Zhao Long Cheng, Li Zi Ye, Wu Fan, Hu Yue, Wang Bai Lin
Department of Hepatobiliary Surgery, Guangzhou Red Cross Hospital of Jinan University, Tongfu Roud 396, Guangzhou, 510220, Guangdong, China.
Department of Pathology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
World J Surg Oncol. 2025 Jan 3;23(1):2. doi: 10.1186/s12957-024-03646-5.
Schwannomas are tumors that originate from the glial cells of the nervous system and can occur on myelinated nerve fibers throughout the body, especially in the craniofacial region. However, pancreatic schwannomas are extremely rare. We report a case of a pancreatic schwannoma that was difficult to differentiate from other pancreatic tumors preoperatively. A 44-year-old female patient was found to have a pancreatic mass on Computed Tomography imaging and the preoperative diagnosis was a pancreatic solid pseudopapillary neoplasm. Meanwhile, the patient had type 2 diabetes and the blood glucose was controlled at 8-15mmol/L by taking oral antidiabetic drugs. During exploratory laparotomy, an 8 cm × 7 cm × 4 cm mass was discovered in the middle part of the pancreas. Considering the preoperative diabetes, the patient underwent a central pancreatectomy (CP) and Roux-en-Y pancreaticojejunostomy. Postoperative histopathological examination confirmed the diagnosis of a pancreatic epitheloid schwannoma. After surgery, the patient developed Grade B pancreatic fistula, which disappeared after treatment. At the same time, the patient's blood glucose remained basically stable by insulin therapy, which was adjusted to oral antidiabetic medications in about 40 days after surgery. At a 32-month follow-up after discharge, no tumor recurrence was observed, and the patient's blood glucose was controlled below 11.1mmol/L with only oral antidiabetic drugs. The radiological diagnosis of pancreatic schwannomas lacks specific features, and diagnosis primarily relies on histopathological examination and immunohistochemical testing. Although pancreatic schwannomas are extremely rare, they must be differentiated from other solid or cystic pancreatic lesions. For patients with pancreatic schwannoma and diabetes, CP may represent a favorable surgical option.
施万细胞瘤是起源于神经系统神经胶质细胞的肿瘤，可发生于全身有髓神经纤维，尤其是颅面部区域。然而，胰腺施万细胞瘤极为罕见。我们报告一例术前难以与其他胰腺肿瘤鉴别的胰腺施万细胞瘤病例。一名44岁女性患者在计算机断层扫描成像中发现胰腺肿块，术前诊断为胰腺实性假乳头状瘤。同时，该患者患有2型糖尿病，通过口服降糖药血糖控制在8 - 15mmol/L。在剖腹探查术中，于胰腺中部发现一个8 cm×7 cm×4 cm的肿块。考虑到术前糖尿病情况，患者接受了胰体尾切除术（CP）和Roux-en-Y胰空肠吻合术。术后组织病理学检查确诊为胰腺上皮样施万细胞瘤。术后患者出现B级胰瘘，经治疗后消失。同时，患者血糖通过胰岛素治疗基本保持稳定，术后约40天调整为口服降糖药。出院后32个月随访，未观察到肿瘤复发，仅用口服降糖药患者血糖控制在11.1mmol/L以下。胰腺施万细胞瘤的影像学诊断缺乏特异性特征，诊断主要依靠组织病理学检查和免疫组化检测。尽管胰腺施万细胞瘤极为罕见，但必须与其他胰腺实性或囊性病变相鉴别。对于患有胰腺施万细胞瘤和糖尿病的患者，胰体尾切除术可能是一种有利的手术选择。
