MRI Findings and Diagnostic Significance of Soft Tissue Schwannomas in the Extremities

Objective:To analyze the MRI features and rare manifestations of schwannomas of the extremities to improve diagnosis.Methods:Retrospective analysis of 23 cases of schwannomas in the extremities confirmed by surgical pathology,summarizing its signs,signal characteristics and MRI enhancement.Results:Among the 23 cases,20 were single lesions,and 3 were multiple lesions,resulting in a total of 28 lesions.The distribution of these lesions included 7 in the thigh,9 in the calves,4 in the armpits,3 in the hips,and 4 each in the upper arms and forearms.Additionally,there was one lesion located in the groin.On T1-weighted imaging(T1WI),the lesions showed iso-intensity or hypo-intensity.On T2-weighted imaging(T2WI),they appeared slightly hyperintense or hyper-intense.Some lesions exhibited multiple small vesicle-like higher signals,cystic changes,and fiber spacing on T2WI.Furthermore,one lesion showed a liquid-liquid plane.The“target sign”was observed in 18 lesions(64.3%)and“neuropathic signs”were present in six lesions(21.4%).Finally,it was noted that on MRI enhancement,the lesions demonstrated uniform or uneven enhancement.The lesions were uniformly or unevenly enhanced on MRI enhancement.Conclusions:The MRI findings of schwannoma in the extremities exhibit specific characteristics.The cystic changes on T2WI also display distinct features.Recognition of rare MRI findings,such as cystic changes,liquid-liquid plane and septum,should be emphasized to enhance the accuracy of pre-diagnosing schwannomas.

Giant Spinal Schwannomas. Presentation of Two Cases with Interdisciplinary Surgical Resection

Purpose: To report two quite rare cases of giant schwannomas of the cervical and thoracic spine. Surgical resection is usually the treatment of choice for these neoplasms. Methods: The first patient is a 48-year-old male that came to our department, complaining about weakness and paresthesia of both lower extremities and upper left extremity, and a considerably big dorsal palpable lump. MRI and CT scan were used to diagnose giant cervical schwannoma. Because of the intensity of symptoms, he was subjected to surgery. Multidisciplinary resection involving neurosurgical and oncosurgicalteamn was performed for intravertebral and extravertebral approaches. The second patient is a 55-year-old female that came to the hospital complaining about incapacitating pain and dysesthesia involving T6, T7, and T8 dermatomes, with no other deficits. MRI and CT scan were used to diagnose giant thoracic schwannoma. Because of the intensity of the pain, surgery was decided as the treatment of choice. Video assisted thoracoscopic surgery was performed and total resection was achieved, with improvement of the symptoms. Results: Both patients showed complete remission of the symptoms, with no major deficits after surgery. Conclusion: Although infrequent, giant spinal schwannomas may be the cause of visible lumps in the back with radicular symptoms. When asymptomatic, conservative treatment could be viable, but when they present symptoms, surgery offers good results.

Misdiagnosis of Facial Nerve Palsy: A Case Report of Sporadic Vestibular Schwannomas (Non-NFM2) Causing Facial Nerve Palsy Be Misled by Bell’s Palsy in a Child

We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.

Hemi-semi Laminectomy Approach for the Microsurgical Treatment of Spinal Schwannomas

Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the micro- surgical treatment of spinal schwannomas. Methods A total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We ret- rospectively analyzed the clinical outcomes of these patients. Results Of them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwarmomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symp- toms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred. Conclusion Hemi-semi laminectomy is a safe and effective method for resection of spinal schwan- nomas

Endoscopic ultrasound features of gastric schwannomas with radiological correlation:A case series report

Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract.They are usually misdiagnosed as other submucosal tumors preoperatively.Experience of the imaging features of gastric schwannomas is extremely limited.In this report,we summarize the features of a series of endoscopic ultrasound(EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate.We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results.Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity,and a well-demarcated margin.The tumors originated from the fourth layer.Cystic changes and calcification were uncommon.Marginal hypoechoic haloes were observed in two patients.The results described here were different from those of previous studies.In the EUS evaluation,the internal echogenicity of gastric schwannomas was heterogeneous and low,but slightly higher than that of muscularis pro-pria.These features might help us differentiate gastric schwannomas from other submucosal tumors.Further investigation is needed to differentiate these mesenchymal tumors.

