Pancreatic schwannoma: A rare case and a brief literature review

IntroductionPancreatic schwannoma (PS) is an extremly rare benign tumor. Less than 50 cases of pancreatic schwannoma have been described in the English literature over the past thirty years.Presentation of case reportA 63-year-old female underwent left modified radical mastectomy 2 years ago due to breast cancer. During her routine check-up, a 65 × 63 × 55 mm measured calcified, well-demarcated, cystic-mass having septations and calcifications that localized to the pancreatic head was detected by abdominal computerized tomography. She was asymptomatic and her tumor markers were in normal ranges. A standard Whipple procedure was performed, and the histo-pathological diagnosis of the resected specimen was reported as ancient schwannoma with clear surgical margins. Patient’s postoperative course was eventful. She had a biliary leakage after surgery which was managed conservatively. She is under follow-up.DiscussionPancreatic schwannoma also known as neurilemoma or neuroma is a slowly growing, encapsulated, mostly benign tumor with smooth well-delineated margins that originates from myelin producing schwann cells located on the nerve sheath of the peripheral epineurium of either the sympathetic or parasympathetic autonomic fibers. PS’s are extremly rare. The head of pancreas being involved in the vast majority of cases (40%), followed by its body (20%). Management of pancreatic schwannomas remains largely controversial. Both enucleation and radical surgical resections have revealed great therapeutic efficiency. with a well prognosis without recurrences.ConclusionAlthough rare, PS’s should be considered in the differential diagnosis of the other solid or cystic masses of the pancreas.     

Pancreatic schwannoma: Report of a case

Among pancreatic neoplasms, pancreatic schwannoma is quite rare. We report a case of solitary pancreatic schwannoma, plus a literature review of this tumor. A 71-year-old woman was diagnosed by abdominal ultrasonography as having a pancreatic tumor and was hospitalized in our department at Kumamoto University Hospital on January 26, 2006. Abdominal computed tomography, magnetic resonance imaging, and endoscopic ultrasonography all showed this tumor, which was located in the body of the pancreas, to have cystic and solid components, and with a septum in the cystic part of the lesion. The tumor, preoperatively identified as a mucinous cystic neoplasm, was clearly separated from the normal pancreatic parenchyma. We performed a spleen-preserving distal pancreatectomy with a lymph node dissection on February 7, 2006. A histopathological examination of the resected specimen by means of hematoxylin and eosin revealed the tumor to consist of two parts: one with a compact spindle cell pattern (Antoni type A), and the other showing degeneration of fat (Antoni type B). We also found positive results for immunohistochemical staining for S-100 and vimentin. These findings confirmed the tumor’s classification as a pancreatic schwannoma.     

Pancreatic schwannoma: Report of a case

(Received for publication on June 24, 1998; accepted on Mar. 11, 1999)     

Intramedullary melanotic schwannoma. Report of a case and review of the literature

A case of an intramedullary melanotic schwannoma located in the spinal cord at the T2-T3 level is described. The lesion occurred in a 44-year-old woman with a 10-year history of weakness and sensory numbness in both legs and feet. At operation the lesion appeared as a well-demarcated grey-brown intramedullary mass. Histologically, it was composed of interlacing bundles of spindle cells showing their cytoplasm filled with melanin. Among spinal cord neoplasms, melanotic schwannomas are rare tumours, which have apparently been reported only in three previous instances. The clinical, diagnostic and pathological features, as well as the possible aetiology of these rare tumours are discussed.     

原发性膀胱神经鞘瘤1例报告并文献复习

目的 探讨原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤在组织病理学、临床表现、治疗和预后上的特点,确立两者的鉴别诊断思路.方法 回顾1例原发于膀胱的神经鞘瘤的临床诊疗过程,结合有关膀胱神经鞘瘤及膀胱恶性周围神经鞘瘤的文献资料进行分析.结果 在组织病理和免疫组化方面,原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤有明显差异.结论 原发于膀胱的神经鞘瘤临床极其少见,易与膀胱常见肿瘤混淆,造成误诊,免疫组化为重要的确诊依据.膀胱恶性周围神经鞘瘤应以高度恶性的软组织肉瘤进行处理.临床上应重视两种疾病的鉴别,以正确地指导临床诊疗.     

Pancreatic echinococcosis. Report of a clinical case and review of the literature

We report a case of a suppurative hydatid cyst of the pancreas treated surgically (internal drainage on Roux "Y" loop). Follow-up at 6 months revealed no evidence of the cyst. We emphasise the low incidence of the disease in a pancreatic site (02-2% in the literature). This was the first case in our experience despite the fact that Sicily is an area in which the parasite is endemic. We also emphasise the preoperative diagnostic difficulties: ultrasonography and computed tomography yielded very images very similar to those of a pseudocyst or cystic carcinoma. In most cases, in fact, as in the one reported here, the condition is diagnosed during surgery.     

