Candost HANEDAN, Neslihan ÖZTÜRK, Firdevs ŞAHİN DURAN, Berna TURHAN, İnan UZUNOĞLU
Cyprus Journal of Medical Sciences - 2026;11(3):234-238
Presacral (retrorectal) schwannomas are rare, benign tumors originating from the Schwann cells of the sacral nerve roots. Their deep pelvic location and proximity to major neurovascular structures make surgical management challenging. We report a case of a 57-year-old postmenopausal woman who presented with postmenopausal bleeding, an incidental finding that led to the discovery of the pelvic mass, and who was found to have a giant presacral mass involving the left internal iliac artery. Magnetic resonance imaging revealed a 12x8x12 cm lesion, consistent with a Klimo type III schwannoma arising from the presacral region. The tumor was completely excised through an anterior multidisciplinary surgical approach with intraoperative neuromonitoring, followed by total hysterectomy and bilateral salpingo-oophorectomy. The postoperative course was uneventful, and the patient remained disease-free at 39 months of follow-up. This case highlights the importance of meticulous preoperative imaging, multidisciplinary surgical planning, and intraoperative neuromonitoring for the safe management of large presacral schwannomas with major vascular involvement.
