Pelvic schwannoma in a 2-year-old boy: A case report

Abstract

Introduction

Schwannomas are benign tumors that arise from the Schwann cells found in peripheral nerve sheaths. These uncommon masses are rare tumors of childhood. When they do occur, the vast majority are located in the head and neck region. Pelvic schwannomas are exceedingly rare in patients under 10 years old.

Case presentation

A previously healthy 2-year-old boy presented with intermittent abdominal pain and poor appetite. Physical exam revealed a large, palpable abdominal mass that extended from the pelvis to well above the umbilicus. Ultrasound and CT imaging delineated a 14 cm mass that seemed to originate from the pre-sacral area. Rhabdomyosarcoma was the primary differential diagnosis, along with teratoma. An open biopsy was performed, and pathology revealed a cellular schwannoma. Given that the mass was non-malignant but symptomatic, the patient was taken for surgical resection. A midline laparotomy was performed and the mass carefully freed from surrounding structures. It was adherent but not invasive. Complete resection was performed without injury to surrounding structures. The patient discharged home on post-operative day 3 and has since had full symptom resolution. The final pathology was consistent with the original biopsy results. Genetic testing was negative for neurofibromatosis. While recurrence is unlikely, yearly ultrasounds are planned for monitoring.

Conclusion

Pelvic schwannoma is an uncommon, but important, addition to the differential diagnosis for pediatric pelvic masses and should be managed with surgical resection and genetic testing when encountered.