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Special Feature
September 1, 2006

Image of the Month—Diagnosis

Arch Surg. 2006;141(9):942. doi:10.1001/archsurg.141.9.941-b

Operative resection was planned via laparoscopy, with an approach similar to that of a left adrenalectomy. Intraoperatively, a solid mass anterior and inferior to the left renal vein was identified; it appeared encapsulated and was easily dissected free from adjacent structures (Figure 2). Her postoperative course was uneventful and she was discharged home on hospital day 2. Pathologic examination demonstrated a 5.4 × 4.3 × 3.7-cm mass with a well-developed capsule. Tumor cells stained positive for S100 protein and CD34 cells and negative for desmin and muscle-specific actin, which is consistent with a benign schwannoma.

The majority of schwannomas occur in the head, neck, or extremities, with few cases reported originating in the retroperitoneum.1Because patients may be asymptomatic or only have vague abdominal pain, these schwannomas may be identified incidentally when evaluating other patient complaints or they may grow to large sizes prior to overt symptoms. Schwannomas are associated with von Recklinghausen disease in 5% to 18% of cases, and patients generally present between the ages of 20 and 50 years, with only 5% having onset in childhood or adolescence.2In the absence of von Recklinghausen disease, schwannomas rarely develop in the retroperitoneum, with only 3% of all sporadic schwannomas, both malignant and benign, occurring here.3When sporadic, they are typically benign lesions, particularly when identified in the retroperitoneum.

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