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AlNuaimi D, Abdulghaffar S, Iuppa G, AlDuaij A, Badrawi N, Balci NC. Pancreatic schwannoma: a rare differential diagnosis for a pancreatic mass. BJR Case Rep 2023; 9:20230029. [PMID: 37576002 PMCID: PMC10412914 DOI: 10.1259/bjrcr.20230029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023] Open
Abstract
Pancreatic schwannomas are rare benign tumors with low malignant potential and are often difficult to diagnose due to their non-specific presenting symptoms and overlapping radiological imaging characteristics. Cross-sectional imaging plays an important role in the initial diagnosis and in delineating the extent of the lesion. However, biopsy and histopathological examination remains the gold-standard for a definite diagnosis. The management of pancreatic schwannomas includes surgical resection often yielding excellent clinical outcomes with low recurrence rates. We present a case of a 33-year-old female patient with a history of a recurrent vague upper abdominal pain where CT of the upper abdomen showed a hypodense pancreatic mass. Robotic subtotal pancreatectomy was done with histopathology showing spindled Schwann cells indicative of a pancreatic schwannoma.
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Affiliation(s)
- Dana AlNuaimi
- Department of Health, Abu Dhabi, United Arab Emirates
| | | | | | | | - Noor Badrawi
- Dubai Health Authority, Dubai, United Arab Emirates
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Ribeiro MB, Abe ES, Kondo A, Safatle-Ribeiro AV, Pereira MA, Zilberstein B, Ribeiro Jr U. Gastric cancer with concurrent pancreatic schwannoma: A case report. World J Gastrointest Pathophysiol 2022; 13:107-113. [PMID: 35720164 PMCID: PMC9157687 DOI: 10.4291/wjgp.v13.i3.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/23/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The differential diagnosis of abdominal masses is somewhat troublesome, especially when there is a malignancy to be evaluated. We report herein a unique case of gastric adenocarcinoma concurrent with a pancreatic schwannoma. Correct assessment of intraoperative findings is essential for adequate tumor staging and to decide the proper management of a concurrent pancreatic lesion.
CASE SUMMARY Computed tomography scan performed for gastric cancer staging revealed a solid and cystic pancreatic mass that had no signs of local invasiveness. Surgical resection of the pancreas was decided preoperatively since a radical approach of the gastric tumor could be performed. There were no signs of distant metastases, and the large pancreatic mass was in contact with the posterior gastric wall. Histopathological study revealed a pancreatic schwannoma, which is an uncommon neoplasm that arises from Schwann cells around peripheral nerves.
CONCLUSION Therefore, pancreatic masses deserve special attention regarding the differential diagnosis in patients with gastric cancer. The presence of a large pancreatic mass should not preclude the potentially curative intent of the gastric cancer treatment.
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Affiliation(s)
- Mateus Barradas Ribeiro
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
| | - Emerson Shigueaki Abe
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
| | - André Kondo
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
| | - Marina Alessandra Pereira
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
| | - Bruno Zilberstein
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01249000, Brazil
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Xu SY, Zhou B, Wei SM, Zhao YN, Yan S. Successful treatment of pancreatic schwannoma by enucleation: A case report. Medicine (Baltimore) 2022; 101:e28874. [PMID: 35244041 PMCID: PMC8896508 DOI: 10.1097/md.0000000000028874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pancreatic schwannomas are extremely rare and are difficult to diagnose preoperatively. Over the past 50 years, only 96 cases of pancreatic schwannoma have been reported in English literature. Herein, we report a case of pancreatic schwannoma treated with enucleation. PATIENT CONCERNS A 66-year-old woman visited a local hospital due to ventosities. Ultrasonography and computed tomography revealed a pancreatic mass. She visited our hospital for further diagnosis and treatment. DIAGNOSIS AND INTERVENTIONS Magnetic resonance imaging revealed a tumor in the pancreatic body, and a solid pseudopapillary tumor was considered preoperatively. During the surgery, a pancreatic mass was found growing in the pancreatic body and tail. A successful tumor enucleation was performed. The mass was 7 × 6 × 3 cm in size with a thin capsule. Pathological examination revealed that the tumor was mainly composed of spindle-shaped cells with a palisading arrangement and no atypia. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining showed that protein S-100 was strongly positive. The tumor was diagnosed as a benign schwannoma originating from the pancreatic body and tail. OUTCOMES Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications. LESSONS Pancreatic schwannomas are extremely rare and difficult to diagnose using imaging examinations. Enucleation is a safe and efficacious treatment for exophytic pancreatic schwannomas.
