Common bile duct schwannoma: A case report and review of literature

Fenoglio, Luigi; Severini, S; Cena, Paola; Migliore, Elena; Bracco, Christian; Pomero, Fulvio; Panzone, S.; Cavallero, G; Silvestri, Alberto; Brizio, Rodolfo; Borghi, Felice

doi:10.3748/wjg.v13.i8.1275

Cited by 27 publications

(21 citation statements)

References 25 publications

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“…Endoscopic ultrasound data are scarce; the image described corresponds to a solid tumor of the non-vascular peri-bile duct, containing multiple anechogenic areas that are cystic in appearance. 4,5 These data are very different to the misleading pseudo-ganglionic image observed in this case. Surgery was necessary because of the impossibility of ruling out a cholangiocarcinoma on the basis of the preoperative radiological examinations and the Case Report need to prevent the installation of biliary cirrhosis secondary to this benign lesion.…”

Section: Discussioncontrasting

confidence: 53%

“…4 When symptomatic, symptoms are caused by the compression of adjacent structures; 5 thus, jaundice is the clinical sign that is described most often in the majority of reported case histories. 1,2,4,5,12,13 The non-jaundice symptomatic forms, as in this case report, are exceptional. 14 Febrile pain in the right hypochondrium with spontaneously favorable evolution reveals the nature of this type of lesion, which probably is intermittently compressive.…”

Section: Discussionmentioning

confidence: 99%

“…4 Little is known about these neurogenic tumors in the biliary system, because most of them seem to be asymptomatic. 4 When symptomatic, symptoms are caused by the compression of adjacent structures; 5 thus, jaundice is the clinical sign that is described most often in the majority of reported case histories. 1,2,4,5,12,13 The non-jaundice symptomatic forms, as in this case report, are exceptional.…”

Section: Discussionmentioning

confidence: 99%

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Primary neurofibroma of the common bile duct: a case report

Béchade

Boulanger

Palazzo³

et al. 2009

Gastroenterol Insights

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Obstructive jaundice secondary to common bile duct stricture is attributed most commonly to pancreatic cancer and cholangiocarcinoma. Benign tumors of the extrahepatic biliary duct such as papilloma or adenoma are rare, accounting for 6% of biliary tumors.1,2 Among them, neurofibromas of the extrahepatic biliary tract are extremely rare and clinically nonspecific. Their preoperative diagnosis is most difficult, especially when there is no history of cholecystectomy or biliary tract trauma.3,4 We report a case of such a lesion in a young female patient. Case ReportA 28-year-old female patient was referred for upper abdominal pain and fever (38.5°C) that had been evolving over eight days. She had no family history of a hereditary disorder, nor personal previous history of cholecystectomy or trauma of the bile duct. The physical examination was normal, except for tenderness in the right hypochondrium. There was no evidence of jaundice. The laboratory studies revealed: serum alanine aminotransferase (ALAT), 54Abdominal ultrasonography showed mild hepatomegaly and slight dilatation of the intrahepatic biliary tracts, which seemed to be secondary to adenopathies of the hepatic hilum measuring 15.8 mm and 12.9 mm. Abdominal computed axial tomography (CT) (Figure 1) showed a well-demarcated, homogeneous and hypodense mass (20-35 UH) on unenhanced scans, with no enhancement after injection of the contrast medium. The mass surrounded the entire common bile duct and invaded the hepatic hilum, without any dilatation of the intrahepatic biliary tracts and without adenopathy. Abdominal magnetic resonance imaging (MRI) (Figure 2) showed a tissue mass with very clear borders, infiltrating the hepatic hilum. This mass was pushing the common bile duct back, sheathing the right and particularly the left portal pedicles as well as the bile duct, with no dilatation of the intrahepatic bile ducts and no mass effect on the blood vessels. This lesion had low signal intensity on T1-weighted images with moderate and heterogeneous signal intensity on T2-weighted images: it seemed to contain more hyperintense lesions on T2-weighted images. The contrast-enhanced T1-weighted images showed no enhancement. The endoscopic ultrasound (Figure 3) revealed multiple, oval, coalescent masses at the hepatic pedicle, particularly in front of and behind the portal vein; the largest of these masses had an axis of 3 cm. No fine needle aspiration was carried out on these lesions.Evolution of pain and fever was spontaneously favorable without any treatment, especially antibiotics. There was no explanation of the fever after physical and laboratory examinations. The endoscopic ultrasound ruled out any stones in the gall bladder and common bile duct, which could explain such a high fever. Endoscopic retrograde cholangiography was not performed.Assuming that a low-grade lymphoma, sarcoidosis, an inflammatory pseudotumor of the ganglion, or ganglionic tuberculosis was involved, we performed a surgical biopsy under laparoscopy and finally diagnosed a pri...

