Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2017; 23(20): 3744-3751
Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3744
Successful treatment of a pancreatic schwannoma by spleen-preserving distal pancreatectomy
Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Ke Sun, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang
Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, 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, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, 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, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Key Laboratory of Organ Transplantation, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, Shu-Sen Zheng, Wei-Lin Wang, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Shao-Yan Xu, Ying-Sheng Wu, Jian-Hui Li, Zhen-Hua Hu, 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 the case data, prepared the photos and wrote the manuscript; Sun K proofread the pathologic materials; Wang WL, Wu YS, Li JH, Hu ZH and Zheng SS revised the manuscript; all authors approved the final version to be published.
Supported by the National Basic Research Program of China (973 Program), No. 2013CB531403; the National Natural Science Foundation of China, No. 81572307; and the Zhejiang Natural Science Foundation, No. LY15H160033.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital, School of Medicine, Zhejiang University.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: No commercial or associated interest in any form has been received or will be received from any commercial party related either directly or indirectly to the content of this paper.
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, MD, PhD, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. wam@zju.edu.cn
Telephone: +86-571-87236466 Fax: +86-571-87236466
Received: January 17, 2017
Peer-review started: January 19, 2017
First decision: February 10, 2016
Revised: February 26, 2016
Accepted: March 21, 2017
Article in press: March 21, 2017
Published online: May 28, 2017
Processing time: 129 Days and 22.2 Hours
Abstract

Schwannomas are neurogenic tumors that arise from the neural sheaths of peripheral nerves. These tumors can be located in any area of the human body; the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are very rare. Over the past 40 years, only 67 cases of pancreatic schwannomas have been reported in the English literature. Here we present a case of pancreatic schwannoma in a 62-year-old male. The tumor was revealed by ultrasound and computed tomography in the neck and body of the pancreas. An accurate diagnosis was difficult to obtain preoperatively. The patient consented to the performance of a laparotomy, and the mass was found in the neck and body of the pancreas and successfully treated using a spleen-preserving distal pancreatectomy with splenic artery and vein preservation. The procedure has only been reported in one other case of pancreatic schwannoma; here we present the second reported case. Macroscopically, the tumor was well circumscribed, gray-white in color and 3.3 cm × 2.8 cm in size. Microscopically, the tumor cells were spindle-shaped and had a palisading arrangement with no atypia, which are results compatible with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemically, the tumor cells were strongly positive for S-100 protein. The tumor was definitively diagnosed as a schwannoma of the pancreatic neck and body. The patient was followed for 72 mo and has been doing well without any complications.

Keywords: Schwannoma; Pancreas; Spleen-preserving distal pancreatectomy; S-100; Mesenchymal tumor

Core tip: Over the past 40 years, only 67 cases of pancreatic schwannoma have been reported in the English literature. An accurate preoperative diagnosis is difficult to obtain. Here, we present the case of a patient with a pancreatic schwannoma who underwent spleen-preserving distal pancreatectomy. This surgical intervention has only been previously reported in one case of pancreatic schwannoma. After surgery, the patient recovered quickly and had a good prognosis. In this case report, we share our experience in the diagnosis and treatment of a rare pancreatic schwannoma and performed a literature review to deepen the understanding of the subject.