Bekki Tomoaki, Oishi Koichi, Tadokoro Takeshi, Namba Yosuke, Okimoto Sho, Mukai Shoichiro, Saito Yasufumi, Fujisaki Seiji, Nishida Toshihiro, Ohdan Hideki, Fukuda Toshikatsu
Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan.
Department of Pathology, Chugoku Rosai Hospital, Hiroshima, Japan.
Surg Case Rep. 2021 Aug 19;7(1):187. doi: 10.1186/s40792-021-01271-y.
The occurrence of schwannomas in the hepatoduodenal ligament is rare, and its preoperative accurate diagnosis is difficult. Only few cases have been treated with laparoscopic surgery.
A 54-year-old man visited our hospital following abnormal abdominal computed tomography findings. He had no complaints, and his laboratory investigations were normal. Abdominal contrast-enhanced computed tomography revealed a tumor with enhancement at the margin of the hepatoduodenal ligament. The abdominal magnetic resonance imaging findings of the tumor showed hypointensity on the T1-weighted images and mixed hypointensity and hyperintensity on the T2-weighted fat-suppression images. Positron emission tomography showed localized accumulation of fludeoxyglucose only in the hepatoduodenal ligament tumor. The patient underwent laparoscopic tumor resection for accurate diagnosis. Histopathologically, the tumor was mainly composed of spindle cells, which were strongly positive for S-100 protein on immunohistochemical staining. The patient was discharged without any postoperative complications on day 5.
Complete tumor resection is essential for schwannomas to avoid recurrence. Laparoscopic surgery is useful for schwannomas occurring in the hepatoduodenal ligament and can be performed safely by devising an appropriate surgical method.
肝十二指肠韧带内神经鞘瘤的发生较为罕见，术前准确诊断困难。仅有少数病例采用腹腔镜手术治疗。
一名54岁男性因腹部计算机断层扫描异常结果前来我院就诊。他无任何不适主诉，实验室检查结果正常。腹部增强计算机断层扫描显示肝十二指肠韧带边缘有一强化肿瘤。该肿瘤的腹部磁共振成像结果显示，在T1加权图像上呈低信号，在T2加权脂肪抑制图像上呈低信号与高信号混合。正电子发射断层扫描显示仅肝十二指肠韧带肿瘤内有氟脱氧葡萄糖局部聚集。为明确诊断，患者接受了腹腔镜肿瘤切除术。组织病理学检查显示，肿瘤主要由梭形细胞组成，免疫组织化学染色显示S-100蛋白呈强阳性。患者术后第5天无任何并发症出院。
对于神经鞘瘤，完整切除肿瘤对于避免复发至关重要。腹腔镜手术对于发生在肝十二指肠韧带的神经鞘瘤是有用的，通过设计合适的手术方法可以安全地进行。
