|Year : 2018 | Volume
| Issue : 1 | Page : 48-49
Isolated psoas schwannoma: A rare retroperitoneal tumor
Mohd Ilyas, Zubair Ahmad, Irshad Ahmad Banday, Suhail Rafiq, Naseer Choh
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||30-May-2018|
Dr. Mohd Ilyas
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar - 190 011, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Retroperitoneal neurogenic tumors are very rare. Isolated or primary psoas schwannoma is one of the rarest tumors of retroperitoneum. The images of such a case are presented in this report.
Keywords: Imaging, psoas muscle, schwannoma
|How to cite this article:|
Ilyas M, Ahmad Z, Banday IA, Rafiq S, Choh N. Isolated psoas schwannoma: A rare retroperitoneal tumor. Acta Med Int 2018;5:48-9
| Introduction|| |
Schwannomas are the benign tumors arising from the Schwann cells of the peripheral nerves. Retroperitoneum is one the rarest locations for schwannomas, except in cases of von Recklinghausen's disease.
| Case Report|| |
A 25-year-old male presented with the chief complaints of colicky left flank pain and burning micturition for 2 weeks. The ultrasonography revealed moderate left-sided ureterohydronephrosis (Grade-II) with 4 cm × 4.3 cm hypoechoic lesion in the left psoas region [Figure 1].
|Figure 1: (a) Sonographic image of the left kidney showing the Grade-II hydronephrosis. (b) Sonographic image showing a hypoechoic lesion in the left psoas muscle|
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The magnetic resonance (MR) imaging revealed Grade-II left hydronephrosis with dilated upper and an altered signal intensity lesion lying beneath the psoas fascia compressing the ureter. The lesion was well defined, hyperintense on T2 and short inversion time inversion recovery sequences showing homogeneous intense enhancement. The MR features were suggestive of benign neurogenic tumor [Figure 2]. The histopathological examination from biopsy specimen revealed the features of schwannoma.
|Figure 2: Magnetic resonance images showing the Grade-II hydronephrosis of left kidney showing (a) hyperenhancing lesion in the left psoas muscle (b) and lesion in the subfascial region of the left psoas muscle (c)|
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The patient underwent resection of the lesion. The hydronephrosis resolved over next 3 weeks. The patient is under follow-up and presently free of symptoms.
| Discussion|| |
Psoas schwannoma is one the most unusual extrinsic causes of hydronephrosis. The present case displays a unique presentation of psoas schwannoma as a cause of urinary obstruction and flank pain. The retroperitoneum comprises only 0.5%–5% of cases of schwannomas in patients who do not have von Recklinghausen's disease. These tumors may present as recurrent chronic abdominal pain and colicky pain in cases of urinary obstruction and may remain asymptomatic in cases where the mass effect on adjacent structures is minimal. Clinically and sonographically, it may be confused with psoas abscess, but MR imaging and histopathology form the gold standard for accurate diagnosis. The complete excision with negative margins results in full recovery as in the present case.
| Conclusion|| |
Psoas muscle schwannoma is a rare retroperitoneal tumor and MR imaging plays a pivotal role in the diagnosis and exact delineation of the tumor extent and location.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Makhoul E, Kamel R, Hanna N. Schwannoma of the psoas: An unusual cause of abdominal pain. Arab J Gastroenterol 2017;18:44-6.
Claes H, Oyen R, Stessens R, Vereecken R. Solitary benign schwannoma in the psoas muscle. J Urol 1987;137:753-6.
[Figure 1], [Figure 2]