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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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2
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Debs P, Fayad LM, Ahlawat S. MR Neurography of Peripheral Nerve Tumors and Tumor-Mimics. Semin Roentgenol 2022; 57:232-240. [DOI: 10.1053/j.ro.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
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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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Tomioka K, Aoki T, Koizumi T, Elewa A, Kusano T, Matsuda K, Nogaki K, Tashiro Y, Wada Y, Hakozaki T, Shibata H, Hirai T, Yamazaki T, Saito K, Enami Y, Sugiura I, Nakajima Y, Arai J, Kajiwara A, Uozumi S, Shimozuma YU, Uchikoshi M, Sakaki M, Yoshida H, Miura S, Murakami M. Laparoscopic Treatment of a Hepatoduodenal Ligament Schwannoma With Infrared Indocyanine Green Fluorescence. In Vivo 2021; 34:2037-2041. [PMID: 32606179 DOI: 10.21873/invivo.12004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
Schwannomas occurring in the hepatoduodenal ligament are extremely rare, with only four cases reported. Here, we describe a case of a 30-mm schwannoma that originated in the hepatoduodenal ligament of a 38-year-old female found during a periodic medical check-up. Magnetic resonance imaging demonstrated a tumor in the hepatoduodenal ligament. Following an ultrasound-guided microbiopsy, histological examination showed solitary fibrous tumor or schwannomas in the liver or originating from the hepαtoduodenal ligament. The relationship between the tumor and associated organs was confirmed intraoperatively, and the tumor was removed safely in its entirety using indocyanine green. The postoperative histopathological examination revealed the presence of a schwannoma with typical characteristics. To our knowledge, this is the first case of hepatoduodenal ligament schwannoma treated by laparoscopic surgery using indocyanine green fluorescence imaging.
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Affiliation(s)
- Kodai Tomioka
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Takeshi Aoki
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Tomotake Koizumi
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Ahmed Elewa
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Tomokazu Kusano
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Kazuhiro Matsuda
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Koji Nogaki
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Yoshihiko Tashiro
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Yusuke Wada
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Tomoki Hakozaki
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Hideki Shibata
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Takahito Hirai
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Tatsuya Yamazaki
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Kazuhiko Saito
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Yuta Enami
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
| | - Ikuya Sugiura
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Yoko Nakajima
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Jun Arai
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Atsushi Kajiwara
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Shojiro Uozumi
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Y U Shimozuma
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Manabu Uchikoshi
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Masashi Sakaki
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Hitoshi Yoshida
- Department of Medicine, Division of Gastroenterology, Showa University, Tokyo, Japan
| | - Sakiko Miura
- Department of Medicine, Division of Pathology, Showa University, Tokyo, Japan
| | - Masahiko Murakami
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University, Tokyo, Japan
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Wang JK, Wu Q, Wu ZR, Liu F, Ran CD, Yin CH, Li FY. Schwannoma in the hepatoduodenal ligament with portal vein invasion: A case report. Medicine (Baltimore) 2020; 99:e20940. [PMID: 32702833 PMCID: PMC7373541 DOI: 10.1097/md.0000000000020940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature. PATIENT CONCERNS Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area. DIAGNOSES Schwannoma in the hepatoduodenal ligament with portal vein invasion. INTERVENTIONS Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein. OUTCOMES The patient had a good prognosis and had no recurrence after 37 months of follow-up. LESSONS Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.
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Affiliation(s)
| | | | - Zhen-Ru Wu
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Surgery
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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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Tahir A, Sdoudi A, Chahed M, Elbaitil A, Fakherdine L, Sbihi Y, Bennouna D, Fadili M. [Carpal tunnel syndrome secondary to a rare anatomical variation of the median nerve]. Pan Afr Med J 2019; 31:39. [PMID: 30918565 PMCID: PMC6430855 DOI: 10.11604/pamj.2018.31.39.15526] [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: 03/21/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022] Open
Abstract
Carpal tunnel syndrome is one of the the most common reasons for consultation in hand surgery with an annual incidence of 300 per 100 000 inhabitants and, in France, of 80 000 surgical interventions. In most cases, carpal tunnel syndrome is idiopathic occurring without a recognizable cause. However, beyond these forms, the merging of several mechanisms can explain the cause-and-effect relationship of this pathology . This study aimed to highlight an exceptional association of a carpal tunnel syndrome secondary to a rare anatomical variety of the median nerve.
