To the content
1 . 2022

Difficulties in differential diagnosis and treatment tactics of presacral formations in a patient with rectal cancer progression (case report)


Aim – to present a rare case of a benign presacral neurogenic tumor, preoperatively regarded as a local recurrence of colorectal cancer, in a patient with colorectal liver metastases, which had a cardiotoxic effect of chemotherapy.

Key points. A patient previously underwent anterior resection due to cancer of the upper rectum and received chemotherapy for the liver metastases diagnosed in the late postoperative period.

Due to specific hyperfixation of a contrast in the presacral area, near the colorectal anastomosis, and previously diagnosed liver metastases, the patient underwent an extrafascial low anterior resection, atypical liver resection of S4, S5/S8, S7. There were no complications in the postoperative period. Histological examination of the specimens demonstrated the presence of a benign neurogenic tumor in the presacral area, as well as metastases of adenocarcinoma in the resected liver tissue.

Conclusion. Resection of presacral tumors, regardless of their nature, usually leads to the development of neurological disorders. Safe and radical removal of such tumors, as well as the complexity of the following postoperative management, requires a multidisciplinary team, including surgeons of various specializations (coloproctology, neurosurgery, urology) and neurologists, rehabilitation therapists to ensure optimal course of the intraoperative and postoperative period, reducing the duration of inpatient treatment, and ensuring the timely resumption of chemotherapy.

Keywords:colorectal cancer; metastatic colorectal cancer; schwannoma; presacral tumor; case report

Funding. The work was carried out within the framework of research work 0394-2021-0011.
Conflict of interest. The authors declare no conflict of interest.
For citation: Bedzhanyan A.L., Petrenko K.N., Bredikhin M.I., Sumbaev A.A., Konstantinova Yu.S., Tyurina E.A., Dymova O.V., Frolova Yu.V. Difficulties in differential diagnosis and treatment tactics of presacral formations in a patient with rectal cancer progression (case report). Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (1): 128–34. DOI:  (in Russian)


1.      Conti P., et al. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol. 2004; 61 (1): 34–43.

2.      Kriger A., et al. Schwannoma of small pelvis and gluteal area. Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal Named after N.I. Pirogov]. 2017; (10): 88–90. (in Russian)

3.      Sinchikhin S.P., Magakyan S.G., Magakyan O.G. Pelvic schwannoma. Ginekologiya. [Gynecology]. 2020; 22 (5): 84–6. DOI: (in Russian)

4.      Mason T.H., Keigher H.A. Intramedullary spinal neurilemmoma: case report. J Neurosurg. 1968; 29 (4): 414–6.

5.      Jayaraj S.M., et al. Ancient schwannoma masquerading as parotid pleomorphic adenoma. J Laryngol Otol. 1997; 111 (11): 1088–90.

6.      Roth S.H., et al. Schwannoma-like pleomorphic adenoma: two cases and a review of the literature. Head Neck Pathol. 2020; 14 (1): 166–72.

7.      Tyshchenko O.M., et al. Retroperitoneal schwannoma – diagnostic riddle for the surgeon. Klinicheskaya onkologiya [Clinical Oncology]. 2016; (1): 3–5. (in Russian)

8.      Stepanova Y.A., Grishankov S.A., Karelskaya N.A., et al. Retroperitoneal schwannoma [Clinical Case] // Journal of Clinical Practice. 2016: 7 (2): 58-66. doi: 10.17816/clinpract7258-66  (in Russian)

9.      Yang C.-C., Chen H.-C., Chen C.-M. Endoscopic resection of a presacral schwannoma: case report. J Neurosurg Spine. 2007; 7 (1): 86–9.

10.   Ningshu L., et al. Laparoscopic management of obturator nerve schwannomas: experiences with 6 cases and review of the literature. Surg Laparosc Endosc Percutan Tech. 2012; 22 (2): 143–7.

11.   Bugaev V.E., Nikulin M.P., Melikov S.A. Principles of diagnosis and surgical treatment of patients with retroperitoneal schwannomas. Sovremennaya onkologiya [Modern Oncology]. 2017; 19 (4): 28–35. (in Russian)

12.   Fourney D.R., et al. En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine. 2005; 3 (2): 111–22.

13.   Buchs N., Taylor S., Roche B. The posterior approach for low retrorectal tumors in adults. Int J Colorectal Dis. 2007;  22 (4): 381–5.

14.   Çağlı S., et al. Giant sacral schwannomas. J Neurooncol. 2012; 110 (1): 105–10.

15.   Pongsthorn C., et al. Giant sacral schwannoma: a report of six cases. Ups J Med Sci. 2010; 115 (2): 146–52.

16.   Tortorelli A.P., et al. Retroperitoneal schwannomas: diagnostic and therapeutic implications. Tumori. 2007; 93 (3):  312–5.

17.   Xu H., et al. A giant pelvic malignant schwannoma: a case report and literature review. Int. J Clin Exp Pathol. 2015; 8 (11): 15 363–8.

Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Medicine today

II Всероссийская конференция с международным участием "Воспаление глаза" 12 ноября 2022 года, Москва Воспалительные заболевания глаза - широко распространенная и многогранная проблема, с которой может столкнуться в своей практике любой специалист. Найти оптимальные алгоритмы...

Масштабное событие в области дерматовенерологии и косметологии - II конференция InteDeCo 2022 "Интегративная дерматовенерология и косметология. Новые стандарты взаимодействия" - состоится 16-17 декабря 2022 года. Программа мероприятия пройдет на современной...

VIII Московский Городской Съезд педиатров с межрегиональным и международным участием "Трудный диагноз в педиатрии" Приглашаем педиатров, детских эндокринологов, реаниматологов, гинекологов, неонатологов, кардиологов, хирургов, урологов, психологов, специалистов по лучевой...

Journals of «GEOTAR-Media»