Fukuhara Sotaro, Fukuda Saburo, Tazawa Hirofumi, Imaoka Kouki, Mochizuki Tetsuya, Hirata Yuzo, Fujisaki Seiji, Takahashi Mamoru, Nishida Toshihiro, Sakimoto Hideto
Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan.
Department of Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193 Japan.
Int J Surg Case Rep. 2017;36:161-166. doi: 10.1016/j.ijscr.2017.05.031. Epub 2017 Jun 1.
Schwannomas are neoplasms originating from Schwann cells in nerve sheath, but pancreatic schwannomas are rare.
A 59-year-old female incidentally pointed out a 2-cm-sized solid mass in the pancreas head by computed tomography (CT) which was performed for other reasons. Magnetic resonance imaging (MRI) showed a mass with hypointensity on T1-weighted images and a heterogenous hyperintensity on T2-weighted images. Magnetic resonance cholangiopancreatography (MRCP) showed no abnormal findings in the main pancreatic duct. The mass of the pancreas head showed a significantly increased uptake on fluorin-18 fluorodeoxyglucose positron emission tomography CT (FDG-PET/CT). Based on the radiological findings, a malignant potential tumor was preliminarily considered. Subtotal stomach-preserving pancreatoduodenectomy (SSSPD) was performed to make a definite diagnosis. The resected specimen showed a well-encapsulated circumscribed mass, measuring 2.0cm, in the pancreas head. Histopathological examination revealed proliferation of spindle cells showing interlacing and palisading patterns in the tumor. The proliferating cells showed no atypia and few mitoses. Immunohistochemically, the spindle cells were positive for S-100 protein. The Ki67 labeling index was approximately 2%. Based on these findings, a diagnosis of benign schwannoma of the pancreas was made.
Although pancreatic schwannoma is a rare neoplasm, it is important to take into account this tumor in the differential diagnosis of pancreatic tumors. In addition, we should be aware that FDG-PET/CT shows abnormal accumulation in a benign pancreatic schwannoma.
施万细胞瘤是起源于神经鞘膜施万细胞的肿瘤，但胰腺施万细胞瘤较为罕见。
一名59岁女性因其他原因行计算机断层扫描（CT）时偶然发现胰头有一个2厘米大小的实性肿块。磁共振成像（MRI）显示该肿块在T1加权图像上呈低信号，在T2加权图像上呈不均匀高信号。磁共振胰胆管造影（MRCP）显示主胰管无异常发现。胰头肿块在氟-18氟脱氧葡萄糖正电子发射断层扫描CT（FDG-PET/CT）上摄取明显增加。根据影像学表现，初步考虑为具有恶性潜能的肿瘤。为明确诊断，行保留幽门的胰十二指肠次全切除术（SSSPD）。切除标本显示胰头有一个边界清楚、包膜完整的肿块，大小为2.0厘米。组织病理学检查显示肿瘤内梭形细胞呈交织状和栅栏状排列。增生的细胞无异型性，有丝分裂少见。免疫组化显示梭形细胞S-100蛋白阳性。Ki67标记指数约为2%。根据这些发现，诊断为胰腺良性施万细胞瘤。
尽管胰腺施万细胞瘤是一种罕见肿瘤，但在胰腺肿瘤的鉴别诊断中考虑到这种肿瘤很重要。此外，我们应该意识到FDG-PET/CT在良性胰腺施万细胞瘤中显示异常摄取。