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Affiliation(s)
- Shao-Yan Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Bo Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Shu-Mei Wei
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Ya-Nan Zhao
- Department of Ultrasound, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang Province, China
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Pancreatic/peripancreatic neurogenic tumor; little known masses not to be missed. Pancreatology 2021; 21:1386-1394. [PMID: 34446337 DOI: 10.1016/j.pan.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retroperitoneal neurogenic tumors are extremely rare pathological entities; therefore, few clinical features and natural courses, especially originating from the pancreatic/peripancreatic regions, have been reported. This study aimed to investigate the clinicopathological features of pancreatic and peripancreatic neurogenic tumors and assess the diagnostic value of computed tomography (CT) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). METHODS Between 2006 and 2018, patients who were diagnosed with neurogenic tumors were included. In total, 90 histologically confirmed cases of neurogenic tumors located in the pancreatic/peripancreatic regions were selected for analysis. RESULTS The mean age was 49.2 ± 13.1 years. There were no differences in sex distribution of the tumors. Schwannomas (44.4%) and paragangliomas (41.1%) were the most common neurogenic tumors. The sensitivity of CT was 62.2% in 90 cases. EUS-FNB was performed in 30 cases and the sensitivity of it was 83.3%. The diagnosis of neurogenic tumors with EUS-FNB or CT was not significantly associated with tumor location and size. Surgical resection was performed in 78 cases. Of the 12 patients who did not undergo surgery, 10 cases were followed-up without any increase in tumor size. CONCLUSIONS Through the present study, we verified radiological, pathological, and clinical aspects of the pancreatic/peripancreatic neurogenic tumors which little known before, therefore, this study can serve as the basis for research to present an optimal diagnosis and treatment of neurogenic tumors. In addition, EUS-FNB is useful in the diagnosis of pancreatic/peripancreatic neurogenic tumors with relatively high sensitivity and can help establish therapeutic plans before the surgery.
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Shi Z, Cao D, Zhuang Q, You R, Li X, Li Z, Li Y, Huang X. MR imaging features of pancreatic schwannoma: a Chinese case series and a systematic review of 25 cases. Cancer Imaging 2021; 21:23. [PMID: 33588954 PMCID: PMC7885599 DOI: 10.1186/s40644-021-00390-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a paucity of existing literature centering on the magnetic resonance (MR) imaging features of pancreatic schwannomas, due to the neoplasm's nonspecific presentation and its rarity. We aimed to identify the characteristic imaging features of pancreatic schwannoma. METHODS This retrospective search was conducted for histologically confirmed pancreatic schwannoma in multi-institutional database of pathology. Abdominal magnetic resonance imaging (MRI) was performed before histologic examination and their MR imaging studies were independently reviewed. The search yielded six adults (mean age, 46 years) with a definitive histologic postoperative diagnosis of single pancreatic schwannoma each. Additionally, a comprehensive English and Chinese literature review for pancreatic schwannoma and reported MR-imaging findings since 1961 was also conducted. MR imaging features of those cases in the literature were analyzed, summarized and compared with our case series. RESULTS This rare entity appeared to be a well-circumscribed, exophytic, oval or round pancreatic mass with a mean greatest diameter of 3.7 cm. Five schwannomas were located in the pancreatic head-neck and one in the pancreatic tail. On MRI, all cases appeared hypointense on T1-weighted images, inhomogeneous hyperintense on T2-weighted images, and hyperintense on diffusion-weighted images. The mean apparent diffusion coefficient (ADC) values of pancreatic schwannoma were 1.11 ± 0.29 × 10- 3 mm2/s and significantly lower than the surrounding pancreas. The lesion-to-pancreas signal intensity ratio (SIR) at unenhanced T1-weighted images was 0.53 ± 0.07. On dynamic contrast-enhanced MRI, most of the lesions (67%, 4/6) showed homogeneously iso- or hypointense on arterial and portal venous phases, and hyperenhancement on delayed phase compared with the surrounding pancreas. In our analysis of the time intensity curves, all cases exhibited a gradual enhancement pattern. CONCLUSIONS A well-circumscribed mass displaying inhomogeneous hyperintensity on T2, marked hypointensity on T1, hyperintensity on DWI, and with early slight enhancement at arterial phase and progressive enhancement at portal venous and delayed phase, may suggest the diagnosis of pancreatic schwannoma.
