A Surgically Resected Pancreatic Schwannoma with Obstructive Jaundice with Special Reference to Differential Diagnosis from Other Cystic Lesions in the Pancreas

Watanabe, Tomohiro; Araki, Kenichiro; Ishii, Norihiro; Igarashi, Takamichi; Watanabe, Akira; Kubo, Norio; Kuwano, Hiroyuki; Shirabe, Ken

doi:10.1159/000485559

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…To date, all 5 cases of pancreatic schwannoma that underwent PET/CT had increased FDG uptake. [8,17,23,29] Recently, an increasing number of cases have undergone endoscopic ultrasound fine needle aspiration (EUS-FNA), which has greatly contributed to precise preoperative diagnosis. Of the 12 patients with pancreatic schwannoma who underwent EUS-FNA, 9 were accurately diagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…On 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), elevated FDG activity in schwannomas has been reported, [90] even though they are usually benign. To date, all 5 cases of pancreatic schwannoma that underwent PET/CT had increased FDG uptake [8,17,23,29] . Recently, an increasing number of cases have undergone endoscopic ultrasound fine needle aspiration (EUS-FNA), which has greatly contributed to precise preoperative diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment of pancreatic schwannoma by enucleation

Zhou

Wei

et al. 2022

Medicine

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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 Â 6 Â 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful treatment of pancreatic schwannoma by enucleation

Zhou

Wei

et al. 2022

Medicine

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“…They may mimic other, more common pancreatic lesions, such as pancreatic neuroendocrine tumors, mucinous cystic neoplasms, solid pseudopapillary neoplasms, mucinous cystadenocarcinomas, serous cystic neoplasms, acinar cell carcinomas, and pancreatic pseudocysts [ 24 ]. EUS-guided fine needle biopsy is useful to establish precise preoperative diagnosis and avoid unnecessary extensive radical resection [ 25 , 26 ], although its high false-negative rate and the difficulty of performing biopsy for cystic or small lesions are problems [ 24 , 27 , 28 ]. In our case, EUS-guided fine needle biopsy provided an accurate diagnosis, resulting in a clinically reasonable treatment.…”

Section: Discussionmentioning

confidence: 99%

A case of peripancreatic plexiform schwannoma

et al. 2021

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Background Plexiform schwannoma is one of the least common variants of schwannoma, accounting for only 5% of all schwannoma cases. It generally occurs in the skin and subcutaneous tissues and is uncommon in deep soft tissue or viscera. We present an extremely rare case of plexiform schwannoma arising from the peripancreatic plexus. Case presentation A 29-year-old man presented with hyperglycemia detected during a medical checkup. He was diagnosed with type 1 diabetes based on the clinical findings and laboratory tests. During the diagnostic process for diabetes, a 2.5 cm mass was incidentally detected in the pancreas by abdominal ultrasound. Contrast-enhanced computed tomography revealed a mass that was gradually enhanced at the body and tail of the pancreas. Magnetic resonance imaging revealed low signal intensity of the mass on T1-weighted images and high signal intensity on T2-weighted and diffusion-weighted images. Magnetic resonance cholangiopancreatography showed no abnormal findings in the main pancreatic duct. Endoscopic ultrasonography (EUS) showed a lobulated, low-echoic mass with a clear boundary. EUS-guided fine needle biopsy was performed, and spindle-shaped cells that were diffusely immunopositive for S-100 and negative for c-kit and desmin were detected, resulting in a diagnosis of a neurogenic tumor arising from the pancreas or the peripancreatic nerve plexus. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. Although the tumor was connected to the splenic plexus, the splenic artery could be divided along its adventitial plane. Macroscopic findings of the excised tumor consisted of multiple yellowish-white nodules, and its histopathological features were consistent with plexiform schwannoma. There was no pancreatic tissue on the dorsal surface of the tumor, which suggested that the tumor arose from the peripancreatic nerve plexus. Conclusions The findings documented herein can aid in the differential diagnosis of peripancreatic schwannoma and in planning appropriate treatment.

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“…Pancreatic schwannomas are really significant because they may be easily misdiagnosed as malignant tumors or as other benign neoplasms based on their histologic appearance and imaging features, despite the use of multiple noninvasive imaging modalities [3]. Furthermore, correct diagnosis of a pancreatic schwannoma can lead to an optimal treatment, be helpful in avoiding an unnecessary radical resection, endoscopic ultrasonography or percutaneous biopsies [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

MR imaging features of pancreatic schwannoma: a Chinese case series and a systematic review of 25 cases

et al. 2021

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Background There is a paucity of existing literature centering on the magnetic resonance (MR) imaging features of pancreatic schwannomas, due to the neoplasm’s nonspecific presentation and its rarity. We aimed to identify the characteristic imaging features of pancreatic schwannoma. Methods This retrospective search was conducted for histologically confirmed pancreatic schwannoma in multi-institutional database of pathology. Abdominal magnetic resonance imaging (MRI) was performed before histologic examination and their MR imaging studies were independently reviewed. The search yielded six adults (mean age, 46 years) with a definitive histologic postoperative diagnosis of single pancreatic schwannoma each. Additionally, a comprehensive English and Chinese literature review for pancreatic schwannoma and reported MR-imaging findings since 1961 was also conducted. MR imaging features of those cases in the literature were analyzed, summarized and compared with our case series. Results This rare entity appeared to be a well-circumscribed, exophytic, oval or round pancreatic mass with a mean greatest diameter of 3.7 cm. Five schwannomas were located in the pancreatic head-neck and one in the pancreatic tail. On MRI, all cases appeared hypointense on T1-weighted images, inhomogeneous hyperintense on T2-weighted images, and hyperintense on diffusion-weighted images. The mean apparent diffusion coefficient (ADC) values of pancreatic schwannoma were 1.11 ± 0.29 × 10− 3 mm2/s and significantly lower than the surrounding pancreas. The lesion-to-pancreas signal intensity ratio (SIR) at unenhanced T1-weighted images was 0.53 ± 0.07. On dynamic contrast-enhanced MRI, most of the lesions (67%, 4/6) showed homogeneously iso- or hypointense on arterial and portal venous phases, and hyperenhancement on delayed phase compared with the surrounding pancreas. In our analysis of the time intensity curves, all cases exhibited a gradual enhancement pattern. Conclusions A well-circumscribed mass displaying inhomogeneous hyperintensity on T2, marked hypointensity on T1, hyperintensity on DWI, and with early slight enhancement at arterial phase and progressive enhancement at portal venous and delayed phase, may suggest the diagnosis of pancreatic schwannoma.

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A Surgically Resected Pancreatic Schwannoma with Obstructive Jaundice with Special Reference to Differential Diagnosis from Other Cystic Lesions in the Pancreas

Cited by 7 publications

References 16 publications

Successful treatment of pancreatic schwannoma by enucleation

Successful treatment of pancreatic schwannoma by enucleation

A case of peripancreatic plexiform schwannoma

MR imaging features of pancreatic schwannoma: a Chinese case series and a systematic review of 25 cases

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