Suzuki Kazunobu, Shiraishi Takuya, Shioi Ikuma, Ozawa Naoya, Okada Takuhisa, Osone Katsuya, Sano Takaaki, Araki Kenichiro, Ogawa Hiroomi, Sano Akihiko, Sakai Makoto, Sohda Makoto, Shirabe Ken, Saeki Hiroshi
Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan.
Surg Case Rep. 2023 May 11;9(1):76. doi: 10.1186/s40792-023-01658-z.
Schwannoma, which clinicians sometimes struggle to diagnose, is a tumor arising from Schwann cells of peripheral nerves, often in the soft tissues and rarely in the gastrointestinal tract. Pancreatic neuroendocrine tumor (PNET) is rare among pancreatic tumors, and recurrence can occur long after resection. Here, we were presented with a case where a sigmoid colon schwannoma was difficult to distinguish from a postoperative recurrence of PNET and was diagnosed after laparoscopic resection.
A 51-year-old man was diagnosed with PNET (NET G2) after a distal pancreatectomy (DP) 13 years ago. The patient underwent hepatectomy due to liver metastasis 12 years after initial radical surgery. The follow-up magnetic resonance imaging (MRI) after hepatectomy showed pelvic nodules, and laparoscopic surgery was performed for both diagnosis and treatment because peritoneal dissemination of PNET could not be ruled out. Since the tumor was in the sigmoid colon, a partial colon resection was performed. The histopathological diagnosis was a schwannoma, and the patient was discharged on the seventh postoperative day.
We experienced a case of sigmoid colon schwannoma that was difficult to differentiate from peritoneal dissemination of PNET and was later diagnosed after laparoscopic resection. In addition, this case involved a long-term postoperative recurrence of PNET that was amenable to radical resection, further establishing the importance of long-term imaging follow-up.
神经鞘瘤是一种起源于周围神经施万细胞的肿瘤，临床医生有时难以诊断，它常发生于软组织，很少发生于胃肠道。胰腺神经内分泌肿瘤（PNET）在胰腺肿瘤中较为罕见，且切除后很长时间可能会复发。在此，我们报告一例乙状结肠神经鞘瘤，其难以与PNET术后复发相鉴别，经腹腔镜切除后得以确诊。
一名51岁男性13年前因远端胰腺切除术被诊断为PNET（NET G2）。初次根治性手术后12年，患者因肝转移接受了肝切除术。肝切除术后的随访磁共振成像（MRI）显示盆腔有结节，由于不能排除PNET的腹膜播散，遂行腹腔镜手术以明确诊断并进行治疗。由于肿瘤位于乙状结肠，故行部分结肠切除术。组织病理学诊断为神经鞘瘤，患者术后第7天出院。
我们遇到一例乙状结肠神经鞘瘤，难以与PNET的腹膜播散相鉴别，经腹腔镜切除后确诊。此外，该病例涉及PNET术后长期复发且可进行根治性切除，进一步证实了长期影像学随访的重要性。
