Особенности диагностики и хирургического лечения больных забрюшинными шванномами (обзор литературы)
Особенности диагностики и хирургического лечения больных забрюшинными шванномами (обзор литературы)
Бугаев В.Е., Никулин М.П., Меликов С.А. Особенности диагностики и хирургического лечения больных забрюшинными шванномами (обзор литературы). Современная Онкология. 2017; 19 (4): 28–35.
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Bugaev V.E., Nikulin M.P., Melikov S.A. Principles of diagnosis and surgical treatment of patients with retroperitoneal schwannomas. Journal of Modern Oncology. 2017; 19 (4): 28–35.
Особенности диагностики и хирургического лечения больных забрюшинными шванномами (обзор литературы)
Бугаев В.Е., Никулин М.П., Меликов С.А. Особенности диагностики и хирургического лечения больных забрюшинными шванномами (обзор литературы). Современная Онкология. 2017; 19 (4): 28–35.
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Bugaev V.E., Nikulin M.P., Melikov S.A. Principles of diagnosis and surgical treatment of patients with retroperitoneal schwannomas. Journal of Modern Oncology. 2017; 19 (4): 28–35.
Шванномы являются опухолями, исходящими из шванновских клеток оболочек периферических нервов. В большинстве случаев шванномы представляют собой доброкачественную опухоль, однако встречаются и злокачественные формы. Забрюшинная локализация является редкой формой шванномы. Низкая частота встречаемости забрюшинных шванном затрудняет выработку единых подходов диагностики, хирургического лечения и дальнейшего наблюдения этой группы больных. На предоперационном этапе определение злокачественного потенциала опухоли представляет сложности. Проведение иммуногистохимического исследования удаленной опухоли позволяет точно дифференцировать ее гистогенез и определить степень злокачественности. Радикальное хирургическое вмешательство является единственным методом лечения, позволяющим добиться оптимальных отдаленных результатов. Особенности анатомического расположения тазовых шванном обусловливают высокую частоту комбинированных резекций, а также значительные риски интраоперационной кровопотери.
В зависимости от распространенности опухолевого процесса при тазовой локализации дискутабельными остаются выбор оптимального оперативного доступа, необходимость в резекции крестца и нервов. При доброкачественной шванноме прогноз отдаленной выживаемости благоприятный, в то время как при злокачественной форме отмечается высокая частота рецидивов.
Schwannomas are rare tumors that arise from well-differentiated schwannoma cells of peripheral nerve sheaths. Schwannomas are usually benign tumors. However, malignant form of schwannomas may occur, which is associated with high recurrence rate and unfavorable long-term prognosis. Retroperitoneal localization of schwannomas is rare. With a little data available it is difficult to develop a unified approach for preoperative evaluation, surgical treatment and follow-up of patients with retroperitoneal schwannomas. Assessment of malignant potential of tumor before resection is challenging while immunohistochemical analysis of resected specimen allows to clearly define histological type and malignant grade of tumor. Complete resection of retroperitoneal schwannoma is the only treatment option that may provide acceptable long-term results. As most of the retroperitoneal schwannomas are localized in an anatomical complex area there is high risk of combined resection and massive intraoperative blood loss. Choice of optimal operative approach, necessity of sacral and nerve resection depending on the degree of disease extent remains the matter of debates. Benign retroperitoneal schwannomas have favourable prognosis for long-term survival while malignant tumors are associated with high recurrence rate.
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1. Stilidi I.S., Abgarian M.G., Kalinin A.E. i dr. Khirurgicheskoe lechenie bol'noi intraabdominal'noi zlokachestvennoi shvannomoi. Khirurgiia. Zhurn. im. N.I.Pirogova. 2017; 9: 91–4. [in Russian]
2. Knight D, Birch R, Pringle J. Benign solitary schwannomas: A Review of 234 Cases. J Bone Joint Surg 2007; 89-B (3): 382–7. DOI:10.1302/ 0301-620x.89b3.18123.
3. Patocskai EJ, Tabatabaian M, Thomas MJ. Cellular schwannoma: a rare presacral tumour. Can J Surg 2002; 45 (2): 141–4.
4. Daneshmand S, Youssefzadeh D, Chamie K et al. Benign retroperitoneal schwannoma: a case series and review of the literature. Urology 2003; 62 (6): 993–7. DOI: 10.1016/s0090-4295(03)00792-1.
5. Li Q, Gao C, Juzi J et al. Analysis of 82 cases of retroperitoneal schwannoma. ANZ J Surg 2007; 77 (4): 237–40. DOI:10.1111/j.1445-2197.2007 .04025.x.
6. Song J, Kim S, Park E et al. Schwannoma in the retroperitoneum. J Obstet Gynaecol Res 2007; 33 (3): 371–5. DOI:10.1111/j.1447-0756.2007. 00539.x.