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Affiliation(s)
- Zhenshan Shi
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China.
| | - Qian Zhuang
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, Fujian, China
| | - Ruixiong You
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Xiumei Li
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Zhongmin Li
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Yueming Li
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, Fujian, China
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A rare tumour of pancreas-Case report. Int J Surg Case Rep 2020; 72:636-638. [PMID: 32611536 PMCID: PMC7365773 DOI: 10.1016/j.ijscr.2020.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/13/2020] [Accepted: 04/19/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pancreatic schwannomas are very rare neoplasm arising from Schwann cells that present in the nerve sheath. Schwannoma usually occur in the extremities but can also be found in the trunk, head and neck, retroperitoneum, mediastinum, pelvis and rectum. PRESENTATION OF CASE We briefly describe a 30-year-old female patient with upper abdominal pain and on examination by ultrasound and Computed tomography of abdomen revealed a solid tumor arising from body of the pancreas. A laparoscopic splenic vessel preserving distal pancreatectomy (kimura) was performed. DISCUSSION Approximately only 50 cases reported in the literature and none of these cases were diagnosed as schwannoma preoperatively. CT scan is often useful to establish pancreatic lesion which usually demonstrate hypodense lesion with encapsulation CONCLUSION: Although the incidence of pancreatic schwannoma is low, it must be considered as one possibility in the differential diagnosis of mass lesions in the pancreas and whenever possible especially in large tumors surgical resections should be considered due to increased chance of transformation to malignancy.
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Javed AA, Wright MJ, Hasanain A, Chang K, Burkhart RA, Hruban RH, Thompson E, Fishman EK, Cameron JL, He J, Wolfgang CL, Weiss MJ. Pancreatic Nerve Sheath Tumors: a Single Institutional Series and Systematic Review of the Literature. J Gastrointest Surg 2020; 24:841-848. [PMID: 30941687 DOI: 10.1007/s11605-019-04201-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/05/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Improvement in imaging has resulted in frequent diagnosis of benign and premalignant pancreatic tumors. Pancreatic nerve sheath (PNS) tumors are one of the rarest pancreatic tumors. Literature on PNS is limited and their biology is poorly understood. Here, we report the largest series of PNS tumors to date and review the literature to evaluate the current data available on PNS tumors. METHODS An institutional database was used to identify patients who underwent resection for PNS tumors. Clinicopathological characteristics and outcomes of these patients were reported. Furthermore, a review of literature was performed. RESULTS From January 1994 through December 2016, seven patients underwent resection for PNS tumors. The median age was 57.7 years (IQR, 44.9-61.9) and the sex was approximately equally distributed (male = 4; 57.1%). Three (42.9%) patients were diagnosed incidentally and six (85.7%) were misdiagnosed as having other pancreatic tumors. The median tumor size was 2.1 (IQR 1.8-3.0) cm and six (85.7%) had no nodal disease. At a median follow-up of 15.5 (IQR 13.7-49.3) months, six patients were alive without evidence of disease and one patient was lost to follow-up. The literature review identified 49 studies reporting 54 patients with PNS tumors. Forty-six were misdiagnosed as having other pancreatic tumors. The median tumor size was 3.6 (range 1-20) cm, nodal disease was present in six patients (22.2%), and no patient had distant metastatic disease. At the time of last follow-up, all patients were free of disease. CONCLUSION This is the largest single institution series on PNS tumors reported to date. These tumors are rare and are often misdiagnosed, given their radiological characteristics. PNS tumors have a benign course of disease and surgical resection results in favorable long-term outcomes.
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Affiliation(s)
- Ammar A Javed
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael J Wright
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alina Hasanain
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kevin Chang
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Ralph H Hruban
- Departments of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Elliot K Fishman
- Departments of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John L Cameron
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jin He
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Matthew J Weiss
- Departments of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
- , Baltimore, USA.
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Pancreatic schwannoma, an extremely rare and challenging entity: Report of two cases and review of literature. Pancreatology 2019; 19:729-737. [PMID: 31153779 DOI: 10.1016/j.pan.2019.05.460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Pancreatic schwannoma is a rare benign tumor, for which the preoperative and intraoperative definitive diagnosis is quite challenging. We present the clinical, radiological and pathologic features of two primary pancreatic schwannomas identified in our pathology database over a period of 30 years at our tertiary care hospital. To better understand the clinico-pathological and radiological features of this entity, we provide a comprehensive review of 73 cases described in the English literature, along with our two cases. This review will especially focus on preoperative and intraoperative diagnosis to assess their accuracy for pancreatic schwannoma. The three most common preoperative diagnoses based on imaging for pancreatic schwannomas were cystic neoplasm (56%), pancreatic neuroendocrine tumor (29%) and mucinous cystic neoplasm (26%). Imaging could not definitely diagnose pancreatic schwannoma in any of the reported cases. To obtain a definite diagnosis before surgery, 25 cases underwent imaging-guided fine-needle aspiration (FNA)/biopsy, of which 60% were correctly reported as benign with definite diagnosis of pancreatic schwannoma in 48%. A higher diagnostic accuracy was observed in biopsies (71%) than FNA (37%). In addition, an intraoperative frozen section was carried out in 15 cases, and 47% were correctly diagnosed. Despite relatively low accuracy, preoperative histological assessment can be helpful in surgical managment. A core tissue specimen is recommended to improve the diagnostic accuracy in this setting.