Multiple schwannomas with pseudoglandular element synchronously occurring under the tongue:A case report

BACKGROUND Schwannoma is a rare benign,encapsulated tumor of the nerve sheath under the tongue,mostly occurring as solitary tumors with classical histological pattern and several common morphological variants.To our knowledge,multiple schwannomas with pseudoglandular element synchronously occurring under the tongue are rare;we report herein the first such case.CASE SUMMARY A 53-year-old man had first noticed an isolated asymptomatic mass under the tongue,and as the mass grew,the tongue was elevated.Physical examination showed multiple oval neoplasms,and the overlying mucosa was normal.Computed tomography showed three low-density oval neoplasms under the tongue,which were cystic-solid with unclear boundary.The patient has no cutaneous tumors,VIII nerve tumors,or lens opacities and no history of neurofibromatosis 2 or confirmed schwannomatosis in any first-degree relative.Magnetic resonance imaging showed no evidence of vestibular schwannoma.The preoperative diagnosis was mucoepidermoid carcinoma.During hospitalization,all neoplasms were completely excised by surgeons through an intraoral approach under general anesthesia.The diagnosis of the multiple schwannomas with pseudoglandular element was made by histopathology after surgery.At the 15-mo follow-up visit,the patient had no sign of recurrence or development of other peripheral nerve tumors.CONCLUSION Although rare,multiple schwannomas with pseudoglandular element do exist in patients presenting with masses under the tongue.Oral surgeons should be aware of the existence of multiple schwannomas with pseudoglandular element when considering masses under the tongue due to the different prognosis between multiple schwannomas with pseudoglandular element and mucoepidermoid carcinoma.

THE ANALYSIS OF NF2 GENE MUTATION IN SPORADIC SCHWANNOMAS

Objective To analyze the mutation of NF2 gene (exon 2,4,6 and 13) in schwannomas. Methods The NF2 gene mutation in 36 schwannomas were observed by PCR-SSCP and DNA sequence. The proliferative index of schwannoma was detected by immunohistochemistry. Results We found 13 mutations in 36 schwannomas, including 6 deletion or insertion resulting in a frameshift, 2 nonsense mutations, 2 missense mutations, and 3 alterations affecting acceptor or donor of splicing sites in E4,E6,E13. The proliferative index of schwannomas with mutation were significantly higher than those without mutation(P<0.05). Conclusion NF2 gene mutation is the frequent event in the tumorigenesis of schwannomas, and there is some correlation between the mutation and clinical behavior(tumor proliferation).

Evaluation of Vestibular Function in Diagnosis of Vestibular Schwannomas

Vestibular schwannomas(VS)are benign tumors of the vestibular nerve.The common first symptoms are hearing loss and tinnitus,followed by imbalance,vertigo,and facial nerve involvement.The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests,which often interfere with clinicians’diagnoses.Thus,the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging(MRI),ignoring the evaluation of vestibular function at the source of pathological lesions.With the development and improvement of vestibular evaluation technology and its wide application in the clinic,modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives,providing an objective basis for the diagnosis and treatment of vestibular diseases.In this report,we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.

Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review

BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach′s plexus or less frequently from Meissner′s plexus.The main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors(GISTs),which are classified by their immunohistochemistry.The treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important role.Wedge resection,subtotal or total gastrectomy can be done.In its counterpart,esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2%of all esophageal tumors.The main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor,followed by GIST.The treatment consists on tumoral enucleation or esophagectomy.AIM To review the available literature about gastrointestinal schwannomas;especially lesions from de stomach and esophagus,including diagnosis,treatment,and follow up,as well as,reporting our institutional experience.METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines.The following databases were used for reviewing process:Pub Med,Ovid,MEDLINE,and Scopus.Only English language manuscripts were included.All gastrointestinal schwannomas specifically located in the esophagus and stomach were included.Cases that did not report long-term follow-up were excluded.RESULTS Gastric localization showed a higher prevalence in both,the literature review and our institution:94.95%(n=317)and 83%(n=5)respectively.With a follow-up with disease-free survival greater than 36 mo in most cases:62.01%(n=80)vs66.66%(n=4).In both groups,the median size was>4.1 cm.Surgical treatment is curative in most cases CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal tumors.It has a good prognosis,and most are benign.A disease-free survival of more than 36 mo can be achieved by surgery.