腹膜后神经鞘瘤1例报告并文献复习

目的报告1例腹膜后神经鞘瘤,并复习相关文献,分析其临床诊治现状。方法通过对1例腹膜后神经鞘瘤的诊断、治疗方法及术后病理、随访的回顾,结合国内外有关文献报道,综合分析腹膜后神经鞘瘤的诊断及治疗状况。结果本例行手术治疗,术后病理证实为腹膜后神经鞘瘤,随访半年无复发。结论腹膜后神经鞘瘤诊断困难,影像学检查无特异性,确诊依靠病理检查,理想的治疗方法是通过外科手术完整切除肿瘤,其预后良好,早期复发率低。     

Abducens nerve schwannoma: a case report and review of the literature

BACKGROUND: Schwannomas of the abducens nerve are extremely rare tumors; only 10 cases have been reported so far. The tumor may be located within the cavernous sinus (CS) or more commonly at the prepontine region. Patients usually present with VIth cranial nerve paresis. CASE DESCRIPTION: We report a case of a 42-year-old male patient who presented with headache, vertigo, and hearing deficit, but no symptoms or signs related to a VIth cranial nerve impairment. Computed tomography and magnetic resonance imaging showed a large mass with a ring-like contrast enhancement in the prepontine area. Surgical treatment, via a simple retrosigmoid suboccipital approach, revealed a schwannoma originating from the VIth cranial nerve at its prepontine portion. Postoperative histological examination confirmed the diagnosis of schwannoma, and the patient had only a VIth cranial nerve palsy, which resolved during long-term follow-up. CONCLUSIONS: Abducens schwannomas are rare tumors, representing less than 1% of all intracranial schwannomas in our clinic and about 13% of oculomotor nerve schwannomas reported in the literature. These lesions can be mainly divided into tumors originating from the intracavernous portion of the VIth cranial nerve or more commonly from the cisternal part of the nerve, leading to a lesion in the prepontine region. In such cases, with no invasion of the cavernous sinus, radical tumor resection with preservation of the abducens nerve can be performed via a simple suboccipital retrosigmoid approach.     

Retroperitoneal giant schwannoma: a case report and review of the literature

Schwannomas are rare tumours that originate in the neural sheath and account for only a small percentage of all retroperitoneal tumours. They are usually solitary, circumscribed and encapsulated lesions eccentrically located on proximal nerves or spinal nerve roots. Presentation is typically varied and non-specific, ranging from abdominal pain, an abdominal mass or an incidental finding. The preoperative diagnosis is difficult and laboratory tests are usually unremarkable. We report the case of a 66-year-old female presenting with abdominal pain in her left flank and with an ultrasonographic diagnosis of a left kidney mass. She was diagnosed as suffering from a giant retroperitoneal schwannoma after surgical exploration and complete excision. The role of CT scan and CT-guided needle biopsy is emphasised, in that ultrasonography and fine needle aspiration alone do not provide sufficient information regarding aetiology and malignancy. Radical surgical excision is curative but recurrences may occur. Careful follow-up is needed.     

Benign schwannoma of the pelvic retroperitoneum. Report of a case and review of the literature

Benign schwannoma is a tumor arising from Schwann cells (forming the neural sheath of peripheral nerves). The retroperitoneal location is unusual (0.5-5% of cases). Most common locations are cranial nerves (especially the 8th pair) and, in peripheral nerve system the neck, mediastinum and extremities. To this date the known cases of benign retroperitoneal schwannoma are about 60, of which less than 20 in the pelvis. The low frequency of this tumor and the lack of specific instrumental signs and objective symptoms (since it develops in a deep and broad region as retroperitoneum) make presurgical diagnosis very difficult. It can be confirmed only during surgery and definitive histological examination. The information provided by ultrasonography, CT and MR help to limit diagnostic hypothesis, but they don't show any pathognomonic images. The resection of this tumor is the appropriate treatment, even though it is really a complex one. Prognosis is quite good since post-surgical recurrences are unusual. If they appear is probably because excision wasn't radical. Complete resection is the best treatment for retroperitoneal pelvic schwannoma and today it can be performed also by laparoscopy. Partial resection can be used when the mass is strongly connected to essential organs in order to prevent iatrogenic harms (neural deficit, vessel lesions); this may occur in 10% of cases. This paper describes a benign schwannoma with pelvic retroperitoneal location, incidentally discovered during a routine gynecological check up. The purpose of this study is to review current therapeutic and diagnostic techniques in retroperitoneal pelvic schwannoma (including a review of current literature) and to identify th problems that can be encountered in the differential diagnosis of this unusual disease from other neoplasms occurring in the same place.     