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Wang S, Xing C, Wu H, Dai M, Zhao Y. Pancreatic schwannoma mimicking pancreatic cystadenoma: A case report and literature review of the imaging features. Medicine (Baltimore) 2019; 98:e16095. [PMID: 31192973 PMCID: PMC6587594 DOI: 10.1097/md.0000000000016095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Schwannomas, also known as neurilemmoma, are benign neoplasms that originating from Schwann cells in peripheral nerve sheaths. The head, neck, and extremities are the most common sites; however, pancreatic schwannomas are rare neoplasms. Accurate preoperative diagnosis of these tumors is very tough because of pancreatic schwannomas usually mimicking other cystic tumors. Here we present a case of pancreatic schwannoma misdiagnosed as pancreatic cystadenoma. PATIENT CONCERNS We presented a rare case of a 55-year-old female admitted to our hospital for abdominal distension. The physical examination and results of laboratory testing reveal no abnormalities. DIAGNOSIS A computed tomography (CT) scan detected a hypodense 2.4 cm × 2.6 cm mass with a clear margin at the neck of the pancreas. Pancreatic cystadenoma was strongly suspected. INTERVENTIONS The patient underwent robotic distal pancreatectomy with splenectomy. The gross specimen showed a pale and solid mass with a capsule. OUTCOMES Histological examination of the surgical specimen demonstrated a pancreatic schwannoma. Immunohistochemistry results were as follows: S-100 (+), CD117 (-), SMA (-), and Desmin (-). She was discharged on postoperative day 6 and no recurrence of the tumor happened during the 12-month follow-up. CONCLUSION Precise preoperative diagnosis of pancreatic schwannomas is very difficult despite the application of multiple imaging modalities. Surgery is the most effective treatment for this rare disease and the final diagnosis usually relies on pathology. Following complete tumor removal, patients with pancreatic schwannomas generally have a good prognosis.
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Affiliation(s)
| | | | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
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Xu SY, Wu YS, Li JH, Sun K, Hu ZH, Zheng SS, Wang WL. Successful treatment of a pancreatic schwannoma by spleen-preserving distal pancreatectomy. World J Gastroenterol 2018. [PMID: 28611527 DOI: 10.3748/wjg.v24.i20.3744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Schwannomas are neurogenic tumors that arise from the neural sheaths of peripheral nerves. These tumors can be located in any area of the human body; the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are very rare. Over the past 40 years, only 67 cases of pancreatic schwannomas have been reported in the English literature. Here we present a case of pancreatic schwannoma in a 62-year-old male. The tumor was revealed by ultrasound and computed tomography in the neck and body of the pancreas. An accurate diagnosis was difficult to obtain preoperatively. The patient consented to the performance of a laparotomy, and the mass was found in the neck and body of the pancreas and successfully treated using a spleen-preserving distal pancreatectomy with splenic artery and vein preservation. The procedure has only been reported in one other case of pancreatic schwannoma; here we present the second reported case. Macroscopically, the tumor was well circumscribed, gray-white in color and 3.3 cm × 2.8 cm in size. Microscopically, the tumor cells were spindle-shaped and had a palisading arrangement with no atypia, which are results compatible with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemically, the tumor cells were strongly positive for S-100 protein. The tumor was definitively diagnosed as a schwannoma of the pancreatic neck and body. The patient was followed for 72 mo and has been doing well without any complications.
