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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 April;59(2):115-20
Ileopsoas schwannoma with lii severe osteolisys
Gino G. C. 1, Boffano M. 2, Albertini U. 1, Tosco P. 3, Carannante G. 4, Bertoldo U. 1, Brach del Prever E. M. 1
1 Unità Complessa di Chirurgia Oncologica e Ricostruttiva Dipartimento di Ortopedia e Traumatologia AO CTO/Maria Adelaide, Torino, Torino, Italia
2 Scuola di Specializzazione in Ortopedia e Traumatologia Università degli Studi di Torino, Torino, Italia
3 Dipartimento di Ortopedia e Traumatologia AO CTO/Maria Adelaide, Torino, Torino, Italia
4 Unità Chirurgia Vertebrale Dipartimento di Ortopedia e Traumatologia AO CTO/Maria Adelaide, Torino, Torino, Italia
Schwannoma is a benign neoplasm, or amar-thoma for some authors, consisting of Schwann cells. The presentation can be asymptomatic or, more frequently, painful due to nerve compression. A retroperitoneal localization, particularly inside the ileopsoas muscle, is very rare. The aim of this article was to define different presentations and treatments for psoas schwannomas through a case report analysis. Authors present the analysis of a case of a schwannoma localized in the ileopsoas muscle surgically treated with en bloc excision, double surgical access and posterior vertebral stabilization. A review of literature was made using Pubmed, Ovid, Scirus; keywords used for the search were: neurinoma, schwannoma, retroperitoneal, psoas, in different combinations. Inclusion criteria for the search were the English, French, Italian language of the articles; no restriction was posed for the type of paper. The diagnosis and treatment of retroperitoneal schwannomas that have grown inside the psoas muscle have been evaluated in 9 case reports, with brief literature reviews. A neurinoma localized in the ileopsoas is a rare neoplasm and diagnosis is often accidental. The surgical approach is invasive and may be performed through laparotomic exploration, or double surgical access, depending on the structures involved; frequently peripheral nervous deficits persist.
Ileopsoas schwannoma treatment is difficult and cannot be standardized; adequate preoperatory staging and treatment in a specialized reference centre are mandatory.