Retropancreatic ancient schwannoma: a great mimicker of malignant cystic neoplasm

Abstract

Retropancreatic ancient schwannoma: a great mimicker of malignant cystic neoplasmA 48-year-old female presented to our hospital with a history of mild, intermittent, vague abdominal pain for the last 6 months. Ultrasonography of the abdomen showed a complex cystic lesion in relation to the head of the pancreas. A contrast-enhanced computed tomography scan revealed a cystic lesion of size 55 Â 45 Â 44 mm with internal septations, posterior to the head of pancreas. It was closely abutting the inferior vena cava, abdominal aorta, and abutting and displacing the superior mesenteric artery laterally (Fig. 1a-c). Endoscopic ultrasound further confirmed the retropancreatic origin of the cystic lesion having hyperechoic densities and sepaatations (Fig. 1d). Endoscopic ultrasound (EUS) guided aspiration of the cystic fluid showed elevated level of CA 19-9 (95 U/L). However, the levels of CEA, amylase and adenosine deaminase were normal, and the aspirate was negative for mucin and malignant cells. Based on these parameters, malignancy could not be ruled out completely, and surgical intervention was planned.Abdomen was opened through upper midline incision. The tumour was found posterior to the pancreratico-duodenal complex