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Affiliation(s)
- Shao-Yan Xu
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ying-Sheng Wu
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Hui Li
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ke Sun
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Zhen-Hua Hu
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shu-Sen Zheng
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wei-Lin Wang
- Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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Ma Y, Shen B, Jia Y, Luo Y, Tian Y, Dong Z, Chen W, Li ZP, Feng ST. Pancreatic schwannoma: a case report and an updated 40-year review of the literature yielding 68 cases. BMC Cancer 2017; 17:853. [PMID: 29241452 PMCID: PMC5731208 DOI: 10.1186/s12885-017-3856-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic schwannoma is a rare tumor. Preoperative diagnosis of pancreatic schwannoma is challenging due to its tendency to mimic other lesions of the pancreas. We describe a case of pancreatic schwannoma and present a review of the cases currently reported in the English literature to identify characteristics of pancreatic schwannoma on imaging. CASE PRESENTATION A 53-year-old male presented with a history of intermittent periumbilical abdominal pain and lower back pain for 1 week. Based on ultrasound (US) and computed tomography (CT) findings, we made a preoperative diagnosis of solid pseudopapillary tumor and performed a standard pancreaticoduodenectomy. Pathological examination showed that the tumor was composed of spindle cells with a palisading arrangement, and immunohistochemistry revealed strong positive staining for S-100 protein, which was consistent with a diagnosis of pancreatic schwannoma. At the 8-month follow-up visit, the patient was doing well without recurrent disease, and his abdominal pain had resolved. CONCLUSIONS Although pancreatic schwannoma is rare, it should be included in the list of differential diagnoses of pancreatic masses, both solid and cystic. A tumor size larger than 6.90 cm, vascular encasement, or visceral invasion should elicit suspicion of malignant transformation.
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Affiliation(s)
- Yuntong Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
- Washington University in St. Louis School of Medicine, St. Louis, MO USA
| | - Bingqi Shen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
| | - Yingmei Jia
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
| | - Yisu Tian
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
| | - Wei Chen
- Department of Pancreaticobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong 510080 China
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Abstract
Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the "gold standard." We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Fukuhara S, Fukuda S, Tazawa H, Imaoka K, Mochizuki T, Hirata Y, Fujisaki S, Takahashi M, Nishida T, Sakimoto H. A case of pancreatic schwannoma showing increased FDG uptake on PET/CT. Int J Surg Case Rep 2017; 36:161-166. [PMID: 28599230 PMCID: PMC5466559 DOI: 10.1016/j.ijscr.2017.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/27/2017] [Indexed: 02/09/2023] Open
Abstract
Pancreatic schwannoma is rare and preoperative diagnosis is difficult due to the lack of specific symptoms, radiological characteristics and tumor markers. Incidental detection of pancreatic schwannoma is predicted to increase due to the widespread use of CT and MRI. It is important to take into account this tumor in the differential diagnosis of pancreatic tumors. We should be aware that FDG-PET/CT shows abnormal accumulation in a benign pancreatic schwannoma.
Introduction Schwannomas are neoplasms originating from Schwann cells in nerve sheath, but pancreatic schwannomas are rare. Presentation of case A 59-year-old female incidentally pointed out a 2-cm-sized solid mass in the pancreas head by computed tomography (CT) which was performed for other reasons. Magnetic resonance imaging (MRI) showed a mass with hypointensity on T1-weighted images and a heterogenous hyperintensity on T2-weighted images. Magnetic resonance cholangiopancreatography (MRCP) showed no abnormal findings in the main pancreatic duct. The mass of the pancreas head showed a significantly increased uptake on fluorin-18 fluorodeoxyglucose positron emission tomography CT (FDG-PET/CT). Based on the radiological findings, a malignant potential tumor was preliminarily considered. Subtotal stomach-preserving pancreatoduodenectomy (SSSPD) was performed to make a definite diagnosis. The resected specimen showed a well-encapsulated circumscribed mass, measuring 2.0 cm, in the pancreas head. Histopathological examination revealed proliferation of spindle cells showing interlacing and palisading patterns in the tumor. The proliferating cells showed no atypia and few mitoses. Immunohistochemically, the spindle cells were positive for S-100 protein. The Ki67 labeling index was approximately 2%. Based on these findings, a diagnosis of benign schwannoma of the pancreas was made. Conclusion Although pancreatic schwannoma is a rare neoplasm, it is important to take into account this tumor in the differential diagnosis of pancreatic tumors. In addition, we should be aware that FDG-PET/CT shows abnormal accumulation in a benign pancreatic schwannoma.
