Contrast-Enhanced Ultrasound Combined With Biopsy for the Preoperative Diagnosis of a Rare Pelvic Schwannoma: A Case Report.
- 1Department of Ultrasound, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China.
Abstract
BACKGROUND Primary pelvic schwannomas are rare and often misdiagnosed due to non-specific imaging features. Accurate preoperative evaluation remains a challenge. The clinical utility of contrast-enhanced ultrasound (CEUS) combined with time-intensity curve (TIC) analysis and targeted biopsy was evaluated for the preoperative diagnosis and management of a pelvic schwannoma. CASE REPORT A 66-year-old man presented with dysuria and lumbago. Imaging revealed a large, mixed cystic-solid pelvic mass. Conventional ultrasound demonstrated a predominantly cystic-solid lesion with limited Doppler flow, whereas CEUS showed progressive dendritic enhancement of the viable solid component from the periphery toward the center, with non-enhancement of cystic or necrotic areas. TIC analysis demonstrated a distinctive "equal-in and slow-out" perfusion pattern, supported by quantitative parameters (rise time, time to peak, fall time, and washout area under the curve). Based on these perfusion characteristics, ultrasound-guided biopsy was directed toward hyperenhanced viable regions while avoiding necrotic zones, thereby improving tissue sampling accuracy. Immunohistochemistry confirmed S-100 and SOX-10 positivity, establishing a definitive diagnosis. Complete surgical resection with bladder defect repair was performed. Postoperatively, urinary function recovered, and no recurrent urinary or pelvic symptoms were reported during outpatient follow-up. CONCLUSIONS Quantitative CEUS-TIC analysis combined with targeted biopsy provides an effective preoperative diagnostic strategy for pelvic schwannomas. The observed CEUS-TIC perfusion pattern may correspond to the heterogeneous microvascular distribution of Antoni A and Antoni B regions; however, this hypothesis requires validation in future imaging-pathology correlation studies.
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BibTeX
@article{wang2026contrastenhanced,
title = {{Contrast-Enhanced Ultrasound Combined With Biopsy for the Preoperative Diagnosis of a Rare Pelvic Schwannoma: A Case Report.}},
author = {Jinzhe Wang and Li Wei and Yufei Wang},
journal = {The American journal of case reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.953317},
url = {https://europepmc.org/article/MED/42894353},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Contrast-Enhanced Ultrasound Combined With Biopsy for the Preoperative Diagnosis of a Rare Pelvic Schwannoma: A Case Report.
AU - Jinzhe Wang
AU - Li Wei
AU - Yufei Wang
PY - 2026
DA - 2026/10/19
JO - The American journal of case reports
DO - 10.12659/ajcr.953317
UR - https://europepmc.org/article/MED/42894353
AB - BACKGROUND Primary pelvic schwannomas are rare and often misdiagnosed due to non-specific imaging features. Accurate preoperative evaluation remains a challenge. The clinical utility of contrast-enhanced ultrasound (CEUS) combined with time-intensity curve (TIC) analysis and targeted biopsy was evaluated for the preoperative diagnosis and management of a pelvic schwannoma. CASE REPORT A 66-year-old man presented with dysuria and lumbago. Imaging revealed a large, mixed cystic-solid pelvic mass. Conventional ultrasound demonstrated a predominantly cystic-solid lesion with limited Doppler flow, whereas CEUS showed progressive dendritic enhancement of the viable solid component from the periphery toward the center, with non-enhancement of cystic or necrotic areas. TIC analysis demonstrated a distinctive "equal-in and slow-out" perfusion pattern, supported by quantitative parameters (rise time, time to peak, fall time, and washout area under the curve). Based on these perfusion characteristics, ultrasound-guided biopsy was directed toward hyperenhanced viable regions while avoiding necrotic zones, thereby improving tissue sampling accuracy. Immunohistochemistry confirmed S-100 and SOX-10 positivity, establishing a definitive diagnosis. Complete surgical resection with bladder defect repair was performed. Postoperatively, urinary function recovered, and no recurrent urinary or pelvic symptoms were reported during outpatient follow-up. CONCLUSIONS Quantitative CEUS-TIC analysis combined with targeted biopsy provides an effective preoperative diagnostic strategy for pelvic schwannomas. The observed CEUS-TIC perfusion pattern may correspond to the heterogeneous microvascular distribution of Antoni A and Antoni B regions; however, this hypothesis requires validation in future imaging-pathology correlation studies.
SN - 1941-5923
ER -