British Journal of Urology (1998), 82, 917

CASE RE PORT

Intrapelvic neurilemmoma presenting with bladder outletobstructionN.S. SHARMA and M.J. LYNCHKettering General Hospital, Kettering, UK

and displacing the bladder to the right and superiorlyCase report

(Fig. 1); there was no ureteric obstruction. TRUS con-firmed a large echogenic mass in the pelvis, possiblyA 60-year-old man was referred with LUTS; uroflow-

metry showed a peak flow rate of 6 mL/s and a residual infiltrating through the pelvic floor. TRUS-guided biopsiesshowed a benign nerve sheath tumour. The patienturine volume of 377 mL. A DRE revealed a small benign

prostate and a large, smooth, rubbery swelling involving underwent a combined abdominoperineal resection ofthe tumour (Fig. 2). The cavity was packed for haemo-the pelvic floor. CT showed a 12 cm mass within the

pelvis, possibly arising from the left lobe of the prostate stasis and the pack was removed in the ward 2 daysafter surgery. Histology confirmed a 15×7×4.5 cmneurilemmoma. At the 1-year follow-up, he had novoiding or erectile diBculties and no neurological deficit.

Comment

Nerve-sheath tumours are commonly found over theperipheral nerves of the upper torso. Pelvic locations forthese tumours are rare and they are usually enormouswhen discovered. Presenting features can result fromdisplacement of adjacent organs and can include urinaryretention, sciatica and ureteric obstruction. We believethis to be the first case of such a tumour presenting withsymptoms arising from displacement of the bladder neck.These tumours are usually amenable to abdominal orabdominoperineal excision, although laparoscopicexcision has been described. Ultrasound-guided needlebiopsies provide a preoperative diagnosis in most

Fig. 1. CT showing the 12 cm mass between the bladder and patients. Preoperative embolization has been used torectum, with attenuation values of 17–26 Hounsfield units. reduce the size and vascularity by some operators.

References

1 Denes FI, Borelli M, Toledo VP, Goes GM. Pelvic neurilem-moma. Int Urol Nephrol 1978; 10: 279–83

2 Melwin WS. Laparoscopic resection of a pelvic schwannoma.Surg Laparoscopy Endoscopy 1996; 6: 489–91

Authors

N.S. Sharma, MS, FRCS, Registrar.M.J. Lynch, MS, FRCS(Urol), Consultant Urologist.Correspondence: Mr M.J. Lynch, Kettering General Hospital,Kettering NN16 8UZ, UK.

Fig. 2. The excised neurilemmoma.

917© 1998 British Journal of Urology