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Ayoobi Yazdi N, Daneshvar M, Rasuli B, Moradi A, Azizi M. Benign hepatic schwannoma in a patient with chronic hepatitis B infection: A case report. Radiol Case Rep 2024; 19:3146-3151. [PMID: 38779190 PMCID: PMC11109288 DOI: 10.1016/j.radcr.2024.04.052] [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: 04/09/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
A primary benign hepatic schwannoma is an extremely rare disease with a good prognosis. A 55-year-old man with chronic hepatitis B was referred to our hospital because of jaundice, weight loss, and a hepatic lesion found during an ultrasound examination. Magnetic resonance image revealed a 55 × 120 mm solid mass lesion in the segment V and VIII of the liver. The mass extended directly to the segmental biliary ducts and common hepatic duct, causing obstruction of the biliary duct and upstream dilatation, particularly in the left liver lobe. Following the insertion of a percutaneous transhepatic biliary drainage, a biopsy was performed under ultrasound guidance. Histological examination confirmed a benign schwannoma, identified by characteristic pathological findings and positive immunoreactions with S-100 protein, but negative for c-kit, CD117, or CD34. The patient's tumor was removed and upon examination, it was discovered to be a mass filled with pinkish-yellow fluid, measuring 12 × 5 × 5 cm. This is the first known case of a benign schwannoma in the liver parenchyma of a patient with chronic hepatitis B. Furthermore, most previous cases of benign liver schwannomas have reported a smaller size than this case, which is slightly larger.
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Affiliation(s)
- Niloofar Ayoobi Yazdi
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Daneshvar
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Rasuli
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohamad Moradi
- Department of General Surgery Division of HPB and Transplantation Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Azizi
- Department of Pathology, Cancer Institute, Imam Khomeini hospital complex, Tehran University of Medical Sciences, Tehran, Iran
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Le MA, Shi R, Geraghty J, Zayat V, Parikh J. A Rare Case of Hepatic Schwannoma in the Setting of Schwannomatosis. Cureus 2024; 16:e54705. [PMID: 38523988 PMCID: PMC10960616 DOI: 10.7759/cureus.54705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Schwannomas are benign nerve sheath tumors commonly found in the head, neck, vestibular system, and extremities. Primary hepatic schwannomas are exceptionally rare, with 34 cases reported to date according to our review of the literature. This case report describes a 79-year-old man with a medical history of skin and thyroid cancer, who presented with no clinical symptoms and underwent a follow-up MRI due to an initial scan indicating a suspicious hepatic mass resembling an atypical hemangioma. The MRI revealed a 3.6 cm left hepatic mass concerning for an intrahepatic cholangiocarcinoma. Histopathological and immunohistochemical studies of a biopsy of the liver mass confirmed the presence of a benign hepatic schwannoma. Further evaluation revealed multiple spinal schwannomas, leading to the diagnosis of schwannomatosis. The diagnosis of hepatic schwannomas poses challenges through imaging alone. This case underscores the importance of microscopic evaluation in accurately diagnosing hepatic masses. Additionally, the presence of concurrent schwannomas should be considered in patients initially diagnosed with isolated schwannomas.
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Affiliation(s)
- Minh-Anh Le
- Internal Medicine, University of Central Florida College of Medicine/HCA Healthcare Graduate Medical Education, Orlando, USA
| | - Rachel Shi
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Justin Geraghty
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Vania Zayat
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
- Pathology, University of Central Florida College of Medicine, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
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3
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Thi Khuyen N, Quoc Thanh T, Van Trung H, Cong Thao T, Nhu Tung T. Primary Hepatic Schwannoma: Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231215907. [PMID: 38075003 PMCID: PMC10702400 DOI: 10.1177/11795476231215907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/06/2023] [Indexed: 08/27/2024]
Abstract
Primary hepatic schwannoma is an extremely rare tumor with a good prognosis. Preoperative diagnosis is often challenging due to nonspecific clinical symptoms and its rarity. Here, we report a case of a 56-year-old male patient misdiagnosed with malignant liver tumor, later identified as primary hepatic schwannoma. Furthermore, clinical and histopathological features of 19 cases of primary hepatic schwannoma are also documented. The age of the patients ranged from 38 to 72 years, with a mean age of 56.4 years, and the disease was more common in females. Patients typically presented without clinical symptoms and were not associated with neurofibromatosis type 1. Histopathological features of the tumor were similar to soft tissue schwannoma, characterized by a thick capsule consisting of Antoni A and Antoni B areas. Immunohistochemically, the tumor showed strong positivity and diffusely stained with S-100, while being negative for CD34, CD117, and SMA. Complete resection of the tumor was achieved in all patients. The prognosis was favorable, with no signs of recurrence. Follow-up examinations revealed disease-free survival ranging from 6 to 27 months. Differential diagnosis of primary hepatic schwannoma from malignant liver tumors and metastatic liver tumors can be made based on histopathological features and immunohistochemical staining with S-100.
