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.

A Case of Intramedullary Spinal Neurilemmoma

A rare case of intramedullary neurilemmoma of the spinal cord has been reported. A 23-year-old woman was admitted to our hospital, on 4th July, 1982, because of weakness of legs and difficulty of urination. Neurological examination revealed motor weakness of the both lower extremities with muscle atrophy. Sensory examination showed hypesthesia below the level of L3 dermatome of the right side and of L4 dermatome of the left. All deep tendon reflexes of the lower extremities were abolishes and Lasehue's sign was not appeared. Manometric Queckenstedt's test showed a complete block, with CSF protein of 460 mg/dl. Pantopaque myelogram demonstrated a complete block at the midportion of L1 spine. Total removal of the intramedullary tumor which was located in the dorsal column of the thoracolumbar segment was performed. The tumor was 4.0x1.5x1.0 cm in size and it proved to be an Antoni-A type neurilemmoma histologically. Only 20 similar cases have been published so far and summarized on Table 1, including our case. The relevant literature was reviewed.