Multiple Intestinal cystic schwannoma mimicking an ovarian tumor with carcinomatosis: case report

¹University Mohammed VI, General Surgery, Oujda, Morocco

^&Corresponding author
Khalil Maamar, University Mohammed VI, General Surgery, Oujda, Morocco

Introduction    

Schwannoma is a benign tumor of ectodermal origin developed from the nerve sheath that envelops the axons. The incidence of gastrointestinal schwannoma is extremely low, and it mainly occurs in the stomach but rarely in the intestines. Intestinal schwannoma lacks specific clinical manifestations, and its symptoms mainly depend on the size and location of the tumor. We report a case of an intestinal cystic schwannoma simulating an ovarian tumor.

Patient and observation     

We present a case of a-41 year old woman, mother of 4 living children, with no notable pathological history who has had pelvic pain for 4 months with signs of urinary compression. The clinical examination is without particularity. The tumor markers: CA125, ACE, CA 15-9 were negative, the objective pelvic ultrasound in the left lateral uterine, a rounded image of 79/69 mm net contours with double fluid and tissue components (Figure 1). The abdominal and pelvic CT was favorable of a mass probably of ovarian origin associated with multiple intraperitoneal cystic nodules (Figure 2). Laparoscopic exploration revealed a huge vascularized tumor (Figure 3) at the expense of the prolapsed intestine in the pouch of Douglas. Conversion to mini para-umbilical laparotomy allowed resection of the hail carrying the tumor with anastomosis. The postoperative follow-up was simple and the result of the anatomopathology was in favor of a multiple intestinal cystic schwannoma.

Discussion     

Gastrointestinal schwannomas are rare mesenchymal tumors, and account for approximately 5% of all mesenchymal tumors [1,2]. Schwannomas can be solitary or multiple, the most common site (60-70% of all GI cases) is the stomach, followed by the colon and rectum (3%) {1] , Small-intestinal and esophageal schwannomas have been very rarely reported [3]. Most GI schwannomas are incidental findings during screening colonoscopy or imaging [2] the size of the tumor does not condition the prognosis. In a systematic literature review of schwannomas of the colon and rectum published by Bohlok et al. a large portion of patients were asymptomatic on diagnosis (36%), but others presented with rectorrhagia, abdominal pain, or constipation [4]. Other studies noted that GI schwannomas can manifest as colonic obstructions or as intussusceptions [5,6]. Advances in imaging, however, have made it possible to diagnose these tumors earlier, at the first manifestations or sometimes accidentally before their appearance or they can simulate an ovarian tumor as is the case in our observation. The abdominal CT scan is a test of choice to highlight and specify the extent of the tumor before an excisional procedure. With CT imaging, it appears as an exophytic mass with homogenous enhancement. Cystic changes, necrosis, or calcifications within tumors are not commonly found [7]. The complete surgical resection seems to be the treatment of choice because of the preoperative diagnostic uncertainty and the excellent long-term outcome, as these tumors are uniformly benign [8,9] .

Conclusion     

Neurogenic tumors of the small intestine are extremely rare. Although schwannoma is often clinically indolent for many years, complications such as gut compression or bleeding might occur. In these cases, surgical management is required.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

All the authors have read and agreed to the final manuscript.

Figures     

Figure 1: pelvic ultrasound: Image of 79/69 mm net contours with double fluid and tissue components

Figure 2: abdominal and pelvic CT scan: a rounded image of 684/679 mm probably of ovarian origin

Figure 3: tumor depending of large bowel

References