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Patient in his early 30s presented with progressive left anterior thigh dysesthetic nerve pain and hip flexion weakness. Imaging was performed and revealed a very large psoas* mass on the left side extending caudally from the L3 nerve root down to the level of the L4 neural foramina. Patient underwent contrast imaging that identified a psoas mass consistent with nerve sheath tumor/schwannoma**.
We performed a minimally invasive surgery to dissect and remove the mass from the psoas through a left lateral retroperitoneal approach. The tumor was found to come from a sensory branch of L3. The L3 motor branch was able to be identified and dissected free from the tumor, preserving function of the quadriceps.
Post-surgery, the patient’s sensory symptoms completely resolved with no residual numbness and tingling. A follow-up MRI revealed a gross total resection of the schwannoma.
*Psoas: each of a pair of large muscles which run from the lumbar spine through the groin on either side and, with the iliacus, flex the hip. A second muscle, the psoas minor, has a similar action but is often absent. (Source: Oxford Languages)
** Schwannoma is a rare type of tumor that forms in the nervous system. Schwannoma grows from cells called Schwann cells. Schwann cells protect and support the nerve cells of the nervous system. Schwannoma tumors are often benign, which means they are not cancer. (Source: www.cancer.gov)
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