Pudendal Schwannoma; A Rare Reason for Scrotal and Penile Pain

Schwannomas are benign nerve sheath tumors that usually arise from cranial and periferal nerves. Pelvic region schwannomas are rare tumors and only a few cases have been reported in literature. Pudendal nerve schwannomas usually present as a cause of ipsilateral scrotal, penile and perineal region pain. We report the case of a 66-year-old man referred for worsening pain of 6 years duration involving the right scrotal and right penile shaft. After a series of repeated scrotal and penile ultrasonographies (USG), lumbar and brain magnetic resonance (MR) imaging and also blood tests, MR imaging of the pelvic region detected a well-circumscribed small pelvic wall tumor on the pathway of pudendal nerve. Based on the location, imaging characteristics and comparing to the cases reported in literature, we considered this tumor as a pudendal schwannoma. The most commonly described surgical approach for pelvic schwannomas has been open median laparotomy with transperitoneal dissection. The patient refused surgery, for this reason for treatment and control of the pain he underwent nerve block at anesthesiology clinic. At the 4-week follow-up, the patient described a significant decrease in pain.