspiration biopsy of both tumors revealed that the tumor cells were spindle in shape with elongated nuclei. Some of tumor cells were arranged in a palisading fashion. Cell structures that resemble the Verocay bodies were observed. Some of the tumor cells showed pleomorphic bizarre nuclei, but no mitotic activity or chromatin clumping was seen. Inflammatory cells, siderophages and histiocytes were scattered in fibrillar material. These cytologic findings are important in the diagnosis of ancient schwannoma and in the differentiation of this tumor from the malignant spindle cell tumor.