Expression of vascular endothelial growth factor and its receptors VEGFR-1 and 2 in gastrointestinal stromal tumors,leiomyomas and schwannomas

AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs, 15 leiomyomas and 6 schwannomas were examined by immunohistochemistry in this study. RESULTS： VEGF protein was expressed in the cytoplasm of tumor cells, and VEGFRol and 2 were expressed both in the cytoplasm and on the membrane of all tumors. Irnrnunohistochernical staining revealed that 26 GISTs （78.8%）, 9 leiornyornas （60.0%） and 3 schwannornas （50.0%/were positive for VEGF; 24 GISTs （72.7%/, 12 leiornyornas （80.0%） and 4 schwannornas （66.7%） were positive for VEGFR-1; 30 GISTs （90.9%/, 5 leiornyornas （33.3%/and 4 schwannornas （66.7%） were positive for VEGFR-2. VEGFR-2 expression was statistically different between GISTs and leiomyomas （P 〈 0.0001）. However, there was no correlation between the expression of VEGF pathway componenets and the clinical risk categories. CONCLUSION： Our results suggest that the VEGF pathway may play an important role in the differentiation of GISTs, leiomyomas and schwannomas.

Expression of Ets-1 proto-oncoprotein in gastrointestinal stromal tumors, leiomyomas and schwannomas

AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the role of Ets-1 in the growth and differentiation of GISTs. METHODS： Twenty-eight GISTs, nine leiomyomas and six schwannomas were examined by immunohistochemical staining method for Ets-1 in this study. Specimens were selected from surgical pathology archival tissues at Nagasaki University Hospital. RESULTS： Ets-1 protein was expressed in the cytoplasm of cells in all of these tumors. Immunohistochemical staining revealed that 27 GISTs （96.4%）, six leiomyomas （66.7%）, and five schwannomas （83.3%） were positive for Ets-1. Ets-1 expression was statistically different between GISTs and leiomyomas （P〈0.005）. However, there was no correlation between Ets-1 expression and clinical risk categories. CONCLUSION： Ets-1 plays an important role in the growth and differentiation of GISTs, leiomyomas and schwannomas.

Clinical outcome after surgery on schwannomas in the extremities

BACKGROUND Schwannoma is a benign,encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system.Typical symptoms are soreness,radiating pain and sensory loss combined with a soft tissue mass.AIM To evaluate pre-and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation.METHODS In this single center retrospective study design,all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included.The location of the tumor in the extremities was divided into five groups;forearm,arm,shoulder,thigh and leg including foot.The locations of the tumor in the nerves were also categorized as either;proximal,distal,minor or major nerve.During the pre-and postoperative clinical evaluation,symptoms were classified as paresthesia,local pain,radiating pain,swelling,impairment of mobility/strength and asymptomatic tumors that were found incidentally(with magnetic resonance imaging).The patients were evaluated after surgery using the following categories:Asymptomatic or symptomatic patients(radiating and/or local pain)and those with complications.The follow up period was from the time of surgery until last examination of the particular physician.Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up.RESULTS We identified 858 cases from the institutional pathology register.We excluded cases with duplicate diagnoses(n=407),pathology not including schwannomas(n=157),lesions involving the torso,spine and neck(n=150)leaving 144 patients for further analysis.In this group 99 patients underwent surgery and there were five complications recorded:2 infections(treated with antibiotics)and 3 nerve palsies(2 involving the radial nerve and one involving the median nerve)that recovered spontaneously.At the end of follow-up,1.4 mo(range 0.5-76)postoperatively,we recorded a post-operative decrease in clinical symptoms:Local pain 76%(6/25),radiating pain 97%(2/45),swelling 20%(8/10).Symptoms of paresthesia increased by 2.8%(37/36)and there was no change in motor weakness before and after surgery 1%(1/1).Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves(odds ratio:2.63;confidence intervals:1.22-6.42,P=0.029).One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor.No local recurrences were reported.CONCLUSION Surgery of schwannomas can be conducted with low risk of postoperative complications,acceptable decrease in clinical symptoms and risk of malignant transformation is low.

