Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 056] Cancer mimicking schwannoma in CBD: A case report
MIRIN LEE1 , JAEDO YANG1 , HEECHUL YU*1
1 Department Of Surgery, Jeonbuk National University, REPUBLIC OF KOREA
Background : Benign schwannomas arise in neural crest-derived Schwann cells which usually occur from all parts of the body, but the most common sites are the upper extrimities. Schwannoma in the digestive organ is rare, and most such tumors are reported in the stomach, followed by the colorectum and esophagus. Biliary schwannomas are extremely rare. We present the case of a patient with biliary schwannoma that required differentiation from extrahepatic bile duct cancer.
Methods : A 69-year old man was admitted to out institution for gastrectomy due to gastric cancer. Abdominal CT for pre-operative evaluation revealed a incidental hyperdense mass in the remnant cystic duct. He had undergone laparoscopic cholecystectomy for gallstone 30 tears previously. There was no evindence of jaundice or abdominal symptoms. Laboratory studies revealed within normal. The tumor markers including CEA and CA 19-9 were within normal. We planned surgical treatment without additional biliary radiology examination and intervention because he already planned gastrectomy for gastric cancer. We performed extrahepatic bile duct resection. A hard mass was palpable in the hepatoduodenal ligament, but the tumor was noninvasive and mobile. After extrahepatic bile duct resection, biliary reconstruction was performed by the Roux-en-Y hepaticojejunostomy.
Results : A histopathologic examination of the resected specimen revealed that the tumor consisted of spindle cells with wavy nuclei and exhibited a palisading arrangement. Immunohistochemical staining was positive for protein S-100 and negative for SMA, desmin, CD 34, p53 and c-kit. Based on these pathologic findings, we diagnosed the patient with schwannoma of extrahepatic bile duct.The surgical margin was negative, including complete resection. The patient’s postoperative course was uneventful, and he has been doing well without any complications.
Conclusions : Biliary schwannomas are rare tumors which can be successfully treated surgically. The preoperative diagnosis is difficult, especially when associated with other malignancies.
Methods : A 69-year old man was admitted to out institution for gastrectomy due to gastric cancer. Abdominal CT for pre-operative evaluation revealed a incidental hyperdense mass in the remnant cystic duct. He had undergone laparoscopic cholecystectomy for gallstone 30 tears previously. There was no evindence of jaundice or abdominal symptoms. Laboratory studies revealed within normal. The tumor markers including CEA and CA 19-9 were within normal. We planned surgical treatment without additional biliary radiology examination and intervention because he already planned gastrectomy for gastric cancer. We performed extrahepatic bile duct resection. A hard mass was palpable in the hepatoduodenal ligament, but the tumor was noninvasive and mobile. After extrahepatic bile duct resection, biliary reconstruction was performed by the Roux-en-Y hepaticojejunostomy.
Results : A histopathologic examination of the resected specimen revealed that the tumor consisted of spindle cells with wavy nuclei and exhibited a palisading arrangement. Immunohistochemical staining was positive for protein S-100 and negative for SMA, desmin, CD 34, p53 and c-kit. Based on these pathologic findings, we diagnosed the patient with schwannoma of extrahepatic bile duct.The surgical margin was negative, including complete resection. The patient’s postoperative course was uneventful, and he has been doing well without any complications.
Conclusions : Biliary schwannomas are rare tumors which can be successfully treated surgically. The preoperative diagnosis is difficult, especially when associated with other malignancies.
SESSION
E-poster
E-Session 03/03 ~ 03/05 ALL DAY