Abducens nerve schwannoma: case report and review of the literature

Schwannomas of the abducens nerve are extremely rare. The authors report a case with this tumor and discuss its clinical and radiographic characteristics. A 36-year-old man presented with 6-month history of diplopia. Right abducens nerve paresis was noted on neurologic examination. Magnetic resonance imaging revealed a 4-cm sized heterogeneously enhancing mass in the right cerebellopontine angle. Although schwannoma was suggested, no direct radiographic evidences regarding its origin were identified. Instead, the facial and vestibulocochlear nerve complex was found to be displaced posteriorly by the tumor on MR three-dimensional T2-weighted driven equilibrium sequence. Resection of the tumor was carried out via retrosigmoid approach. As the encapsulated partially suckable yellowish tumor was debulked and dissected, the abducens nerve was found to fan along and be attached to the medial surface of the tumor, which was cut at this point. Complete excision of the tumor was accomplished, and reanimation of the nerve was done by end-to-end anastomosis. Histologic feature was typical of schwannoma. Abducens schwannoma, although rare, should be taken into account for differential diagnosis of the cerebellopontine angle tumors. Appreciation of the characteristic clinical and radiographic features may provide an accurate preoperative diagnosis.     

Penile schwannoma mistaken for hemangioma: a rare case report and literature review

Penile neoplasm is uncommon. Schwannomas of the penis are especially rare. For this reason, it is difficult to get an accurate impression to enable decision making. This report primarily deals with the mistaken diagnosis of hemangioma, to the surgery, and the follow-up in real-world. A 38-year-old male patient presented with a palpable mass in the penile root that increased in size with erection. One year after the mass had been found, the patient visited the hospital and complained that the mass was growing. Moreover, the patient explained that the mass seemed to increase during penile erection. On physical examinations, a 2 cm mass without tenderness was palpated in the left penoscrotal junction. About 2.1 cm in size, an isoechoic mass was observed next to the corpus cavernosum on ultrasonography. There was high vascularity inside of the mass. Excision and biopsy were decided upon. Following surgery, a schwannoma was confirmed by pathology. After three months, the patient did not complain of any symptoms and had normal erectile function. Most of these tumors are benign. By December 2020, 40 cases were reported, of which 6 were diagnosed as malignant. The most frequent occurrence site is the penile shaft. In all cases, surgical resection was performed and no recurrence was found. The aim of this case report is to assist clinicians in choosing the best treatment option when faced with this rare condition by discussing the radiological, pathological, and clinical course.     

Solitary schwannoma of the rectum mimicking rectal cancer. Report of a case and review of the literature

A case of a submucosal tumor bulging into the rectum in an old female patient is reported. It proved to be a very rare case of rectal schwannoma, whose differential diagnosis is difficult to obtain preoperatively and optimal treatment and prognosis still uncertain. The mass was removed by means of an ultrasound device after an open anterior rectotomy. The operation was uneventful and the patient is disease free 18 months after.     

A case of intrapulmonary schwannoma and a review of the Japanese literature

A 61 year-old male with abnormal shadow on chest X-ray was admitted. Right upper lobectomy was performed on the suspicious diagnosis of benign lung tumor. The tumor arising from right upper lobe was 5 X 6 X 4.5 cm in diameter. The histological diagnosis was schwannoma. Intrapulmonary schwannoma is an extremely rare and we have found 13 reported cases among in Japanese literatures.     

阴茎多发性神经鞘瘤的临床特征(附1例报告并文献复习)

目的:探讨阴茎多发性神经鞘瘤的临床特征。方法:报告1例阴茎多发性神经鞘瘤患者的临床资料,结合复习相关文献。结果:术前拟诊为阴茎多发性脂肪瘤,行肿瘤切除术,手术治疗后恢复良好。病理报告为阴茎多发性神经鞘瘤。免疫组化:S-100( ),SMA(-)。随访半年无复发。结论:阴茎多发性神经鞘瘤缺乏典型的临床表现,临床诊断困难,需经病理学检查,免疫组化检测肿瘤特异性标志物S-100、SMA有助于确诊。手术切除是治疗本病的主要方法。     

Pancreatic pseudocyst treated by laparoscopic Roux-en-Y cystojejunostomy. Report of a case and review of the literature

Advances in laparoscopic surgical technique and instrumentation have furthered our ability to perform more complex laparoscopic procedures. We report the case of a 45-year-old man in whom a giant pancreatic pseudocyst developed after biliary pancreatitis. He underwent laparoscopic internal drainage by a Roux-en-Y cyst-jejunal anastomosis after unsuccessful percutaneous drainage. The surgical technique and a review of the current literature is presented. We conclude that although laparoscopic internal drainage technically is feasible in selected cases, additional data are required to define the role of this surgical approach in the treatment of pancreatic pseudocysts.