Retroperitoneal neurilemoma

Abstract

Large retroperitoneal neurilemomas are rare. Five such cases are reported in four men and one woman varying in age from twenty-seven to seventy-five years. The tumor was found incidentally during examinations for other conditions in three cases. The other cases presented with abdominal pain, discomfort and increased abdominal girth. The tumors were all attached to the anterior surface of the sacrum. They varied in size from 12 cm in diameter to one containing more than 81 of fluid. The proper treatment is dependent on recognition of the tumor. Laparotomy with adequate biopsy is the preferred method. Due to the thickness of the capsule, a deep incision is necessary to obtain representative tissue. Needle biopsy may be complicated by the development of an infection within the tumor, hemorrhage, and inadequate tissue for diagnosis. The larger the tumor, the greater is the amount of degeneration and cyst formation. Neurilemomas are rarely, if ever, malignant. They may recur if inadequately excised. They displace the bowel, ureters, and major vessels. The capsule is usually thick and very vascular. Angiographic studies are of value in determining location and operability. These tumors may be enucleated from the capsule using packs for control of the extensive venous bleeding. Radiation therapy, although not effective in treatment of the tumor, will result in a decrease in the blood supply. If a tumor is located in regions of difficult access and is very vascular, resection should be considered, based on the presence or absence of symptoms and the patient's age and general condition. After determining the diagnosis by biopsy and frozen section, the tumor may be left alone with less danger to the patient's life.