Published online Oct 7, 2016. doi: 10.3748/wjg.v22.i37.8439
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
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.
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.