Successful treatment of a pancreatic schwannoma by spleen-preserving distal pancreatectomy

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.

Mesenteric schwannoma: a rarity or rising trend?

“…Microscopically, they are comprised of admixture of dense and loose areas referred respectively to as Anton A (closely packed spindle cells) and Anton B areas (hypocellular with myxoid tissue and more water content). 20,21 Schwann cells are characterized by presence of spindle elongated nucleus with a wavy or buckled shape. Schwannoma which lack Anton B areas may resemble sarcoma.…”

Successful treatment of a giant ossified benign mesenteric schwannoma

“…Malignant peripheral sheath nerve tumours (MPNSTs) are uncommon and are always associated with von Recklinghausen’s disease[ 17 ]. Schwannomas mostly develop in young to middle-aged patients[ 18 ] and typically arise in the head, neck, and extremities[ 19 ]. The tumours in the ligament[ 20 ], mesentery[ 10 ] and intra-abdominal organs[ 21 - 23 ] are extremely rare.…”

“…Antoni type A areas consist of closely packed spindle cells, with occasional nuclear palisading. Antoni type B areas are hypocellular and contain more mixoid tissue with high water content[ 18 , 25 ], which can be cystic, haemorrhagic, calcified and even ossified[ 5 , 24 ]. In the present study, some areas of the tumour were ossified, and a true metaplastic bone formation could be seen, with the presence of bone lamellae and osteoblasts, just as reported by Gurzu et al[ 26 ].…”

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

“…Pancreatic schwannoma is usually asymptomatic. In patients with symptomatic schwannomas, abdominal pain is relatively common [ 1 , 2 ]. Additionally, a few cases of patients with jaundice have been reported [ 3 , 4 ].…”

“…Pancreatic schwannomas may develop both a cystic and solid lesion component. A cystic component is reportedly detected in about 60% of pancreatic schwannnomas [ 2 ], and the differential diagnosis from other cystic pancreatic tumors is difficult. We herein report a rare case of pancreatic schwannoma and differential diagnoses of cystic pancreatic lesions.…”