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Affiliation(s)
- Sotaro Fukuhara
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Saburo Fukuda
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan.
| | - Hirofumi Tazawa
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Kouki Imaoka
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Tetsuya Mochizuki
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Yuzo Hirata
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Mamoru Takahashi
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Toshihiro Nishida
- Department of Diagnostic Pathology, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan
| | - Hideto Sakimoto
- Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 Japan
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15
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Xu SY, Wu YS, Li JH, Sun K, Hu ZH, Zheng SS, Wang WL. Successful treatment of a pancreatic schwannoma by spleen-preserving distal pancreatectomy. World J Gastroenterol 2017; 23:3744-3751. [PMID: 28611527 PMCID: PMC5449431 DOI: 10.3748/wjg.v23.i20.3744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/26/2016] [Accepted: 03/21/2017] [Indexed: 02/06/2023] Open
Abstract
Schwannomas are neurogenic tumors that arise from the neural sheaths of peripheral nerves. These tumors can be located in any area of the human body; the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are very rare. Over the past 40 years, only 67 cases of pancreatic schwannomas have been reported in the English literature. Here we present a case of pancreatic schwannoma in a 62-year-old male. The tumor was revealed by ultrasound and computed tomography in the neck and body of the pancreas. An accurate diagnosis was difficult to obtain preoperatively. The patient consented to the performance of a laparotomy, and the mass was found in the neck and body of the pancreas and successfully treated using a spleen-preserving distal pancreatectomy with splenic artery and vein preservation. The procedure has only been reported in one other case of pancreatic schwannoma; here we present the second reported case. Macroscopically, the tumor was well circumscribed, gray-white in color and 3.3 cm × 2.8 cm in size. Microscopically, the tumor cells were spindle-shaped and had a palisading arrangement with no atypia, which are results compatible with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemically, the tumor cells were strongly positive for S-100 protein. The tumor was definitively diagnosed as a schwannoma of the pancreatic neck and body. The patient was followed for 72 mo and has been doing well without any complications.
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16
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Abe K, Ebato T, Tokairin T. A Pancreatic Mass Lesion. Gastroenterology 2017; 152:950-952. [PMID: 28259719 DOI: 10.1053/j.gastro.2016.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/24/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Koichiro Abe
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tadahisa Ebato
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuo Tokairin
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
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17
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Barral M, Faraoun S, Fishman E, Dohan A, Pozzessere C, Berthelin MA, Bazeries P, Barat M, Hoeffel C, Soyer P. Imaging features of rare pancreatic tumors. Diagn Interv Imaging 2016; 97:1259-1273. [DOI: 10.1016/j.diii.2016.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023]
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18
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Xu SY, Sun K, Owusu-Ansah KG, Xie HY, Zhou L, Zheng SS, Wang WL. Central pancreatectomy for pancreatic schwannoma: A case report and literature review. World J Gastroenterol 2016; 22:8439-8446. [PMID: 27729750 PMCID: PMC5055874 DOI: 10.3748/wjg.v22.i37.8439] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 02/06/2023] Open
Abstract
Schwannomas are mesenchymal tumors originating from Schwann cells in peripheral nerve sheaths. Although the tumor can be located in any part of the human body, the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are rare. To our knowledge, only 64 cases of pancreatic schwannoma have been reported in the English literature over the past 40 years. In this paper, we present a pancreatic schwannoma in a 59-year-old female. Ultrasound, computed tomography and magnetic resonance imaging revealed the tumor located in the pancreatic body; however, accurate diagnosis was hard to obtain preoperatively and a pancreatic cystadenoma was preliminarily considered. During laparotomy, the mass was found in the body of the pancreas. An enlarged gallbladder with multiple stones was also observed. We performed central pancreatectomy, end-to-side pancreaticojejunostomy and cholecystectomy. Notably, central pancreatectomy has been reported in only one case prior to this report. The gross specimen showed a mass with a thin capsule, 1.6 cm × 1.1 cm × 1.1 cm in size. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells with palisading arrangement and no atypia, which is consistent with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining revealed strongly positive results for protein S-100. Finally, the tumor was diagnosed as a schwannoma of the pancreatic body. Postoperatively, the patient recovered well and left the hospital 6 d later. During the 53-mo follow-up period, the patient remained well and free of complications.
