Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2016; 22(46): 10260-10266
Published online Dec 14, 2016. doi: 10.3748/wjg.v22.i46.10260
Schwannoma in the hepatoduodenal ligament: A case report and literature review
Shao-Yan Xu, Ke Sun, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang
Shao-Yan Xu, 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, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, 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
Shao-Yan Xu, Hai-Yang Xie, Lin Zhou, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, 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; Sun K proofread the pathologic materials; Xu SY wrote 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 Basic Research Program (973 Program) in China, No. 2013CB531403; the Major Program of Science and Technology of Zhejiang Province, No. 2014C13G2010059; the National Natural Science Foundation of China, No. 81172315 and No. 81572307; and the Fund for Innovative Research Groups of the National Natural Science Foundation of China, No. 81421062.
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: July 13, 2016
Peer-review started: July 15, 2016
First decision: August 29, 2016
Revised: September 13, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: December 14, 2016
Abstract

Schwannomas are mesenchymal neoplasms with low malignant potential that arise from Schwann cells. They can occur almost anywhere, although the most common locations are the head, neck and extremities. Primary benign schwannoma of the hepatoduodenal ligament is rare. To date, only three cases have been reported in the English literature. In the present study, we report a case of hepatoduodenal ligament schwannoma in a 43-year-old male, who was admitted to our hospital because of a abdominal mass found by physical examination. It was hard to determine the definitive location and diagnosis of the mass using ultrasound, computed tomography and magnetic resonance cholangiopancreatography. During laparotomy, the mass was found in the hepatoduodenal ligament and close to the cholecystic duct, so we resected the gallbladder and cholecystic duct along with the mass. The gross specimen revealed an 8.5 cm × 5.5 cm × 3.0 cm localized tumor. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells. Immunohistochemical staining showed a strong positive S-100 protein reaction. Finally, the lesion was diagnosed as a benign schwannoma in the hepatoduodenal ligament. However, one month later, the patient was readmitted to our hospital because of skin and sclera jaundice caused by common bile duct stenosis without common bile duct stone or tumor. The patient recovered well after implantation of a common bile duct stent under endoscopic retrograde cholangiopancreatography. He was followed up for a period of 17 mo, during which he was well with no complications.

Keywords: Schwannoma, Hepatoduodenal ligament, Endoscopic retrograde cholangiopancreatography, Laparotomy, Jaundice

Core tip: To date, only three cases of the hepatoduodenal ligament schwannomas have been reported in the English literature. We present the fourth hepatoduodenal ligament schwannoma. It is challenging to determine the location and obtain a precise diagnosis prior to operation. Following complete tumor excision, patients with benign schwannomas generally have a good prognosis. Common bile duct stenosis after resection of the schwannoma in hepatoduodenal ligament has not been reported and we present the first one cured by implanting a common bile duct stent under endoscopic retrograde cholangiopancreatography. We also conduct a literature review so as to deepen the understanding of the subject.