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Affiliation(s)
- Amine Tahir
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
| | - Amine Sdoudi
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
| | - Mohamed Chahed
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
| | - Aniss Elbaitil
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
| | | | - Yasser Sbihi
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
| | - Driss Bennouna
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
| | - Mustafa Fadili
- Traumatologie-Orthopédie Aile 4, CHU Ibn Rochd, Casablanca, Maroc
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8
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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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Wu YS, Xu SY, Jin J, Sun K, Hu ZH, Wang WL. Successful treatment of a giant ossified benign mesenteric schwannoma. World J Gastroenterol 2018; 24:303-309. [PMID: 29375216 PMCID: PMC5768949 DOI: 10.3748/wjg.v24.i2.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/03/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
Primary benign schwannoma of the mesentery is extremely rare. To date, only 9 cases have been reported in the English literature, while mesenteric schwannoma with ossified degeneration has not been reported thus far. In the present study, we present the first giant ossified benign mesenteric schwannoma in a 58-year-old female. Ultrasound, computed tomography and magnetic resonance imaging were used, but it was still difficult to determine the definitive location and diagnose the mass. By laparotomy, a 10.0 cm × 9.0 cm × 9.0 cm giant mass was found in the mesentery and was then completely resected. Microscopically, the tumour located in the mesentery mainly consisted of spindle-shaped cells with a palisading arrangement. Some areas of the tumour were ossified, and a true metaplastic bone formation was observed, with the presence of bone lamellae and osteoblasts. Immunohistochemical investigation of the tumour located in the mesentery showed that the staining for the S-100 protein was strongly positive, while the stainings of SMA, CD34, CD117 and DOG-1 were negative. The cell proliferation index, measured with Ki67 staining, was less than 3%. Finally, a giant ossified benign mesenteric schwannoma was diagnosed. After surgery, the patient was followed up for a period of 43 mo, during which she remained well, with no evidence of tumour recurrence.
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Affiliation(s)
- Ying-Sheng Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shao-Yan Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jing Jin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ke Sun
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Zhen-Hua Hu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - 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
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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10
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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, Xie HY, Zhou L, Zheng SS, Wang WL. Schwannoma in the hepatoduodenal ligament: A case report and literature review. World J Gastroenterol 2016; 22:10260-10266. [PMID: 28028376 PMCID: PMC5155187 DOI: 10.3748/wjg.v22.i46.10260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/13/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
Schwannomas are mesenchymal neoplasms with low malignant potential that arise from Schwann cells. They can occur almost anywhere, although the most common locations are the head, neck and extremities. Primary benign schwannoma of the hepatoduodenal ligament is rare. To date, only three cases have been reported in the English literature. In the present study, we report a case of hepatoduodenal ligament schwannoma in a 43-year-old male, who was admitted to our hospital because of a abdominal mass found by physical examination. It was hard to determine the definitive location and diagnosis of the mass using ultrasound, computed tomography and magnetic resonance cholangiopancreatography. During laparotomy, the mass was found in the hepatoduodenal ligament and close to the cholecystic duct, so we resected the gallbladder and cholecystic duct along with the mass. The gross specimen revealed an 8.5 cm × 5.5 cm × 3.0 cm localized tumor. