Pancreatic Benign Schwannoma Treated by Simple Enucleation: Case Report and Review of Literature

Abstract

Benign schwannoma in the pancreatic head is very rare, with only 11 patients being reported in the English literature from a Medline search. Furthermore, only 1 of them was treated by simple enucleation. Herein, we present another enucleation case: a 71-year-old male patient with a 1.5 x 1.2-cm low-density mass, mimicking a cystic lesion located at the head of pancreas, which was detected by computed tomography. This tumor failed to be discovered by abdominal ultrasound. At laparotomy, a solid mass 1 cm in diameter was identified; it was the smallest one in the pancreatic head according to the 11 previous reported cases. No complications were found after the operation. At 10-month follow-up, the patient remains asymptomatic and has no signs of recurrence. The data of the 12 patients indicated that simple minimal invasive enucleation for small benign schwannoma in the pancreatic head was feasible and safe; early detection and early treatment of the tumor were helpful in increasing the ratio of enucleation and avoiding a very invasive Whipple operation.

Pancreatic Schwannoma: Literature Review

“…Symptoms such as back pain, anorexia, vomiting, weight loss, jaundice, and gastrointestinal bleeding have also been reported. 6,[11][12][13][14] A clinical examination revealed tenderness in the upper abdomen and a mass in larger cysts. 8 Transabdominal ultrasound examination is not very reliable, and it can miss small pancreatic lesions 11 because of the overlaying bowel.…”

Pancreatic schwannoma: Report of a case

“…Pancreatic schwannomas show no symptoms that are specifi c to the tumor, but the most common symptom was pain in the upper abdomen or right side of the abdomen, 6,8 which was found in 16 cases (48.5%; Table 1). Other symptoms including nausea, melena, body weight loss, and jaundice have also been noted.…”

“…Moreover, to our knowledge, no lymph node metastasis or distant metastasis occurred in these four malignant cases. Certain authors 3,6,8 have recommended an enucleation of the tumor, but decisions could be made about an additional resection following intraoperative consultations with a pathologist who would examine the frozen section. In our case, we could not make a defi nitive preoperative diagnosis of this tumor as pancreatic schwannoma and thus could not rule out a malignancy, and therefore we performed a spleen-preserving distal pancreatectomy with lymph node dissection.…”

“…[2][3][4][5] We found, via a Medline search, only 27 reports of 32 cases of pancreatic schwannoma in the English-language literature. [6][7][8][9] An accurate preoperative diagnosis of this tumor is quite diffi cult if patients have neither any history nor fi ndings of von Recklinghausen disease. 7,10 Our present report describes a patient with pancreatic schwannoma, which was preoperatively diagnosed to be a mucinous cystic neoplasm (MCN) plus a literature review of this tumor.…”

Pancreatic schwannoma: Report of a case and review of literature

“…Since malignant transformation is uncommon, simple enucleation is feasible, safe and sufficient. Early detection and early treatment of tumor were helpful in increasing the ratio of enucleation and avoiding a very extensive pancreatic resection [8,12].…”