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Thakur S, Dash NR, Barwad A, Das P, Madhusudhan KS, Yadav R. Schwannoma of Common Bile Duct: A Clinico-Radiologic Diagnostic Quagmire - A Case Report. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023:1-8. [PMID: 39047176 PMCID: PMC11216546 DOI: 10.1159/000534300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/03/2023] [Indexed: 07/27/2024]
Abstract
Background Schwannomas are benign nerve sheath tumors that are extremely rare in the biliary tract. A comprehensive review of literature enumerated approximately 30 case reports of schwannoma in the biliary tract tree and porta hepatis region. Case Presentation We report a case of a 40-year-old female who presented with abdominal pain. Imaging revealed a mass at the porta hepatis extending from the portal bifurcation till the hilum encasing the main portal vein and abutting the right portal vein. Differentials of carcinoma, lymphoma, and mesenchymal tumor were kept. Ultrasound-guided biopsy of the mass showed a benign nerve sheath tumor, immunopositive for S100. The histopathological evaluation of the excised mass confirmed the origin of mass in the common bile duct. Conclusions Our case highlights that schwannomas, though benign, can mimic a carcinoma or lymphoma if present at a rare site such as bile ducts. An exhaustive clinical and radiological workup with diligent histopathological evaluation is mandatory in dealing with such rare cases as radical surgery and chemotherapy can be avoided in such patients.
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Affiliation(s)
- Shilpi Thakur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Takami K, Yamamoto K, Sakurai H, Kondo N, Shibata C, Katayose Y. Biliary Schwannoma That Required Differentiation from Bile Duct Cancer. Case Rep Gastroenterol 2021; 15:578-586. [PMID: 34616259 PMCID: PMC8454240 DOI: 10.1159/000515369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Schwannomas are benign tumors originating from Schwann cells, which are the main component of the neural sheath. Biliary schwannomas are extremely rare. We report the case of a 78-year-old man who presented with no abdominal symptoms or jaundice. CT imaging showed a hyperdense mass extending along the extrahepatic bile duct, and the upstream bile ducts were dilated. We performed extrahepatic bile duct resection under a preoperative diagnosis of the extrahepatic bile duct cancer. A histopathological examination of the resected specimen revealed that the tumor consisted of spindle cells which exhibited a palisading arrangement. Immunohistochemical staining was positive for protein S-100 and vimentin. Based on these pathological findings, we diagnosed the patient with schwannoma of the extrahepatic bile duct. Our search of the relevant literature revealed 19 case studies of biliary schwannomas. In our case, the surgical findings showed that the tumor was noninvasive and mobile. During surgery, a fast frozen section analysis was performed, and no malignant findings were observed. These results enabled us to avoid extrahepatic bile duct resection with major hepatectomy. We experienced a case of biliary schwannoma that was difficult to distinguish from bile duct cancer.
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Affiliation(s)
- Kazuhiro Takami
- Division of Hepato-biliary-pancreatic surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kuniharu Yamamoto
- Division of Hepato-biliary-pancreatic surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroto Sakurai
- Division of Hepato-biliary-pancreatic surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Noriko Kondo
- Division of Hepato-biliary-pancreatic surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Chikashi Shibata
- Division of Gastoroenterologic surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yu Katayose
- Division of Hepato-biliary-pancreatic surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Amano M, Amano Y, Takagi R, Tang X, Omori Y, Okada M. Case report of portal hepatic schwannoma: presentation of multimodality images. BMC Gastroenterol 2021; 21:183. [PMID: 33879079 PMCID: PMC8058999 DOI: 10.1186/s12876-021-01767-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/14/2021] [Indexed: 03/25/2023] Open
Abstract
Background Portal hepatic schwannoma is a rare benign tumor and difficult to diagnose preoperatively because of its rarity and imaging manifestations that mimic malignancy. We present a case of portal hepatic schwannoma that showed moderate contrast enhancement on computed tomography (CT), extension along the bile duct on T2-weighted imaging and magnetic resonance cholangiopancreatography (MRCP), and uptake of 18F-fluorodeoxyglucose (FDG) on positron emission tomography. Case presentation Ultrasonography at an annual health checkup identified a hepatic mass in a 38-year-old woman. CT showed a well-defined portal hepatic tumor with mild contrast enhancement. T2-weighted imaging and MRCP showed a clavate tumor extending along the intrahepatic bile ducts but no dilatation of the ducts. The tumor exhibited increased FDG uptake, such as maximum standardized uptake values of 5.0 and 6.5 in the early and late phases, respectively. Neither dilatation of intrahepatic bile ducts nor lymphadenopathy was identified, and the multimodality imaging suggested hepatic portal lymphoma, gastrointestinal tumor, or IgG4-related disease rather than cholangiocarcinoma. A needle biopsy via endoscopic ultrasonography was performed, and immunohistology confirmed the tumor as a schwannoma. Conclusions The diagnosis of a portal hepatic schwannoma requires immunohistological examinations in addition to multimodality imaging studies to reflect fully the pathohistological characteristics of the tumor.
