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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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2
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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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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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4
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Abstract
A case of solitary neurofibroma of the common bile duct is presented. A review of the world literature reveals only one previously reported case of solitary neurofibroma in this location. Rare case reports of neurofibroma in association with von Recklinghausen's disease (neurofibromatosis 1) located in the hepatobiliary system are found. Discussion of traumatic neuroma, another clinically and histologically confusing entity occurring in the biliary system, is also included.
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Affiliation(s)
- Mary M. Walsh
- Department of Pathology, Mount Sinai Medical Center, New York, NY
| | - Michael Drew
- Department of Surgery, Parkway Hospital, Forest Hills, New York
| | - Ira J. Bleiweiss
- Department of Pathology, Box 1194, Mount Sinai Hospital, One Gustave L. Levy Place, New York, New York
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5
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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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Fenoglio L, Severini S, Cena P, Migliore E, Bracco C, Pomero F, Panzone S, Cavallero GB, Silvestri A, Brizio R, Borghi F. Common bile duct schwannoma: A case report and review of literature. World J Gastroenterol 2007; 13:1275-8. [PMID: 17451214 PMCID: PMC4147008 DOI: 10.3748/wjg.v13.i8.1275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Schwannoma is a myelin sheath tumor complicated with neurofibroma, neurofibromatosis and neurogenic sarcoma. Peripheral nerve sheath tumors represent 2%-6% of gastrointestinal tract stromal tumors (GIST), but there are deficient data about location of neurogenic tumors in the biliary system and only nine cases of schwannoma of the extrahepatic biliary tract have been reported. These tumors are clinically non-specific. They are usually symptomatic by compressing the close or adjacent structures when being retroperitoneal, and their preoperative diagnosis is extremely difficult. This paper reviews the literature data and describes a case of schwannoma of the common bile duct associated with cholestasis in a healthy young woman, diagnosed and treated in our department. This case is of interest on account of the complexity of its diagnosis and the atypical macroscopic growth pattern of the tumor.
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Affiliation(s)
- Luigi Fenoglio
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo, Italy.
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7
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Abstract
Schwanomas of the biliary tract are very rare with about 55 reported cases. Schwanomas of the gallbladder are the rarest, probably with less then ten reported cases. We reported a 61 old woman in whom we did a cholecystectomy for a tumor of gallbladder 6.5 x 9 cm in diameter with a central softness which showed a histologic appearance of schwanoma. Ten years after surgery the patient is symptom-free and with no signs of recurrency.
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Affiliation(s)
- R Colović
- Institut za bolesti digistivnog sistema KCS, Beograd
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8
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Abstract
Granular cell tumor of the biliary tree is a rare benign tumor that occurs most commonly in young African-American girls. Granular cell tumor rarely is included in the differential diagnosis of biliary obstruction, yet complete surgical excision is curative. The authors report a case of granular cell tumor of the biliary tree in a pediatric patient that required a pancreaticoduodenectomy for cure.
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Affiliation(s)
- E M Reynolds
- Department of Surgery, Broward General Medical Center, Ft Lauderdale, FL, USA
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9
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Mackenzie DJ, Klapper E, Gordon LA, Silberman AW. Granular cell tumor of the biliary system. MEDICAL AND PEDIATRIC ONCOLOGY 1994; 23:50-6. [PMID: 8177145 DOI: 10.1002/mpo.2950230109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Granular cell tumors (GCT) are rare benign neoplasms of Schwann cell origin which have been found in virtually every location in the body. Their location in the biliary system is unusual, and typically occurs in black females during the fourth decade of life. Forty-eight cases have been reported since 1952. We present two patients treated for obstructive jaundice caused by GCT of the extrahepatic biliary tree. The literature on biliary GCT is reviewed and their management is outlined. Local excision with Roux-y-hepaticojejunostomy was performed in one patient with GCT obstructing the common bile duct at the level of the cystic duct. Pancreaticoduodenectomy was performed on one patient for GCT of the common bile duct involving the ampulla and adjacent pancreas. GCT of the extrahepatic biliary system are rare but should be considered in black females who present with obstructive jaundice in the fourth decade of life. Local excision with cholecystectomy and reconstruction of the biliary remnant is indicated. Primary biliary anastomosis is desired but choledochojejunostomy or hepaticojejunostomy may be necessary. Rarely, pancreaticoduodenectomy may be indicated in GCT of the distal common bile duct.