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Affiliation(s)
- Nguyen Thi Khuyen
- Center for Pathology and Molecular Biology, K Hospital, Ha Noi, Vietnam
| | | | - Hoang Van Trung
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Trinh Cong Thao
- Department of Radiology, FV Hospital, Ho Chi Minh City, Vietnam
| | - Tran Nhu Tung
- Department of Pathology, Becamex International Hospital, Binh Duong, Vietnam
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Schwannoma in and around the porta hepatis: radiological features in eight cases and literature review. Abdom Radiol (NY) 2022; 47:1917-1928. [PMID: 35488897 DOI: 10.1007/s00261-022-03524-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Schwannomas in and around the porta hepatis (porta hepatic schwannomas) are rare benign tumors easily misdiagnosed as other pathologies, including malignancies. We aimed to evaluate their imaging features on ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT). METHODS We performed a multi-institutional retrospective study by reviewing the clinical and imaging findings of pathologically proven eight porta hepatic schwannomas (mean age, 55 years; range, 38-80 years; one male and seven females). Preoperative imaging included three ultrasonography, eight CT, eight MRI, and two FDG-PET/CT. RESULTS All patients were asymptomatic. The mean tumor size was 61.9 mm (range, 30-180 mm), and all tumors demonstrated well-defined lesions on ultrasonography and their solid components showed soft tissue attenuation on non-contrast CT. MRI showed two distinct components in all cases: the component with T1-weighted hypointensities and T2-weighted hyperintensities with poor enhancement (suggestive of Antoni B histology); the component with T2-weighted hypointensities with gradually increasing enhancement (suggestive of Antoni A histology), resulting in a heterogeneous pattern on post-contrast CT or MRI (8/8, 100%). The separated deviation of surrounding bile ducts and vessels without obstruction allowed the recognition of extrahepatic localization and their benign nature. A ginger root-like morphology (2/8, 25%) seemed to be suggestive of extension along the Glisson's sheath, although this finding was not seen frequently. CONCLUSION Recognizing imaging features such as extrahepatic location, benign nature with internal structures suggestive of Antoni A/B histology, and characteristic tumor extension may provide key diagnostic clues for porta hepatic schwannomas.
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Bekki T, Oishi K, Tadokoro T, Namba Y, Okimoto S, Mukai S, Saito Y, Fujisaki S, Nishida T, Ohdan H, Fukuda T. Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report. Surg Case Rep 2021; 7:187. [PMID: 34410526 PMCID: PMC8377106 DOI: 10.1186/s40792-021-01271-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/12/2021] [Indexed: 01/16/2023] Open
Abstract
Background The occurrence of schwannomas in the hepatoduodenal ligament is rare, and its preoperative accurate diagnosis is difficult. Only few cases have been treated with laparoscopic surgery. Case presentation A 54-year-old man visited our hospital following abnormal abdominal computed tomography findings. He had no complaints, and his laboratory investigations were normal. Abdominal contrast-enhanced computed tomography revealed a tumor with enhancement at the margin of the hepatoduodenal ligament. The abdominal magnetic resonance imaging findings of the tumor showed hypointensity on the T1-weighted images and mixed hypointensity and hyperintensity on the T2-weighted fat-suppression images. Positron emission tomography showed localized accumulation of fludeoxyglucose only in the hepatoduodenal ligament tumor. The patient underwent laparoscopic tumor resection for accurate diagnosis. Histopathologically, the tumor was mainly composed of spindle cells, which were strongly positive for S-100 protein on immunohistochemical staining. The patient was discharged without any postoperative complications on day 5. Conclusions Complete tumor resection is essential for schwannomas to avoid recurrence. Laparoscopic surgery is useful for schwannomas occurring in the hepatoduodenal ligament and can be performed safely by devising an appropriate surgical method.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan.