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Affiliation(s)
- Maki Amano
- Department of Radiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Yasuo Amano
- Department of Radiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Ryo Takagi
- Department of Radiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Xiaoyan Tang
- Department of Pathology, Nihon University Hospital, Tokyo, 101-8309, Japan
| | - Yuko Omori
- Department of Radiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, 173-8610, Japan
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Ishimaru N, Fujikawa H, Kobayashi Y. Successful preoperative diagnosis and minimally invasive surgery of bile duct schwannoma. Clin J Gastroenterol 2020; 14:336-340. [PMID: 33070262 DOI: 10.1007/s12328-020-01263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
Bile duct schwannomas are rare benign tumors that frequently mimic more life-threatening tumors. Till date, only a few of these tumors have been diagnosed preoperatively. Herein, we report the case of a 68-year-old man who presented with a 1-day history of epigastralgia. The patient was preoperatively diagnosed with bile duct schwannoma using transpapillary biliary forceps biopsy and underwent local resection without major complications. The findings of our study indicate that endoscopic tumor biopsy may be helpful in diagnosing bile duct schwannoma before surgery; thus, enabling surgeons to plan an appropriate surgery while avoiding overtreatment.
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Affiliation(s)
- Naoki Ishimaru
- Department of Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano, 391-8503, Japan
| | - Hirohisa Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Internal Medicine, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano, 391-8503, Japan.
| | - Yoshifumi Kobayashi
- Department of Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano, 391-8503, Japan
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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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Marin Campos C, Garcia Sanz I, Muñoz de Nova JL, Valdés de Anca A, Martín Pérez ME. Schwannoma of the biliary tract resembling cholangiocarcinoma: A case report and review. Ann R Coll Surg Engl 2016; 98:e143-6. [PMID: 27269434 PMCID: PMC5210012 DOI: 10.1308/rcsann.2016.0189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 12/14/2022] Open
Abstract
Schwannomas are benign tumours derived from Schwann cells and are extremely rare in the biliary tract. We present the case of a 62-year-old patient with a common bile duct schwannoma that resembled a cholangiocarcinoma. We also review all 17 previously published cases of schwannoma of the biliary tract and discuss the challenges of preoperative diagnosis.
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Affiliation(s)
| | - I Garcia Sanz
- Hospital Universitario de La Princesa , Madrid , Spain
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Fonseca GM, Montagnini AL, Rocha MDS, Patzina RA, Bernardes MVAA, Cecconello I, Jukemura J. Biliary tract schwannoma: A rare cause of obstructive jaundice in a young patient. World J Gastroenterol 2012; 18:5305-8. [PMID: 23066328 PMCID: PMC3468866 DOI: 10.3748/wjg.v18.i37.5305] [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: 03/12/2012] [Revised: 07/26/2012] [Accepted: 07/28/2012] [Indexed: 02/06/2023] Open
Abstract
Schwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities, trunk, head and neck, retroperitoneum, mediastinum, pelvis, and peritoneum. However, it can arise in the gastrointestinal tract, including biliary tract. We present a 24-year-old male patient with obstructive jaundice, whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct, difficult to differentiate with hilar adenocarcinoma. He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection. The patient recovered well without signs of recurrence of the lesion after 12 mo. We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar. Resection is the treatment of choice for such cases and the tumor did not recur in any of the resected cases.
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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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