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Primary neurofibroma of the common bile duct: a case report

Béchade

Boulanger

Palazzo³

et al. 2009

Gastroenterol Insights

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“…Schwannomas arising in the digestive tract though rare, occur most commonly in the stomach, followed by the colon and rectum [2]. Peripheral nerve sheath tumors represent 2-6% of GIST [4]. Schwannomas of the biliary tract are extremely rare and occur because of an abundant network of sympathetic and parasympathetic nerve fibers to the wall of the gallbladder and bile duct [3,5].…”

Section: Discussionmentioning

confidence: 99%

Schwannoma of common bile duct causing obstructive jaundice

et al. 2010

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Benign schwannomas arise from neural crest-derived Schwann cells. Schwannomas occurring in the biliary tract become clinically symptomatic due to their compression on the extra hepatic biliary tract causing obstructive jaundice. Their preoperative diagnosis is extremely difficult. We report a 38-year-old male who presented with pain abdomen and jaundice.Computed tomography of abdomen showed extra luminal compression of common bile duct (CBD) possibly by a lymph nodal mass. Resection of the CBD, gall bladder and the mass compressing the CBD with Rouxen-Y hepaticojejunostomy was performed. The final histopathology was reported as a schwannoma.

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“…5 This heterogeneity can be explained by the two-component growing pattern observed under a microscope. On the one hand, Antoni type A areas are hypercellular zones in which cells sometimes develop a nuclear palisading pattern known as Verocay bodies.…”

Section: Discussionmentioning

confidence: 99%

Schwannoma of the biliary tract resembling cholangiocarcinoma: A case report and review

Sanz

et al. 2016

annals

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Schwannomas are benign tumours derived from Schwann cells and are extremely rare in the biliary tract. We present the case of a 62-year-old patient with a common bile duct schwannoma that resembled a cholangiocarcinoma. We also review all 17 previously published cases of schwannoma of the biliary tract and discuss the challenges of preoperative diagnosis. KEYWORDSBile ducts -Cholangiocarcinoma -Differential diagnosis -Obstructive jaundice -Schwann cells Although cholangiocarcinoma is the most common biliary neoplasm causing obstructive jaundice, other malignancies, such as lymphoma or neuroendocrine tumours can be implicated. Currently, only 17 cases of biliary schwannoma, a benign tumour of the bile ducts, have been reported in the literature. We present the case of a patient with a biliary schwannoma that resembled a cholangiocarcinoma and caused jaundice. Case reportA 62-year-old man presented with obstructive jaundice and abdominal pain. His past medical history included moderate aortic insufficiency, hepatic steatosis and cholecystectomy. Laboratory tests revealed hyperbilirrubinemia (7.56 mg/dL, normal range 0.2-1.3 mg/dL), raised levels of aspartate transaminase 618 U/L (normal range 4-38 U/L), alanine transaminase (924 U/L, normal range 5-41 U/L), gamma-glutamyl transferase (1034 U/L, normal range 7-32 U/L) and alkaline phosphatase (189 U/L, normal range 4-129 U/L), and an international normalised ratio of 1.05 (normal range <1.3).Abdominal ultrasound showed mild dilation of the intrahepatic biliary tree, with normal extrahepatic biliary ducts. Magnetic resonance cholangiopancreatography (MRCP) revealed both intrahepatic and extrahepatic bile duct dilation secondary to a focal stenosis near the confluence of the right and left hepatic ducts. Subsequent endoscopic retrograde cholangiopancreatography confirmed the stenosis with proximal dilation (Fig 1). Biliary brushings were benign on cytology and a stent was placed. Computed tomography scan revealed no further information as to extent of the disease. Tumour marker levels were 0.68 ng/mL (normal range 0-3 ng/mL) for carcinoembryonic antigen, 1.85 ng/mL (normal range <10 ng/mL) for alpha-fetoprotein and 30.53 U/mL (normal range <30 U/mL) for carbohydrate antigen 19-9.The patient was discussed at the multidisciplinary team meeting and a presumptive diagnosis of cholangiocarcinoma was reached. Management options were discussed with the patient, and it was decided to proceed to operative intervention.At the operation, the biliary tree appeared unremarkable, with no palpable mases. The liver was normal and no ONLINE CASE REPORT Ann R Coll Surg Engl 2016; 98: e143-e146

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Common bile duct schwannoma: A case report and review of literature

Cited by 27 publications

References 25 publications

Primary neurofibroma of the common bile duct: a case report

Primary neurofibroma of the common bile duct: a case report

Schwannoma of common bile duct causing obstructive jaundice

Schwannoma of the biliary tract resembling cholangiocarcinoma: A case report and review

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