| | - Takeshi Tadokoro
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
| | | | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Japan
| | - Toshikatsu Fukuda
- Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Japan
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6
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Choi YI, Kim YS, Kim JH, Lee SH, Shin SG, Kim YS, Choi DJ, Choi SJ, Chung DH, Kwon OS. [Primary Hepatic Schwannoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:150-154. [PMID: 30270598 DOI: 10.4166/kjg.2018.72.3.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A primary benign schwannoma of the liver is extremely rare. Only 30 cases have been reported in the medical literature worldwide, and only one case has been reported in Korea previously. A 56-year-old man was admitted to Gil Medical Center with incidental findings of a hepatic mass by abdominal computed tomography. The computed tomography and magnetic resonance image revealed a 3×2 cm-sized solid mass in the left lobe of the liver. Histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117, and smooth muscle actin. We report a primary benign schwannoma of the liver and review the literature.
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Affiliation(s)
- Youn I Choi
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Seob Kim
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Hee Lee
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Gak Shin
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Soo Kim
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Duck Joo Choi
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Joon Choi
- Departments of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hae Chung
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Haradome H, Woo J, Nakayama H, Watanabe HN, Ogawa M, Moriyama M, Sugitani M, Takayama T, Abe O. Characteristics of Hepatic Schwannoma Presenting as an Unusual Multi-cystic Mass on Gadoxetic Acid Disodium-enhanced MR Imaging. Magn Reson Med Sci 2018; 17:95-99. [PMID: 28190852 PMCID: PMC5760239 DOI: 10.2463/mrms.cr.2016-0101] [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] [Indexed: 11/09/2022] Open
Abstract
Hepatic schwannoma is a very rare hepatic tumor, usually appearing as a hypervascular solid mass with or without various degrees of cystic changes; however, to the best of our knowledge, only the two cases of hepatic schwannoma showing a multi-cystic appearance have previously been reported. We report herein a benign hepatic schwannoma presenting as an unusually large multi-cystic mass. The gadoxetic acid disodium-enhanced magnetic resonance imaging features are described with the histopathologic correlation and briefly review the literature. The solid-like areas showing the early/progressive enhancement, reflecting remnants of the Antoni A/B portion, during the dynamic phases may be helpful imaging features for the differentiation of other multi-cystic hepatic lesions, but pathological evaluation remains essential for diagnosis.
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Affiliation(s)
- Hiroki Haradome
- Department of Radiology, Nihon University School of Medicine
| | - Jun Woo
- Department of Radiology, Nihon University School of Medicine
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine
| | | | - Masahiro Ogawa
- Department of Gastroenterology, Nihon University School of Medicine
| | | | | | | | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo
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Schwannoma in the porta hepatis - laparoscopic excision under laparoscopic ultrasound guidance. Wideochir Inne Tech Maloinwazyjne 2017; 12:301-305. [PMID: 29062453 PMCID: PMC5649500 DOI: 10.5114/wiitm.2017.68795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/17/2017] [Indexed: 12/12/2022] Open
Abstract
Schwannomas are usually benign tumors attached to peripheral nerves and are rarely found in the gastrointestinal tract. Schwannomas in the porta hepatis are extremely rare, with only 15 cases described in the literature to date. A 22-year-old female patient presented with colicky upper abdominal pain lasting 3 months. Magnetic resonance imaging of the abdominal cavity revealed a tumor in the porta hepatis. The patient was qualified for laparoscopy. The tumor was totally excised laparoscopically under guidance of laparoscopic ultrasound without intra- or postoperative complications. Postoperative histopathological examination confirmed the porta hepatic schwannoma. The patient recovered uneventfully with very good cosmetic results. In the follow-up period of 5 months we have not observed any abdominal or general health problems. The present case is the first report in the world of laparoscopic ultrasound guided laparoscopic excision of a porta hepatic schwannoma.
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Yamamoto M, Hasegawa K, Arita J, Maeno R, Akamatsu N, Kaneko J, Watadani T, Okura N, Hayashi A, Shibahara J, Sakamoto Y, Ohtomo K, Fukayama M, Kokudo N. Primary hepatic schwannoma: A case report. Int J Surg Case Rep 2016; 29:146-150. [PMID: 27855352 PMCID: PMC5114688 DOI: 10.1016/j.ijscr.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/05/2016] [Indexed: 02/07/2023] Open
Abstract
A hepatic schwannoma is extremely rare and difficult to diagnose preoperatively. We attempted to gain the radiological feature of the hepatic schwannoma by reviewing case reports. If the hepatic tumor is diagnosed as a schwannoma preoperatively, surgical resection is highly recommended.
