Schwannoma in Pelvis: A Diagnostic Dilemma

Abstract

Schwannoma is the most common benign nerve sheath tumors generally occurring in head and neck and extremities. Schwannomas are very rarely found in pelvic region and are often labeled as gynecological or urological masses in the preoperative workup. Here we present a 40-year-old female patient who presented with micturition difficulty. Initial evaluation by CT and MRI showed a 10-cm pre-sacral mass abutting the bladder and rectum. Biopsy revealed a benign schwannoma. Laparotomy was planned, and we found a 10 × 10 cm mass in pre-sacral space adherent to sigmoid colon, rectum, posterior wall of uterus, bilateral ureters and left internal iliac vessels. Mass was mobilized from surrounding viscera and was excised in toto. Histopathology revealed a 10 × 7×4 cm benign schwannoma. Patient recovered without any complications. Retroperitoneal schwannomas are very rare, and biopsy is required to ascertain the correct diagnosis as radiological features are non-specific. Surgical excision is the only curative option. Most cases will require simple excision or enucleation of the tumor without requirement of major visceral resections.