Tajiri Takuya, Hayashi Hiromitsu, Higashi Takaaki, Yamao Takanobu, Takematsu Toru, Uemura Norio, Yamamura Kensuke, Imai Katsunori, Yamashita Yo-Ichi, Baba Hideo
Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Surg Case Rep. 2020 Apr 19;6(1):76. doi: 10.1186/s40792-020-00839-4.
Schwannomas originate from Schwann cells, which are constituents of peripheral nerve sheaths, and can occur anywhere in the body at any age. Most occur in soft tissues such as subcutaneous tissues and muscles, occurrence in the abdominal cavity being relatively rare. In particular, schwannomas of the gallbladder are extremely rare. We herein report a rare case of a schwannoma that coexisted with systemic sarcoidosis and presented as a steroid-resistant mass in the gallbladder wall.
A 40-year-old woman was found to have thickening of the gallbladder wall during a routine medical examination and was referred to our hospital, where she was found to have granular shadows in the lungs; mediastinal, cervical, intraperitoneal, and inguinal lymphadenopathy; parotid gland enlargement; and an erythematous skin rash. She was diagnosed as having systemic sarcoidosis by transbronchial lung biopsy and bronchoalveolar lavage. All her systemic mass lesions except for the one in the gallbladder resolved or became smaller with steroid treatment. The steroid-resistant gallbladder lesion showed enhancement on contrast-enhanced computed tomography and was shown by endoscopic ultrasonography to be a 30-mm-diameter gallbladder wall lesion. We performed laparoscopic cholecystectomy, which resulted in diagnosis of the steroid-resistant tumor as a schwannoma. Five months after surgery, the patient's prednisolone dosage had been gradually reduced to 5 mg/day and she was doing well with no evidence of recurrence.
Resection of a steroid-resistant tumor resulted in diagnosis of schwannoma, enabling reduction in the patient's steroid dosage for sarcoidosis.
施万细胞瘤起源于施万细胞，施万细胞是周围神经鞘的组成部分，可在任何年龄发生于身体的任何部位。大多数发生于皮下组织和肌肉等软组织中，发生于腹腔相对少见。特别是胆囊施万细胞瘤极为罕见。我们在此报告一例罕见的施万细胞瘤，其与系统性结节病共存，并表现为胆囊壁上对类固醇耐药的肿块。
一名40岁女性在常规体检时发现胆囊壁增厚，遂转诊至我院，在我院发现其肺部有颗粒状阴影；纵隔、颈部、腹腔和腹股沟淋巴结肿大；腮腺肿大；以及皮肤红斑皮疹。经支气管肺活检和支气管肺泡灌洗，她被诊断为系统性结节病。除胆囊病变外，她所有的全身肿块病变在接受类固醇治疗后均消退或变小。对类固醇耐药的胆囊病变在对比增强计算机断层扫描中显示有强化，经内镜超声检查显示为直径30毫米的胆囊壁病变。我们进行了腹腔镜胆囊切除术，结果诊断出对类固醇耐药的肿瘤为施万细胞瘤。术后五个月，患者的泼尼松龙剂量已逐渐减至5毫克/天，她情况良好，无复发迹象。
切除对类固醇耐药的肿瘤后诊断为施万细胞瘤，从而能够减少患者用于结节病的类固醇剂量。