Introduction A hepatic schwannoma is extremely rare and difficult to diagnose preoperatively. Presentation of case We report the case of a 47-year-old male patient who was referred to our hospital for the close investigation of a hepatic tumor which had not been detected two years earlier. An enhanced computed tomography revealed a well-circumscribed and encapsulated tumor with a size of 50 mm which was adjacent to the inferior vena cava (IVC) and the right hepatic vein. The tumor was heterogeneously enhanced until the equilibrium phase. A magnetic resonance image showed a hypointense area on a T1-weighted image and a hyperintense area on a T2-weighted image. These findings differed from those of common malignant hepatic tumors, such as hepatocellular carcinoma and colorectal liver metastases. The tumor was most likely a mucus-producing tumor or a liquefactive degenerated adenocarcinoma. Although we could not confirm an exact diagnosis of the tumor, we performed a surgical resection in view of the possibility of malignancy. The patient underwent a limited liver resection with resection of the IVC. Histologically, the tumor was diagnosed as a benign schwannoma comprised of Antoni A and B areas. The nuclear palisading formation of the tumor showed Verocay bodies. Discussion 15 cases of hepatic schwannoma are reviewed to clarify the typical radiological features. The radiological findings of the present case were consistent with those of the hepatic schwannoma when considering retrospectively. Conclusion A precise preoperative diagnosis of hepatic schwannoma is difficult, and liver resection is recommended when a hepatic schwannoma is suspected.
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Affiliation(s)
- Masaki Yamamoto
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryohei Maeno
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takeyuki Watadani
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoki Okura
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akimasa Hayashi
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Xu SY, Guo H, Shen Y, Sun K, Xie HY, Zhou L, Zheng SS, Wang WL. Multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder: first case report. Medicine (Baltimore) 2016; 95:e4378. [PMID: 27537565 PMCID: PMC5370792 DOI: 10.1097/md.0000000000004378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schwannomas are mesenchymal neoplasms that arise from Schwann cells with low malignant potential. Schwannomas originating from the porta hepatis or intra-abdominal organs are extremely rare. To our knowledge, multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder have not been reported so far and we first report one in the present case. CASE SUMMARY A 31-year-old female was referred to our hospital because of repeated abdomen discomfort, slight abdominal distension, and occasional abdominal pain for seven years. Ultrasound and computed tomography and magnetic resonance cholangiopancreatography found multiple intrahepatic and extrahepatic cystic lesions with the dilation of intrahepatic and extrahepatic bile ducts. By exploratory laparotomy, multiple tumors were found in the porta hepatis, liver, and gallbladder, the biggest one was 11 × 6 cm in size. We completely resected these tumors combined with the left lateral liver lobe, gallbladder, and the invaded left and right hepatic arteries, and then severed vessels were reconstructed. Microscopically, the tumor cells were spindle shaped and palisading arrangement. Atypical cells or signs of malignancy were not found. Immunohistochemical investigation showed the protein S-100 was positive, while SMA, CD34, and CD117 negative. Finally, these tumors were diagnosed as schwannomas in the porta hepatis, liver, and gallbladder. The patient is followed-up for 70 months and has been doing well without any complications. CONCLUSION We report the first patient with multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder. Accurate preoperative diagnosis of these tumors is difficult. Due to closely adhering to the surrounding important tissues, complete removal is challenging.