7. Melikov C.A. Neirogennye opukholi zabriushinnogo prostranstva: sovremennye metody diagnostiki i lecheniia. Dis. … kand. med. nauk. M., 2012. [in Russian]
8. Sridhar K, Ramamurthi R, Vasudevan M et al. Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg: Spine 2001; 94 (2): 210–5. DOI: 10.3171/spi.2001.94.2.0210.
9. Ozdemir N, Bezircioglu H, Akar O. Giant erosive spinal schwannomas: surgical management. Brit J Neurosurg 2010; 24 (5): 526–31. DOI: 10.3109/02688697.2010.487129.
10. Alfieri A, Campello M, Broger M et al. Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up. J Neurosurg: Spine 2011; 14 (2): 167–71. DOI: 10.3171/2010. 10.spine1015.
11. Park S, Chung S, Choe G et al. Spinal Intraosseous Schwannoma: A Case Report and Review. J Korean Neurosurgical Soc 2009; 46 (4): 403. DOI: 10.3340/jkns.2009.46.4.403.
12. Klimo P, Rao G, Schmidt R et al. Nerve sheath tumors involving the sacrum. Neurosurgical Focus 2003; 15 (2): 1–6. DOI: 10.3171/foc.2003. 15.2.12.
13. Dominguez J, Lobato RD, Ramos A et al. Giant intrasacral schwannomas: Report of six cases. Acta Neurochirurgica 1997; 139 (10): 954–60. DOI: 10.1007/bf01411305.
14. Tishchenko A.M., Skoryi D.I., Smachilo R.M. Shvannoma zabriushinnogo prostranstva – diagnosticheskaia zagadka dlia khirurga. Klin. onkologiia. 2016; 1 (21): 3–5. [in Russian]
15. Kalaycı M, Akyüz U, Demirağ A et al. Retroperitoneal Schwannoma: A Rare Case. Case Reports Gastrointestinal Med 2011; 2011: 1–3. DOI: 10.1155/2011/465062.
16. Hughes M, Thomas J, Fisher C et al. Imaging features of retroperitoneal and pelvic schwannomas. Clin Radiol 2005; 60 (8): 886–93. DOI: 10.1016/j.crad.2005.01.016.
17. Choudry H, Nikfarjam M, Liang J et al. Diagnosis and management of retroperitoneal ancient schwannomas. World J Surg Oncol 2009; 7 (1): 12. DOI: 10.1186/1477-7819-7-12.
18. Soderlund V, Goranson H, Bauer H. MR imaging of benign peripheral nerve sheath tumors. Acta Radiologica 1994; 35 (3): 282–6. DOI: 10.3109/02841859409172383.
19. Hayasaka K, Tanaka Y, Soeda S et al. MR Findings in Primary Retroperitoneal Schwannoma. Acta Radiologica 1999; 40 (1): 78–82. DOI: 10.1080/02841859909174408.
20. Hijioka S, Sawaki A, Mizuno N et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of retroperitoneal schwannoma. Endoscopy 2010; 42 (S 02): E296. DOI: 10.1055/s-0030-1255786.
21. Theodosopoulos T, Stafyla V, Tsiantoula P et al. Special problems encountering surgical management of large retroperitoneal schwannomas. World J Surg Oncol 2008; 6 (1): 107. DOI: 10.1186/1477-7819-6-107.
22. Iwasaki M, Nakamura K, Takeshita K et al. Surgical Management of Giant Schwannoma in the Lumbosacral Region. J Spinal Dis. 1998; 11 (5): 444–7. DOI: 10.1097/00002517-199810000-00012.
23. Kinoshita T, Naganuma H, Ishii K et al. CT features of retroperitoneal neurilemmoma. Eur J Radiol 1998; 27 (1): 67–71. DOI: 10.1016/s0720-048x (97)00032-6.
24. Stepanova Iu.A., Grishankov S.A., Karel'skaia N.A. i dr. Neorgannaia zabriushinnaia shvannoma (klinicheskoe nabliudenie). Klin. praktika. 2016; 2: 58–66. [in Russian]
25. Hide I, Baudouin C, Murray S et al. Giant ancient schwannoma of the pelvis. Skeletal Radiol 2000; 29 (9): 538–42. DOI: 10.1007/s0025 60000266.
26. Walczak DA, Jaguscik R, Olborski B et al. Retroperitoneal «ancient» Schwannoma – a rare case of rare location: Case report and literature review. Pol Przegl Chir 2012; 84: 646–50.
27. Veliovits D, Fiska A, Zorbas G et al. Retroperitoneal schwannomas. Am J Case Reports 2012; 13: 244–6. DOI: 10.12659/ajcr.883494.
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Авторы
В.Е.Бугаев*, М.П.Никулин, С.А.Меликов
ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23
*vladbugaev@mail.ru
________________________________________________
V.E.Bugaev*, M.P.Nikulin, S.A.Melikov
N.N.Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23
*vladbugaev@mail.ru