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19
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Pecero-Hormigo MDC, Costo-Campoamor A, Cordero PLG, Fernandez-Gonzalez N, Molina-Infante J. Pancreatic tail schwannoma. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:458-459. [PMID: 27496806 DOI: 10.1016/j.gastrohep.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/23/2016] [Indexed: 12/17/2022]
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20
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Ercan M, Aziret M, Bal A, Şentürk A, Karaman K, Kahyaoğlu Z, Koçer HB, Bostancı B, Akoğlu M. Pancreatic schwannoma: A rare case and a brief literature review. Int J Surg Case Rep 2016; 22:101-4. [PMID: 27084984 PMCID: PMC4844663 DOI: 10.1016/j.ijscr.2016.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Pancreatic schwannoma (PS) is an extremly rare benign tumor. Less than 50 cases of pancreatic schwannoma have been described in the English literature over the past thirty years. PRESENTATION OF CASE REPORT A 63-year-old female underwent left modified radical mastectomy 2 years ago due to breast cancer. During her routine check-up, a 65×63×55mm measured calcified, well-demarcated, cystic-mass having septations and calcifications that localized to the pancreatic head was detected by abdominal computerized tomography. She was asymptomatic and her tumor markers were in normal ranges. A standard Whipple procedure was performed, and the histo-pathological diagnosis of the resected specimen was reported as ancient schwannoma with clear surgical margins. Patient's postoperative course was eventful. She had a biliary leakage after surgery which was managed conservatively. She is under follow-up. DISCUSSION Pancreatic schwannoma also known as neurilemoma or neuroma is a slowly growing, encapsulated, mostly benign tumor with smooth well-delineated margins that originates from myelin producing schwann cells located on the nerve sheath of the peripheral epineurium of either the sympathetic or parasympathetic autonomic fibers. PS's are extremly rare. The head of pancreas being involved in the vast majority of cases (40%), followed by its body (20%). Management of pancreatic schwannomas remains largely controversial. Both enucleation and radical surgical resections have revealed great therapeutic efficiency. with a well prognosis without recurrences. CONCLUSION Although rare, PS's should be considered in the differential diagnosis of the other solid or cystic masses of the pancreas.
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Affiliation(s)
- Metin Ercan
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Mehmet Aziret
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
| | - Ali Bal
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Adem Şentürk
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Kerem Karaman
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Zeynep Kahyaoğlu
- Sakarya University of Faculty of Medicine, Department of Pathology, Sakarya, Turkey
| | - Havva Belma Koçer
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Birol Bostancı
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Musa Akoğlu
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
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21
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Manning MA, Srivastava A, Paal EE, Gould CF, Mortele KJ. Nonepithelial Neoplasms of the Pancreas: Radiologic-Pathologic Correlation, Part 1—Benign Tumors:From the Radiologic Pathology Archives. Radiographics 2016; 36:123-41. [DOI: 10.1148/rg.2016150212] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Duma N, Ramirez DC, Young G, Nikias G, Karpeh M, Bamboat ZM. Enlarging Pancreatic Schwannoma: A Case Report and Review of the Literature. Clin Pract 2015; 5:793. [PMID: 26918099 PMCID: PMC4745593 DOI: 10.4081/cp.2015.793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 11/28/2015] [Accepted: 12/17/2015] [Indexed: 12/14/2022] Open
Abstract
A 72-year-old female presented with dyspepsia for 2 years and an incidental mass in the head of the pancreas on abdominal computed tomography (CT) scan. Patient had multiple negative endoscopic ultrasound guided biopsies. She was followed up for 3 years with serial imaging until an abdominal CT scan showed an increase in size of the pancreatic mass. Physical examination was unremarkable. Laboratory tests including tumor markers were normal. Given the enlarging size of the mass and its impingement on the portal vein, the consensus was to proceed with surgery. Histology revealed a 3.5 cm mass showing a spindle cell neoplasm with mild atypia. The lesion was well defined and nerve tissue was noted at the periphery. On immuno-stains, the spindle cells were positive for S-100 protein and negative for pan-cytokeratin, CD-34, CD-117, smooth muscle actin and Melan A, consistent with the diagnosis of a pancreatic schwannoma.
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Affiliation(s)
| | | | - Gloria Young
- Hackensack University Medical Center , Hackensack, NJ, USA
| | - George Nikias
- Hackensack University Medical Center , Hackensack, NJ, USA
| | - Martin Karpeh
- Hackensack University Medical Center , Hackensack, NJ, USA
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23
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Ohbatake Y, Makino I, Kitagawa H, Nakanuma S, Hayashi H, Nakagawara H, Miyashita T, Tajima H, Takamura H, Ninomiya I, Fushida S, Fujimura T, Ohta T. A case of pancreatic schwannoma - The features in imaging studies compared with its pathological findings: Report of a case. Clin J Gastroenterol 2014; 7:265-70. [PMID: 26183748 DOI: 10.1007/s12328-014-0480-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/16/2014] [Indexed: 12/15/2022]
Abstract
Pancreatic schwannoma is a very rare tumor that tends to be confused with other pancreatic tumors preoperatively. We report a case of schwannoma of the pancreatic head. A 40-year-old woman was admitted to our hospital for treatment of a pancreatic tumor which was found by medical checkup. It was a well-defined solid tumor exhibiting heterogeneous enhancement with some necrotic foci on contrast-enhanced computed tomography (CT) and on magnetic resonance imaging (MRI). Angiography and CT during arteriography revealed the main feeding arteries of the tumor to be the posterior and anterior superior pancreaticoduodenal arteries. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed accumulation of FDG in the tumor with a maximum standardized uptake value of 3.6. We diagnosed a solid pseudopapillary neoplasm or a pancreatic neuroendocrine tumor preoperatively and performed pylorus-preserving pancreaticoduodenectomy. The tumor had well a well-defined capsule and was composed of a large solid portion containing spindle cells and a smaller hemorrhagic portion containing hypocellular stroma, and diagnosed as pancreatic schwannoma by immunohistochemistry. In this case, CT during arteriography was useful in determining the origin of the tumor. MRI reflected the pathological features of the tumor. The most important finding was that FDG-PET showed abnormal accumulation of FDG in the benign pancreatic schwannoma.