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Affiliation(s)
- Shao-yan Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Hua Guo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Yan Shen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Ke Sun
- Department of pathology (KS), First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou,China
| | - Hai-yang Xie
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Lin Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Shu-sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Wei-lin Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Organ Transplantation
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
- Correspondence: Weilin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun road, Zhejiang Province, Hangzhou 310003, China (e-mail: )
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Wan DAL, Zhai ZL, Ren KW, Yang YC, Lin SZ, Zheng SS. Hepatic schwannoma: A case report and an updated 40-year review of the literature yielding 30 cases. Mol Clin Oncol 2016; 4:959-964. [PMID: 27313857 DOI: 10.3892/mco.2016.850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/25/2016] [Indexed: 12/21/2022] Open
Abstract
Hepatic schwannoma is a rare benign disease with a good prognosis. Early diagnosis is difficult due to the absence of specific clinical presentations and its rarity. The present study briefly described a 64-year-old female patient with hepatic schwannoma mimicking intrahepatic cholangiocarcinoma. Furthermore, the clinical data of 30 patients with hepatic schwannoma were also reviewed and analyzed. The mean age of the 30 patients was 51.7 years (range, 21-83 years) and ~2/3 were female. All patients in the benign group underwent surgical treatment and survived until the last follow-up, of whom 19 received complete resection and the remaining 1 underwent liver transplantation. However, in the malignant group, only three cases who underwent the surgical resection remained alive at last follow-up. Another seven cases were succumbed to mortality, 4 cases of whom had deteriorated to have no operation opportunity by the time they saw a doctor, and among the remaining three cases with hepatectomy, 1 died of liver dysfunction at 21 days postoperatively, 2 succumbed to recurrences at 18 and 23 months postoperatively. In conclusion, hepatic schwannoma is a rare benign disease with a good prognosis. However, once the malignant transformation occurs, the prognosis is not satisfied. Complete resection is the mainstay for cure and liver transplantation is often necessary.
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Affiliation(s)
- DA-Long Wan
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Zheng-Long Zhai
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Kui-Wu Ren
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Yun-Chuan Yang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Sheng-Zhang Lin
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Shu-Sen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
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Yin SY, Zhai ZL, Ren KW, Yang YC, Wan DL, Liu XY, Wang LJ, Zheng SS. Porta hepatic schwannoma: case report and a 30-year review of the literature yielding 15 cases. World J Surg Oncol 2016; 14:103. [PMID: 27038921 PMCID: PMC4818894 DOI: 10.1186/s12957-016-0858-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/24/2016] [Indexed: 02/06/2023] Open
Abstract
Background Schwannomas located in the periportal region are extremely rare. Only 14 cases have been reported in the medical literature worldwide. Cases of porta hepatic schwannomas reported in the literature worldwide were reviewed. As a result, it is very challenging for surgeons to make a preoperative diagnosis due to its rarity and nonspecific imaging manifestations. Case Presentation A 57-year-old Chinese female was admitted to our institution with complaint of upper abdominal distension and the abdominal CT in the local hospital revealed a hypodense mass in the porta hepatis. A fine needle aspiration (FNA) was made to confirm the diagnosis, but the result was just suggestive of spindle cell neoplasia. Eventually, the patient underwent surgery and postoperative pathology confirmed schwannoma in porta hepatis. The patient recovered uneventfully with no evidence of recurrence after a follow-up period of 41 months. Conclusions It is essential for the final diagnosis of porta hepatic schwannomas to combine histological examination with immunohistochemistry after surgery. The main treatment of porta hepatic schwannomas is complete excision with free margins and no lymph node dissection. In some cases, biliary reconstruction or the proper hepatic and the gastroduodenal artery resection was performed because the tumor was inseparably attached to the extrahepatic bile duct or the proper hepatic and the gastroduodenal artery. Malignant transformation of schwannomas is very rare and the overall prognosis is satisfactory.
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Affiliation(s)
- Sheng-yong Yin
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Zheng-long Zhai
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Kui-wu Ren
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Yun-chuan Yang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Da-long Wan
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Xiao-yan Liu
- Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Li-jun Wang
- Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China
| | - Shu-sen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China. .,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Hangzhou, China.
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Ota Y, Aso K, Watanabe K, Einama T, Imai K, Karasaki H, Sudo R, Tamaki Y, Okada M, Tokusashi Y, Kono T, Miyokawa N, Haneda M, Taniguchi M, Furukawa H. Hepatic schwannoma: Imaging findings on CT, MRI and contrast-enhanced ultrasonography. World J Gastroenterol 2012; 18:4967-72. [PMID: 23002371 PMCID: PMC3447281 DOI: 10.3748/wjg.v18.i35.4967] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/12/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor. We compared the imaging and pathological findings, and examined the possibility of preoperatively diagnosing a benign liver schwannoma. A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver. A malignant tumor was suspected, and a right hepatectomy was performed. After this, the diagnosis of a primary benign schwannoma of the liver was made through pathological examination. Contrast-enhanced ultrasonography (CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase; most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells. In the postvascular phase, CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas; most likely due to aggregation of siderophores. Because discriminating between a benign and malignant schwannoma of the liver is difficult, surgery is generally recommended. However, the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.