Management of Spinal Schwannomas in Gabriel TouréHospital: Review of 11 Cases

Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Touré Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23 - 62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resec-tion was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all cases. Postoperative complications developed in two patients, including one with cerebrospinal fluid leakage and other one with wound infection. In the short-term follow-up period, most of the patients (90.9%) appeared to be improved in comparison with their preoperative neurological status. There was no operative mortality. Conclusion: In this study, the clinical manifestations and surgical results of 11 cases of spinal schwannoma have been reviewed. Early diagnosis and appropriate treatment are essential for good outcome.

Management of intratemporal facial nerve schwannomas: The evolution of treatment paradigms from 2000-2015

Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several signs and symptoms which can suggest the facial nerve as the origin of the tumor. Intratemporal FNS can be multiple, like "beads on a string", or solitary lesions of the internal auditory canal. This variable tumormorphology necessitates multiple treatment options to allow patients the best chance of preservation of facial nerve function. Historically FNS were managed with resection of the nerve with cable grafting. However this leaves the patient with permanent facial weakness and asymmetry. Currently most patients find this outcome unacceptable, especially when they present with good to normal facial nerve function. Facial paralysis has a significantly negative impact on quality life, so treatment regimens that spare facial nerve function have been used in patients who present with moderate to good facial nerve function. Nerve sparing options include tumor debulking, decompression of the bony facial canal, radiosurgery, and observation. The choice of management depends on the degree of facial nerve dysfunction at presentation, hearing status in the affected ear, medical comorbidities and patient preference. Each treatment option will be discussed in detail and suggestions for patient management will be presented.

Microsurgical Management of Vestibular Schwannomas with Brainstem Compression: Surgical Challenges and Outcome

Background: Vestibular schwannomas exerting brainstem compression with or without hydrocephalus are challenging for neurosurgeons regarding the plan of surgery, operative risk and postoperative sequale. Purpose: To report our experience with the surgical challenges and outcomes for Hannover type T4a & T4b vestibular schwannomas. Methods: Retrospective case study conducted at neurosurgery department, Mansoura University between October 2016 and May 2019 of 16 patients with vestibular schwannoma compressing the brainstem. We reviewed their clinical, radiological, surgical data, incidence of complications and outcome. Results: We had 16 patients: 10 of Hanover grade T4b and 6 of grade T4a. Gross total resection was achieved in 2 cases while subtotal resection was achieved in 5 cases and in the remaining 9 cases;only partial resection was feasible. We had 4 cases of mortality. Among new onset morbidity after surgery, 3 cases had post-operative bulbar manifestation and 4 cases had brainstem dysfunction. Conclusion: Vestibular schwannomas compressing the brain stem are challenging in their clinical presentation, surgery and post-operative outcome. The outcome of patients treated with hydrocephalus prior to vestibular schwannoma surgery is better than those who did initial VS surgery. Patients presented with significant brainstem, bulbar manifestation had worse outcome and needed longer ICU stay and longer time for recovery.

Comprehensive evaluation of rare case:From diagnosis to treatment of a sigmoid Schwannoma:A case report

BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve trunks,with rarity in the gastrointestinal tract.Among gastrointestinal locations,the stomach harbors the majority of nerve sheath tumors,while such occurrences in the sigmoid colon are exceptionally infrequent.CASE SUMMARY This study presented a clinical case involving a 60-year-old female patient who,during colonoscopy,was diagnosed with a submucosal lesion that was later identified as a nerve sheath tumor.The patient underwent surgical resection,and the diagnosis was confirmed through immunohistochemistry.This study highlighted an exceptionally uncommon occurrence of a nerve sheath tumor in the sigmoid colon,which was effectively managed within our department.Additionally,a comprehensive review of relevant studies was conducted.CONCLUSION The preoperative diagnosis of nerve sheath tumors poses challenges,as the definitive diagnosis still relies on pathology and immunohistochemistry.Although categorized as benign,these tumors have the potential to demonstrate malignant behavior.Consequently,the optimal treatment approach entails the complete surgical excision of the tumor,ensuring the absence of residual lesions at the margins.