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells. Immunohistochemical staining showed a strong positive S-100 protein reaction. Finally, the lesion was diagnosed as a benign schwannoma in the hepatoduodenal ligament. However, one month later, the patient was readmitted to our hospital because of skin and sclera jaundice caused by common bile duct stenosis without common bile duct stone or tumor. The patient recovered well after implantation of a common bile duct stent under endoscopic retrograde cholangiopancreatography. He was followed up for a period of 17 mo, during which he was well with no 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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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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Xu SY, Sun K, Xie HY, Zhou L, Zheng SS, Wang WL. Hemorrhagic, calcified, and ossified benign retroperitoneal schwannoma: First case report. Medicine (Baltimore) 2016; 95:e4318. [PMID: 27472709 PMCID: PMC5265846 DOI: 10.1097/md.0000000000004318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Schwannomas are mesenchymal tumors arising from the neural sheaths of peripheral nerves. They can almost develop in any part of the body, while head, neck and extremities are the most common sites. Occurrence in the retroperitoneum is rare. Schwannomas can show secondary degenerative changes including cyst formation, hyalinization, hemorrhage, and calcification, whereas the ossified retroperitoneal schwannoma was only reported in a malignant one. CASE SUMMARY We first present a benign ossified retroperitoneal schwannoma in a 61-year-old female. The mass was found by a routine health examination. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well-defined mass in the area among duodenum, right liver, and kidney. Definitive preoperative diagnosis of the mass was difficult. By laparotomy, the mass was found in the retroperitoneum. We completely removed the tumor and gross specimen showed a mass with a capsule and 6 × 6 × 4.8 cm in size. Microscopic examination showed the tumor is composed of spindle-shaped cells with degenerative changes of hemorrhage, calcification, and ossification. Immunohistochemically, S-100 protein was strongly positive. Finally, the mass was diagnosed as a hemorrhagic, calcified, and ossified benign schwannoma in the retroperitoneum. The patient was followed up for a period of 21 months, during which she was well with no evidence of recurrence. CONCLUSION We report the first case of a benign retroperitoneal schwannoma with secondary degenerative changes including hemorrhage, calcification, and ossification. Precise preoperative diagnosis of the tumor is challenging even with multiple preoperative imaging modalities. After complete resection, patients with benign retroperitoneal schwanommas generally have good prognosis.
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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
| | - Ke Sun
- Department of pathology, 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: Wei-Lin 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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Tao L, Xu S, Ren Z, Lu Y, Kong X, Weng X, Xie Z, Hu Z. Laparoscopic resection of benign schwannoma in the hepatoduodenal ligament: A case report and review of the literature. Oncol Lett 2016; 11:3349-3353. [PMID: 27123115 PMCID: PMC4841058 DOI: 10.3892/ol.2016.4410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/09/2016] [Indexed: 12/13/2022] Open
Abstract
Schwannomas are mesenchymal neoplasms with a low malignant potential, which arise from Schwann cells. The tumors can occur in most parts of the body; however, the head, neck and flexor surfaces of the extremities are the most common locations. Schwannomas occurring in the hepatoduodenal ligament are extremely rare. To the best of our knowledge, only two cases of schwannoma in the hepatoduodenal ligament have been reported in the literature, and treatment of such cases by laparoscopic surgery has not yet been reported. The present study reports a case of schwannoma in the hepatoduodenal ligament in a 50-year-old male patient. Physical and laboratory examinations showed no abnormal results. Ultrasound and computed tomography failed to definitively diagnose the mass and identify its location. During laparoscopic surgery, a mass was identified in the hepatoduodenal ligament and was completely removed. The gross specimen was a 4.5×2.5×2.5-cm localized mass, yellowish-white in color. Microscopic examination revealed that the tumor was mainly composed of spindle-shaped cells and no atypical cells were identified. Immunohistochemical staining showed a strong positive S-100 protein reaction, whereas cluster of differentiation 34 and epithelial membrane antigen were negative. The final diagnosis of the lesion was benign schwannoma of the hepatoduodenal ligament. The patient was followed-up for 7 months and, at the time of writing, was healthy and without any complications. The aim of the present study was to describe a rare case of hepatoduodenal ligament schwannoma in a 50-year-old male patient, and present a review of the literature. To the best of our knowledge, this is the first case of hepatoduodenal ligament schwannoma treated by laparoscopic surgery.