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Hayashi M, Takeshita A, Yamamoto K, Tanigawa N. Primary hepatic benign schwannoma. World J Gastrointest Surg 2012; 4:73-8. [PMID: 22530081 PMCID: PMC3332224 DOI: 10.4240/wjgs.v4.i3.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/03/2012] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
Schwannoma is predominantly a benign neoplasm of the Schwann cells in the neural sheath of the peripheral nerves. Occurrence of schwannoma in parenchymatous organs, such as liver, is extremely rare. A 64-year-old man without neurofibromatosis was observed to have a space-occupying lesion of 23mm diameter in the liver during follow-up examination for a previously resected gastrointestinal stromal tumor (GIST) in the small intestine. He underwent lateral segmentectomy of the liver under a provisional diagnosis of hepatic metastatic recurrence of the GIST. Histological examination confirmed the diagnosis of a benign schwannoma, confirmed by characteristic pathological findings and positive immunoreactions with the neurogenic marker S-100 protein, but negative for c-kit, or CD34. The tumor was the smallest among the reported cases. When the primary hepatic schwannoma is small in size, preoperative clinical diagnosis is difficult. Therefore, this disease should be listed as differential diagnosis for liver tumor with clinically benign characteristics.
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Affiliation(s)
- Michihiro Hayashi
- Michihiro Hayashi, Nobuhiko Tanigawa, Department of General and Gastroenterological Surgery, Department of Pathology, Department of Radiology, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
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Panait L, Learn P, Dimaio C, Klimstra D, Do KG, Schwarz T, D'Angelica M, DeMatteo R, Kingham P, Allen P, Fong Y, Jarnagin WR. Resection of perihilar biliary schwannoma. Surg Oncol 2011; 20:e157-9. [PMID: 21665464 DOI: 10.1016/j.suronc.2011.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Schwannomas are usually benign nerve sheath tumors, which typically arise in the head, neck, spinal cord and extremities. Schwannoma of the biliary tract is an extremely rare finding. Patients generally lack symptoms and seek medical attention when tumor growth causes obstructive jaundice. Preoperative diagnosis is difficult and resection is the treatment of choice. METHODS A 54 year-old female with history of back and right labia minor melanoma for which she underwent complete excision and right inguinal lymph node dissection more than 10 years ago, was evaluated for new onset gastroesophageal reflux symptoms and found to have markedly abnormal liver enzymes. Imagining studies revealed intrahepatic ductal dilatation and a 5.2 cm mass in the porta hepatis that was not consistent with cholangiocarcinoma or hepatocellular carcinoma. Multiple percutaneous biopsies of the mass failed to provide a definitive diagnosis. With a high clinical suspicion of metastatic melanoma and no other evident sites of disease, operative intervention was undertaken for diagnosis and definitive treatment. RESULTS Diagnostic laparoscopy was performed initially, but access to the mass was difficult, given its location. Subsequently, the patient underwent laparotomy, with tumor excision, common bile duct resection and hepato-jejunostomy. Pathologic examination and analysis were consistent with cellular schwannoma. Postoperatively, the patient recovered uneventfully, and liver function studies returned to normal. CONCLUSION Schwannomas are uncommon tumors, which very rarely arise from the biliary tract and cause biliary obstruction. Exploration is indicated in order to establish the diagnosis and to render definitive treatment.
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Affiliation(s)
- Lucian Panait
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Abstract
Primary malignant liver mesenchymal tumor is a rare condition defined as a tumor with vascular, fibrous, adipose, and other mesenchymal tissue differentiation. We report a case of primary malignant liver mesenchymal tumor in a 51-year-old male with anemia, weight loss and hepatomegaly. Finally unconventional liver biopsy and histological manifestation led to the definitive diagnosis.
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Kim YC, Park MS, Chung YE, Kim MJ, Park YN, Kang JH, Kim KA, Kim KW. MRI findings of uncommon non-hepatocyte origin primary liver tumours with pathological correlation. Br J Radiol 2010; 83:1080-6. [PMID: 20923912 DOI: 10.1259/bjr/61140265] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The objective of this article was to illustrate the MRI findings of uncommon non-hepatocyte origin primary liver tumours, correlate them with the pathological features and discuss differential diagnoses. In conclusion, the MRI findings of uncommon benign and malignant non-hepatocyte-origin primary liver tumours vary. Awareness of characteristic MRI features can aid differential diagnosis and prevent unnecessary surgery.
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Affiliation(s)
- Y C Kim
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Republic of Korea
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