Malignant peripheral nerve sheath tumor arising from the greater omentum: Case report
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Malignant peripheral nerve sheath tumor arising from the greater omentum: Case report Masashi Miguchi, Yuji Takakura*, Hiroyuki Egi, Takao Hinoi, Tomohiro Adachi, Yasuo Kawaguchi, Manabu Shinomura, Masakazu Tokunaga, Masazumi Okajima, Hideki Ohdan
Abstract Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue tumors that arise from a peripheral nerve or exhibit nerve sheath differentiation. Most of these tumors arise on the trunk, extremities, or head and neck regions; they are very rarely located in the abdominal cavity. The patient was a 71-year-old man who was referred to our hospital for a mass and pain in the right lower abdomen. Abdominal computed tomography revealed a large (9 × 9 cm), well-circumscribed, lobulated, heterogeneously enhanced mass in the pelvis. Exploratory laparotomy revealed a large mass in the greater omentum, and the tumor was completely excised. Histopathological analysis revealed that the tumor was composed of spindle cells with high mitotic activity. On staining the tumor, positive results were obtained for S-100 but negative results were obtained for c-kit, cluster of differentiation (CD)34, asmooth muscle actin, and desmin. These findings strongly supported a diagnosis of MPNST primarily arising from the greater omentum. To the best of our knowledge, this is the first reported case of an MPNST arising from the greater omentum. In this report, we have described the case of a patient with an MPNST arising from the greater omentum and have discussed the clinical characteristics and management of MPNSTs. Background Primary solid omental tumors are rare and include various types of tumors such as gastrointestinal stromal tumors (GIST), leiomyosarcomas, hemangiocytomas, fibrosarcomas, leiomyomas, liposarcomas, desmoids tumors, fibromas, mesotheliomas, and myosarcomas [1]. Although the pathological spectrum of primary omental tumors is diverse, no report has yet been published on malignant peripheral nerve sheath tumors (MPNSTs) arising from the greater omentum. In this report, we describe the extremely rare case of a Japanese man who had an MPNST arising from the greater omentum. Case presentation The patient was a 71-year-old man who was healthy by birth and was admitted to our hospital with pain in the right lower abdomen. Physical examination revealed a large, firm, movable mass in the abdomen. The hematological tests, including those for the serum levels of * Correspondence: [email protected] Deparment of Gastroenterological Surgery, Hiroshima University Hospital 1-23 Kasumi, Minami-ku, Hiroshima city, Hiroshima 734-8551, Japan
tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA125, yielded normal results. Abdominal computed tomography (CT) revealed a large (approximately, 9 × 9 cm), well-circumscribed, lobulated mass in the pelvis. The central region of the mass appeared to have low density, while the marginal region was well enhanced in the CT scan (Figure 1A). CT/
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