Contrast-Enhanced Ultrasound Combined With Biopsy for the Preoperative Diagnosis of a Rare Pelvic Schwannoma: A Case Report.
Jinzhe Wang, Li Wei, Yufei Wang
✦ AI-curated · Sources linked
Case in brief
A 66-year-old man with dysuria and lumbago had a large mixed cystic-solid pelvic mass. Conventional ultrasound showed limited Doppler flow; contrast-enhanced ultrasound (CEUS) demonstrated progressive peripheral-to-central dendritic enhancement in viable solid tissue, with cystic or necrotic areas remaining unenhanced. Time-intensity curve analysis showed an “equal-in and slow-out” perfusion pattern. CEUS-guided biopsy targeted hyperenhanced viable regions, and immunohistochemistry was positive for S-100 and SOX-10, confirming schwannoma. Complete resection with bladder defect repair was followed by recovery of urinary function and no reported recurrent urinary or pelvic symptoms during outpatient follow-up.
What made this case unusual
The mass showed a distinctive CEUS pattern—progressive dendritic enhancement and an “equal-in and slow-out” time-intensity curve—which was used to target viable tissue and avoid necrotic areas during biopsy.
Diagnostic / clinical pearl
In a heterogeneous pelvic mass, CEUS can help distinguish enhancing viable tissue from non-enhancing cystic or necrotic regions and guide biopsy sampling; histopathology and immunohistochemistry establish the diagnosis.