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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [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: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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2
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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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3
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Aichouni N, Abbou W, Nasri S, Khannoussi W, Ismaili MZ, El Harroudi T, Bennani A, Kamaoui I, Skiker I. Pancreatic schwannoma- CT and MRI findings: A rare case report and review of literature. Ann Med Surg (Lond) 2021; 68:102664. [PMID: 34401136 PMCID: PMC8355828 DOI: 10.1016/j.amsu.2021.102664] [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: 05/23/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Pancreatic schwannoma (PS) is an extremely rare benign tumor. Here we describe the Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) results of PS in a 59 years old woman, as well as a review of the literature. Case presentation A 59-year-old woman consulted for atypical epigastralgia without fatigue, weight loss or fever. CT scan and MRI showed a 35 mm inhomogeneous lesion with well-defined margins located in the pancreas head. The diagnosis of pancreatic tumor was made. The pathologic examination of the biopsied mass yielded a diagnosis of pancreatic schwannoma. Clinical discussion On CT scans, almost all benign PS are well-defined cystic or low-density masses. MRI is helpful in characterizing their typical encapsulation. Conclusion The detection of pancreatic schwannoma is extremely rare. Although multiple imaging modalities are currently available, it is challenging to make an accurate diagnosis before operation. Although multiple imaging modalities are currently available, it is challenging to make an accurate diagnosis before operation. Pancreatic schwannomas of Antoni type A show solid masses with inhomogeneous enhancement. Those of Antoni type B show homogeneous cystic or multiseptated mass. Schwannoma must be discussed as one possibility in the list of differential of pancreatic neoplasms.
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Affiliation(s)
- Narjisse Aichouni
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Widad Abbou
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Siham Nasri
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Wafaa Khannoussi
- Gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - My Zahi Ismaili
- Gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Tijani El Harroudi
- Surgery Oncology, Mohammed VI University Hospital, Regional Oncology Center, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Amal Bennani
- Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Imane Kamaoui
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
| | - Imane Skiker
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed I, Oujda, Morocco
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4
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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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7
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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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Watanabe T, Araki K, Ishii N, Igarashi T, Watanabe A, Kubo N, Kuwano H, Shirabe K. A Surgically Resected Pancreatic Schwannoma with Obstructive Jaundice with Special Reference to Differential Diagnosis from Other Cystic Lesions in the Pancreas. Case Rep Gastroenterol 2018; 12:85-91. [PMID: 29606941 PMCID: PMC5869564 DOI: 10.1159/000485559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022] Open
Abstract
Pancreatic schwannomas are uncommon. About 60% of pancreatic schwannomas develop cystic lesions, and the differential diagnosis from other cystic pancreatic tumors is difficult. A 43-year-old man presented for evaluation of liver dysfunction detected during a medical checkup. Blood testing detected obstructive jaundice. A computed tomography scan revealed a well-defined polycystic tumor of about 5 cm at the pancreatic head. We performed surgical resection to treat the patient's symptoms and facilitate long-term management. Histopathological examination revealed spindle-shaped cells. Immunohistochemical studies showed S100 protein expression and the absence of CD34 and c-kit protein expression. Finally, we diagnosed a schwannoma. Pancreatic schwannoma is usually asymptomatic. The present case presented with obstructive jaundice, which is reportedly a rare symptom. Pancreatic schwannomas should be considered as a differential diagnosis of pancreatic cystic tumors. Dilatation of the pancreatic duct and the 18-fluorodeoxyglucose positron emission tomography findings are important for the differential diagnosis.