Concomitant treatment of ureteral calculi and ipsilateral pelvic sciatic nerve schwannoma with transperitoneal laparoscopic approach: A case report

BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.

Endoscopic“calabash”ligation and resection for small gastric mesenchymal tumors

BACKGROUND Gastric mesenchymal tumors(GMT)are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract.GMT pri-marily encompass gastric stromal tumors(GST),gastric leiomyomas,and gastric schwannomas.Although most GMT are benign,there are still potential malignant changes,especially GST.Thus,early surgical intervention is the primary treat-ment for GMT.We have designed a simple endoscopic“calabash”ligation and resection(ECLR)procedure to treat GMT.Its efficacy and safety need to be com-pared with those of traditional endoscopic techniques,such as endoscopic sub-mucosal excavation(ESE).AIM To assess the safety and effectiveness of ECLR in managing small GMT(sGMT)with a maximum diameter≤20 mm by comparing to ESE.METHODS This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023,underwent endoscopic resection,and received a pathological diagnosis of GMT.Cases with a tumor diameter≤20 mm were chosen and categorized into two cohorts:Study and control groups.The study group was composed of patients treated with ECLR,whereas the control group was composed of those treated with ESE.Data on general clinical characteristics(gender,age,tumor diameter,tumor growth direction,tumor pathological type,and risk grade),surgery-related information(complete tumor resection rate,operation duration,hospitalization duration,hospitalization cost,and surgical complications),and postoperative follow-up were collected for both groups.The aforementioned data were subsequently analyzed and compared.RESULTS Five hundred and eighty-nine individuals were included,with 297 cases in the control group and 292 in the study group.After propensity score matching,the final analysis incorporated 260 subjects in each cohort.The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group.Furthermore,the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group.There were no substantial variations observed in other parameters among the two cohorts.CONCLUSION ECLR is a viable and effective approach for managing sGMT.

Unusual Giant Pre-Sacral Multicystic Schwannoma: A Case Report and Differential Diagnosis

Background: Schwannomas are generally benign neoplasms arising from the nerve sheath. Presacral schwannomas are very rare entities and difficult to diagnose, representing less than 15% of all retrorectal space tumors. Benign schwannoma sometimes displays degenerative changes, such as cyst formation, calcification, hemorrhage, and hyalinization. Usually these degenerations are partially seen in the tumors. Objective: To point out that presacral schwannoma can display markedly multilocular cystic degeneration. Case Report: We present this unique case of a 24-year-old man diagnosed with an unusually large pure multilocular cystic schwannoma, which is revealed by digestive, urinary, and nonspecific neurological symptoms. The patient was successfully treated with radical surgery via an anterior approach leading to the recovery of symptoms. Discussion and Conclusion: This tumor was unusual in its totally multicystic appearance and its resemblance to a wide spectrum of lesions that can occur in the pre-sacral space, such as hydatid and developmental cysts. Preoperative diagnosis is essential to prevent major neurological deficits during surgical intervention.

Solitary intraosseous neurofibroma in the mandible mimicking a cystic lesion:A case report and review of literature

BACKGROUND Neurofibromas are benign tumors of a neurogenic origin.If these tumors occur without any other signs of neurofibromatosis,they are classified as isolated neurofibromas.Neurofibromas in the oral cavity mostly occur within soft tissues,indicating that solitary intraosseous neurofibromas in the mandible are rare.Due to the absence of specific clinical manifestations,early diagnosis and treatment of these tumors are difficult to achieve.CASE SUMMARY A 37-year-old female patient visited our hospital due to numbness and swelling of the gums in the right lower molar area that had persisted for half a month.The patient’s overall condition and intraoral examination revealed no significant abnormalities.She was initially diagnosed with a cystic lesion in the right mandible.However,after a more thorough examination,the final pathological diagnosis was confirmed to be neurofibroma.Complete tumor resection and partial removal of the right inferior alveolar nerve were performed.As of writing this report,there have been no signs of tumor recurrence for nine months following the surgery.CONCLUSION This case report discusses the key features that are useful for differentiating solitary intraosseous neurofibromas from other cystic lesions.