Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2016; 22(37): 8439-8446
Published online Oct 7, 2016. doi: 10.3748/wjg.v22.i37.8439
Central pancreatectomy for pancreatic schwannoma: A case report and literature review
Shao-Yan Xu, Ke Sun, Kwabena Gyabaah Owusu-Ansah, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang
Shao-Yan Xu, Kwabena Gyabaah Owusu-Ansah, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Kwabena Gyabaah Owusu-Ansah, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Kwabena Gyabaah Owusu-Ansah, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Organ Transplantation, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Kwabena Gyabaah Owusu-Ansah, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Ke Sun, Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xu SY collected case data and prepared the photos; Xu SY wrote the manuscript; Sun K proofread the pathologic materials; Owusu-Ansah KG is a native English speaker and edited the manuscript; Xie HY, Zhou L, Zheng SS and Wang WL proofread and revised the manuscript; all authors approved the final version to be published.
Supported by The National Natural Science Foundation of China, No. 81572307; and the National Basic Research Program (973 Program) in China, No. 2013CB531403.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Lin Wang, PhD, MD, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. wam@zju.edu.cn
Telephone: +86-571-87236466 Fax: +86-571-87236466
Received: June 12, 2016
Peer-review started: June 16, 2016
First decision: July 29, 2016
Revised: August 16, 2016
Accepted: August 19, 2016
Article in press: August 19, 2016
Published online: October 7, 2016
Processing time: 110 Days and 6 Hours
Abstract

Schwannomas are mesenchymal tumors originating from Schwann cells in peripheral nerve sheaths. Although the tumor can be located in any part of the human body, the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are rare. To our knowledge, only 64 cases of pancreatic schwannoma have been reported in the English literature over the past 40 years. In this paper, we present a pancreatic schwannoma in a 59-year-old female. Ultrasound, computed tomography and magnetic resonance imaging revealed the tumor located in the pancreatic body; however, accurate diagnosis was hard to obtain preoperatively and a pancreatic cystadenoma was preliminarily considered. During laparotomy, the mass was found in the body of the pancreas. An enlarged gallbladder with multiple stones was also observed. We performed central pancreatectomy, end-to-side pancreaticojejunostomy and cholecystectomy. Notably, central pancreatectomy has been reported in only one case prior to this report. The gross specimen showed a mass with a thin capsule, 1.6 cm × 1.1 cm × 1.1 cm in size. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells with palisading arrangement and no atypia, which is consistent with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining revealed strongly positive results for protein S-100. Finally, the tumor was diagnosed as a schwannoma of the pancreatic body. Postoperatively, the patient recovered well and left the hospital 6 d later. During the 53-mo follow-up period, the patient remained well and free of complications.

Keywords: Pancreaticojejunostomy; Schwannoma; Pancreas; Central pancreatectomy; S-100

Core tip: Over the past 40 years, only 64 cases of pancreatic schwannomas have been reported in the English literature. It is a considerable challenge to obtain a precise preoperative diagnosis, despite the application of multiple imaging modalities. We present a patient with a pancreatic schwannoma and enlarged gallbladder with multiple stones. After central pancreatectomy, end-to-side pancreaticojejunostomy and cholecystectomy, the patient recovered quickly and had a good prognosis. In this study, we focused on the diagnosis and treatment of a pancreatic schwannoma and conducted a literature review to deepen the understanding of the subject.