Issue: Vojnosanit Pregl 2021; Vol.78 (No. 6)
Schwannoma of the abdominal wall – diagnostic challenge
Authors:
Bojan Nikolić, Biserka Vukomanović Djurdjević, Miroslav Mitrović§, Jelena Golubović, Jasna Pešić
Introduction. Schwannoma or neurilemmoma is a benign tumor of the nerve sheath originating from the Schwann cells. Localization in abdominal wall is rare. Schwannomas usually manifest themselves as slow-growing asymptomatic tumors. Symptomatology depends on the location, the involved nerve and the size of the tumor. Case report. We present a 43-year-old female patient with a schwannoma localized in the right hypochondriac region. Diagnostic procedures included ultra-sound with color Doppler (US), highresolution magnetic resonance imaging (MRI), and histopathological examinations (HP). US showed a solid, well-circumscribed mass, with a whorled, echogenic internal architecture in the anterior abdominal wall. MRI revealed an oval, well-circumscribed, heterogeneous, 3 × 2.5 × 2.5 centimeters large fusiform mass. T1-weighted imaging presented low signal intensity, while T2-weighted image showed heterogeneously high signal intensity. The lesion was completely removed. After patho-histological analysis with standard and immunohistochemical methods of coloring, the diagnosis of the schwannoma was confirmed. Conclusion. Schwannoma as a slow-growing tumor, which is often without clinical manifestations, may cause a delay in diagnosis and treatment. Clinical presentation of a schwannoma is indolent and non-specific. Diagnosis of this tumor requires a multidisciplinary and interdisciplinary approach. MR is a useful and highly specific method for the verification of peripheral nerve sheath tumors. A HP analysis confirmed definitive diagnosis of the lesion.