[Intra-abdominal schwannoma. Diagnosis and surgical therapy]

We report three patients who were operated on because of an intraabdominal schwannoma between February 1991 and October 1994 in our department. In the first case, a benign gastric schwannoma was treated by a distal gastric resection (Billroth II); the main symptom was gastric bleeding. In the second case, a malignant duodenal schwannoma with liver metastasis was treated by wide en-bloc resection of the tumor including retroperitoneal lymphadenectomy and an anatomical resection of the right lobe of the liver. A metachronous metastasis of the liver, appearing 7 months postoperatively, was treated by intraparenchymatous laser coagulation; a local recurrence, appearing 19 months postoperatively, led to another tumor resection. The main symptom was a palpable intraabdominal mass in this case. In the third case, a malignant schwannoma of the abdominal wall was resected in fragments in another clinic. Six months later a local recurrence with infiltration of the liver appeared in spite of postoperative radiation and was resected en bloc. Early peritoneal sarcomatosis was apparent at that time. Postoperative chemotherapy did not prevent quick progression of the tumor. The patient died 18 months after the first operation. The clinical presentation, differential diagnosis and operative strategy for benign and malignant intraabdominal schwannomas are discussed.