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Affiliation(s)
- Takayoshi Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan.,Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Kenichiro Araki
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan.,Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Norihiro Ishii
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan
| | - Takamichi Igarashi
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan.,Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Akira Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan.,Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Norio Kubo
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan.,Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Hiroyuki Kuwano
- Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Gunma, Japan.,Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
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9
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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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10
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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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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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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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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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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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Ciledag N, Arda K, Aksoy M. Pancreatic schwannoma: A case report and review of the literature. Oncol Lett 2014; 8:2741-2743. [PMID: 25364457 PMCID: PMC4214448 DOI: 10.3892/ol.2014.2578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 04/01/2014] [Indexed: 12/15/2022] Open
Abstract
Schwannoma or neurilemmoma is a well-defined, benign tumor, which arises from neural crest cells and surrounds the nerve sheath. It is rare neoplasm that is typically found in the extremities, such as the thorax, head, neck, pelvis and rectum. Schwannoma localized to the pancreas is particularly rare and only a limited number of cases have been reported in the literature to date. The present study reports the case of a 30-year-old male with pancreatic schwannoma presenting with weight loss and abdominal pain. Pancreatic schwannoma was diagnosed using magnetic resonance imaging and ultrasonography-guided biopsy, which was followed by a duodenopancreatectomy. Although pancreatic schwannomas are rare, they must be considered during the differential diagnoses of cystic pancreatic masses.
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Affiliation(s)
- Nazan Ciledag
- Department of Radiology, Ankara Oncology Research and Education Hospital, Demetevler, Ankara 06200, Turkey
| | - Kemal Arda
- Department of Radiology, Atatürk Research and Education Hospital, Eskişehir Yolu, Ankara 06800, Turkey
| | - Mustafa Aksoy
- Department of Anesthesia, Atatürk Research and Education Hospital, Eskişehir Yolu, Ankara 06800, Turkey
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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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Liegl B, Bodo K, Martin D, Tsybrovskyy O, Lackner K, Beham A. Microcystic/reticular schwannoma of the pancreas: a potential diagnostic pitfall. Pathol Int 2010; 61:88-92. [PMID: 21255185 DOI: 10.1111/j.1440-1827.2010.02614.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schwannomas occurring in the pancreatic head are rare benign non-recurring mesenchymal neoplasms and are reported to show classic morphologic features. Herein we report a case of a 62 year old male presenting with a 5 cm mass in the pancreatic head encasing the portal vein and the truncus coeliacus. Preoperative fine needle aspiration revealed malignant tumour cells consistent with a moderately differentiated adenocarcinoma. A Whipple surgery was performed after palliative chemotherapy. Histological evaluation revealed a multinodular unencapsulated tumour with focal infiltration into pancreas parenchyma and a striking microcystic/reticular growth pattern. Anastomosing and intersecting strands of spindle cells with eosinophilic cytoplasm set in a myxoid partly collagenous stroma were observed. The tumour cell nuclei were round oval and tapered and showed inconspicuous small nucleoli. Degenerative nuclear atypia was seen. Mitotic activity was sparse (1/50 HPF). Pleomorphism or necrosis was absent. The tumour cells showed strong nuclear and cytoplasmic positivity for S-100 protein, and focal positivity for glial fibrillary acidic protein. The diagnosis of a microcystic/reticular schwannoma was made. The awareness of and, to some extent, the knowledge about this rare tumour are needed to achieve the correct diagnosis and to avoid confusion, especially with malignant pancreatic neoplasms.
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Stojanovic MP, Radojkovic M, Jeremic LM, Zlatic AV, Stanojevic GZ, Jovanovic MA, Kostov MS, Katic VP. Malignant schwannoma of the pancreas involving transversal colon treated with en-bloc resection. World J Gastroenterol 2010; 16:119-22. [PMID: 20039458 PMCID: PMC2799907 DOI: 10.3748/wjg.v16.i1.119] [Citation(s) in RCA: 10] [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] [Indexed: 02/06/2023] Open
Abstract
Pancreatic schwannoma is a very uncommon tumor of the pancreas, with only 27 cases reported. Most pancreatic schwannomas are benign, with only four malignant tumors reported. We describe a case of giant malignant schwannoma of the pancreatic body and tail, which involved the transverse colon. The tumor was treated successfully with en bloc distal splenopancreatectomy and colon resection. This is believed to be the first reported radical operation for malignant schwannoma of the pancreatic body, with infiltration of the transverse colon, with excellent long-term results. The patient is alive and well 28 mo after the operation. The authors conclude that pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms of the pancreas, although the diagnosis can only be confirmed by microscopic examination. In the case of the benign tumors, local excision is adequate, but in the case of malignant schwannoma, oncological standards must be fulfilled.
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