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Affiliation(s)
- D J Mackenzie
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048
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Nagafuchi Y, Mitsuo H, Takeda S, Ohsato K, Tsuneyoshi M, Enjoji M. Benign schwannoma in the hepatoduodenal ligament: report of a case. Surg Today 1993; 23:68-72. [PMID: 7681709 DOI: 10.1007/bf00309003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 62-year-old woman with a large mass in the hepatic hilus underwent surgery. Histologically the tumor was predominantly composed of spindle-shaped cells with nuclear palisading and cells that stained positively for S-100 protein. The diagnosis was benign schwannoma (neurilemoma). The presence of lymphoid cuffing with lymphoid follicles in the capsule and xanthomatous change differed from conventional soft parts schwannoma and closely resembled benign schwannoma in the gastrointestinal tract.
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Affiliation(s)
- Y Nagafuchi
- First Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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Lafreniere R, Demetrick DJ, Benediktsson H. Granular cell neoplasm of the extrahepatic biliary tree: morphological, ultrastructural, and immunohistochemical study and review of the literature. J Surg Oncol 1991; 46:60-6. [PMID: 1986149 DOI: 10.1002/jso.2930460114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A recent case of a biliary granular cell tumor of the cystic duct prompted a literature review and an extensive pathological examination of the tumor in question. A total of 44 cases have been described mostly in black females. Most cases present with biliary symptoms, and simple surgical resection allows complete control of this benign condition. Granular cell tumors are most likely derived from neural crest cells.
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Affiliation(s)
- R Lafreniere
- Division of Surgical Oncology, University of Calgary, Alberta, Canada
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12
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Yamaguchi K, Kuroki S, Daimaru Y, Hashimoto H, Enjoji M. Granular cell tumor of the gallbladder. Report of a case. ACTA PATHOLOGICA JAPONICA 1985; 35:687-91. [PMID: 2994358 DOI: 10.1111/j.1440-1827.1985.tb00609.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A rare case of granular cell tumor of the gallbladder in a 58-year-old Japanese man is presented. This is the third report of such a tumor arising in the gallbladder. The immunohistochemical study demonstrated the localization of the nervous-system-specific protein (S-100 protein) in the granular component cells, thereby supporting the Schwann cell origin of this tumor.
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Abstract
We have reported our experience with two cases of granular cell myoblastoma, bringing the total number of cases to 29. Granular cell myoblastoma of the extrahepatic biliary system is a rare benign tumor that affects black women predominantly. Both black men in this study had multiple lesions involving the skin and biliary system. Surgery is necessary for tissue diagnosis and curative resection. Tumors involving the common bile duct or common hepatic duct require wide local excision and bilioenteric anastomosis. The cause is uncertain, but present data indicate a neuroectoderm origin.
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14
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Abstract
A case of granular cell tumor involving the intrapancreatic portion of the common bile duct is reported. The tumor was misdiagnosed as a bile duct carcinoma clinically and at surgery. Intraoperative needle biopsy failed to provide a specific diagnosis and led to a pancreatico-duodenectomy. The importance of making a specific frozen section diagnosis and the difficulties associated with this in this setting are presented.
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15
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Janes JO, Laughlin CL, Goldberger LE, Berk RN. Differential features of some unusual biliary tumors. GASTROINTESTINAL RADIOLOGY 1982; 7:341-8. [PMID: 6292036 DOI: 10.1007/bf01887668] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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16
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Abstract
Granular cell tumor most commonly appears in the tongue and skin, but has been found in varied locations (10). There are now 14 reported cases of the lesion occurring in the common bile duct. In most of these 14 cases, it has affected black females in their thirties. The lesion is most often benign. It should be considered in the differential diagnosis of obstructive jaundice secondary to bile duct tumors, especially if other granular cell tumors are present. This is the first reported case of pancreaticoduodenectomy for granular cell tumor of the common bile duct.
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17
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Dewar J, Dooley JS, Lindsay I, George P, Sherlock S. Granular cell myoblastoma of the common bile duct treated by biliary drainage and surgery. Gut 1981; 22:70-6. [PMID: 6257594 PMCID: PMC1419301 DOI: 10.1136/gut.22.1.70] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A young Caucasian woman is described in whom obstructive jaundice was caused by a granular cell myoblastoma of the common bile duct. She was treated by percutaneous transhepatic biliary drainage for 10 days, before radical removal. Granular cell myoblastomas are benign lesions of disputed histogenesis, rare among biliary neoplasms, the excision of which is curative.
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Abstract
A granular cell myoblastoma of the common bile duct is described which caused episodes of jaundice in a young woman. Histological examination demonstrated a close association of the tumour with nerve fibres, tending to support the theory of origin from Schwann cells. The lesion is benign and after excision carries an excellent prognosis.
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