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Affiliation(s)
- Liang Tao
- Department of General Surgery, The Third People's Hospital of Haining, Jiaxing, Zhejiang 314408, P.R. China
| | - Shaoyan Xu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhigang Ren
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Yiting Lu
- Department of General Surgery, The Third People's Hospital of Haining, Jiaxing, Zhejiang 314408, P.R. China
| | - Xiaowu Kong
- Department of General Surgery, The Third People's Hospital of Haining, Jiaxing, Zhejiang 314408, P.R. China
| | - Xiaohui Weng
- Department of General Surgery, The Third People's Hospital of Haining, Jiaxing, Zhejiang 314408, P.R. China
| | - Zhijie Xie
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Zhiming Hu
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
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Tumeurs malignes des gaines nerveuses périphériques intracérébrales métastatiques : à propos de deux cas et revue exhaustive des cas de la littérature. Cancer Radiother 2016; 20:119-32. [DOI: 10.1016/j.canrad.2015.07.157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/05/2015] [Accepted: 07/22/2015] [Indexed: 11/17/2022]
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Arabi H, Bakzaza O, El Fikri A, Elktaibi A, Saidi H, El Alaoui M. Compression of the peroneal nerve by a neurofibroma originating from collaterals of the peroneal nerve: a case report. J Med Case Rep 2016; 10:28. [PMID: 26837306 PMCID: PMC4738795 DOI: 10.1186/s13256-016-0815-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 01/19/2016] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Paralysis of the external popliteal sciatic nerve is a frequent pathological condition that occurs after trauma. However, etiologies other than trauma, such as tumors, are also possible. The sensory collaterals of the external popliteal sciatic nerve have a small territory of innervation at the knee, and tumors involving these nerves become symptomatic after compression of the motor nerves. We here describe the first reported case of this phenomenon. CASE PRESENTATION This case involved a lesion compressing the origin of the external popliteal sciatic nerve of a 13-year-old Moroccan boy diagnosed with a neurofibroma. He developed functional impairment of his left lower limb during a football game, and examination revealed a steppage gait. The initial diagnosis was stretching of the peroneal nerve. The definitive diagnosis of a neurofibroma was revealed by imaging and confirmed by surgery and pathology. Treatment involved total removal of the tumor; however, our patient's steppage gait persisted. CONCLUSIONS Our patient developed compression of the external popliteal sciatic nerve from a tumor growing on a collateral nerve. Early diagnosis is an absolute necessity in such cases. Trauma and tumors of sensory nerves can distort the diagnosis, as in this case. Ultrasound and magnetic resonance imaging can contribute to an accurate diagnosis in patients with neuropathy in the absence trauma or tomacula.
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Affiliation(s)
- H Arabi
- Equipe de recherche clinique et épidémiologique de la pathologie ostéo-articulaire, UCH Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco. .,Department of Physical Medicine and Rehabilitation (PMR), Avicenne Military Hospital, Avenue de la Résistance, Gueliz, Marrakech, Morocco.
| | - O Bakzaza
- Department of Vascular Surgery, Avicenne Military Hospital, Marrakech, Morocco.,UCH Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - A El Fikri
- UCH Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.,Department of Imagery, Avicenne Military Hospital, Marrakech, Morocco
| | - A Elktaibi
- UCH Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.,Department of Pathology, Avicenne Military Hospital, Marrakech, Morocco
| | - H Saidi
- Equipe de recherche clinique et épidémiologique de la pathologie ostéo-articulaire, UCH Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - M El Alaoui
- Department of Vascular Surgery, Avicenne Military Hospital, Marrakech, Morocco.,UCH Mohammed VI, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Labonté S. [Myxoid tumors of deep soft tissues]. Ann Pathol 2014; 35:3-14. [PMID: 25533917 DOI: 10.1016/j.annpat.2014.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
Myxoid soft tissue tumors form a heterogeneous group. Their biological potential encompasses the whole spectrum from benign to highly malignant. The present article focuses on myxoid tumors of the deep soft tissues: myxofibrosarcoma, low-grade fibromyxoid sarcoma, myxoma, myxoid liposarcoma, extraskeletal myxoid chondrosarcoma and nodular fasciitis. The last two decades have brought into practice multiple powerful tools that support pathologists in making precise diagnoses, even on small incisional biopsies: detection of fusion transcripts by rt-PCR, detection of chromosomal fusion or breakpoint by FISH, detection of point mutations by PCR and expression of specific markers by immunohistochemistry. Conventional morphology remains the mainstay of diagnosis, and it is essential to obtain adequate clinical and radiological information before interpreting small incisional biopsies. The present article is a summary of morphologic features used to diagnose the most common tumors of the deep soft tissues.
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Affiliation(s)
- Sébastien Labonté
- CHU de Québec/L'Hôtel-Dieu de Québec, 11, Côte-du-Palais, Québec, QC, G1R 2J6, Canada.
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