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Affiliation(s)
- Yoshinao Ohbatake
- Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan,
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Pancreatic tail schwannoma in a 44-year-old male: a case report and literature review. Case Rep Oncol Med 2013; 2013:416713. [PMID: 24371534 PMCID: PMC3859158 DOI: 10.1155/2013/416713] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/25/2013] [Indexed: 12/16/2022] Open
Abstract
Pancreatic schwannomas are exceedingly uncommon neoplasms. According to a recent study in 2012, less than 50 cases of pancreatic schwannoma have been described in the English literature over the past thirty years. The vast majority of pancreatic schwannomas take place in the head and body of pancreas, respectively. Herein, we report the case of pancreatic tail ancient schwannoma in a 44-year-old man who presented with a 4-month history of epigastric pain. On physical examination, epigastric region was moderately tender to palpation without evidence of a palpable mass. All laboratory tests were normal. Contrast-enhanced computed tomography (CT) scan showed a 9.2 × 9.5 × 11.5 cm, huge, and well-defined left suprarenal mass arising either from adrenal gland, pancreas, or retroperitoneum. The mass demonstrated mild heterogeneous enhancement with central cystic/necrotic area. No evidence of distant metastasis was identified. At laparoscopy, the mass was noticed to originate from pancreatic tail. Patient underwent surgical resection of pancreatic tail. Microscopic and immunohistochemical examination of the pancreatic tail specimen showed ancient schwannoma. Patient received no adjuvant therapy. At a postoperative 6-month followup, patient was completely asymptomatic and CT scan imaging showed no evidence of tumor recurrence. Moreover, a literature review on pancreatic schwannomas is presented.
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Moriya T, Kimura W, Hirai I, Takeshita A, Tezuka K, Watanabe T, Mizutani M, Fuse A. Pancreatic schwannoma: Case report and an updated 30-year review of the literature yielding 47 cases. World J Gastroenterol 2012; 18:1538-44. [PMID: 22509087 PMCID: PMC3319951 DOI: 10.3748/wjg.v18.i13.1538] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/24/2011] [Accepted: 01/31/2011] [Indexed: 02/06/2023] Open
Abstract
Pancreatic schwannomas are rare neoplasms. Authors briefly describe a 64-year-old female patient with cystic pancreatic schwannoma mimicking other cystic tumors and review the literature. Databases for PubMed were searched for English-language articles from 1980 to 2010 using a list of keywords, as well as references from review articles. Only 41 articles, including 47 cases, have been reported in the English literature. The mean age was 55.7 years (range 20-87 years), with 45% of patients being male. Mean tumor size was 6.2 cm (range 1-20 cm). Tumor location was the head (40%), head and body (6%), body (21%), body and tail (15%), tail (4%), and uncinate process (13%). Thirty-four percent of patients exhibited solid tumors and 60% of patients exhibited cystic tumors. Treatment included pancreaticoduodenectomy (32%), distal pancreatectomy (21%), enucleation (15%), unresectable (4%), refused operation (2%) and the detail of resection was not specified in 26% of patients. No patients died of disease with a mean follow-up of 15.7 mo (range 3-65 mo), although 5 (11%) patients had a malignancy. The tumor size was significantly related to malignant tumor (13.8 ± 6.2 cm for malignancy vs 5.5 ± 4.4 cm for benign, P = 0.001) and cystic formation (7.9 ± 5.9 cm for cystic tumor vs 3.9 ± 2.4 cm for solid tumor, P = 0.005). The preoperative diagnosis of pancreatic schwannoma remains difficult. Cystic pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms and pseudocysts. In our case, intraoperative frozen section confirmed the diagnosis of a schwannoma. Simple enucleation may be adequate, if this is possible.
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