Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report

Bekki, Tomoaki; Oishi, Koichi; Tadokoro, Takeshi; Namba, Yosuke; Okimoto, Sho; Mukai, Shoichiro; Saito, Yasufumi; Fujisaki, Seiji; Nishida, Toshihiro; Ohdan, Hideki; Fukuda, Toshikatsu

doi:10.1186/s40792-021-01271-y

Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report

Case Report
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Published: 19 August 2021

Volume 7, article number 187, (2021)
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Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report

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Tomoaki Bekki¹,
Koichi Oishi ORCID: orcid.org/0000-0003-1159-3908¹,
Takeshi Tadokoro¹,
Yosuke Namba¹,
Sho Okimoto¹,
Shoichiro Mukai¹,
Yasufumi Saito¹,
Seiji Fujisaki¹,
Toshihiro Nishida²,
Hideki Ohdan³ &
…
Toshikatsu Fukuda^1,3

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Abstract

Background

The occurrence of schwannomas in the hepatoduodenal ligament is rare, and its preoperative accurate diagnosis is difficult. Only few cases have been treated with laparoscopic surgery.

Case presentation

A 54-year-old man visited our hospital following abnormal abdominal computed tomography findings. He had no complaints, and his laboratory investigations were normal. Abdominal contrast-enhanced computed tomography revealed a tumor with enhancement at the margin of the hepatoduodenal ligament. The abdominal magnetic resonance imaging findings of the tumor showed hypointensity on the T1-weighted images and mixed hypointensity and hyperintensity on the T2-weighted fat-suppression images. Positron emission tomography showed localized accumulation of fludeoxyglucose only in the hepatoduodenal ligament tumor. The patient underwent laparoscopic tumor resection for accurate diagnosis. Histopathologically, the tumor was mainly composed of spindle cells, which were strongly positive for S-100 protein on immunohistochemical staining. The patient was discharged without any postoperative complications on day 5.

Conclusions

Complete tumor resection is essential for schwannomas to avoid recurrence. Laparoscopic surgery is useful for schwannomas occurring in the hepatoduodenal ligament and can be performed safely by devising an appropriate surgical method.

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Background

Schwannomas are mesenchymal neoplasms originating from the Schwann cells, which are the neuroglial cells surrounding the peripheral nerves [1]. They can occur in any part of the body, such as the head, neck, trunk, or extremities [1]. Retroperitoneal and gastric schwannomas are the most common types of schwannomas occurring in the abdominal cavity [Full size image

Discussion

Most schwannomas are benign and account for approximately 5% of the benign soft tissue neoplasms [4, 5]. Although schwannomas often originate as solitary neoplasms, around 10% of them originate as multiple neoplasms [6]. The incidence rate of schwannomas is not related to sex or race. They are most commonly found in middle-aged patients (20–50 years old) [1, 4]. Some case reports have reported the occurrence of schwannomas in the abdominal viscera, such as the retroperitoneum [2, 7], stomach [3], gallbladder [8], pancreas [9, 10], bowel mesentery [11], colon [12, 13], and liver [14]. However, schwannomas in the hepatoduodenal ligament are extremely rare, and there are only few case reports on them. Since 1993, several reports have demonstrated schwannomas in the hepatoduodenal ligament, as shown in Table 1 [15,16,17,18,19,20,21,22]. The characteristics of nine cases with schwannoma in the hepatoduodenal ligament, including our case, were as follows: mean age, 49 years (range, 29–70 years) and female-to-male prevalence ratio, 1:2. Most cases were asymptomatic, and only one case reported the presence of two tumors.

Table1 Review of diagnosed cases of schwannoma in the hepatoduodenal ligament

Full size table

Generally, contrast-enhanced CT findings of schwannomas show a hypodense mass with peripheral enhancement [23]. The MRI findings usually present as hypointensity on T1-weighted images and mixed hypointensity and hyperintensity on T2-weighted images [24, 25]. Schwannomas demonstrate accumulation of FDG on PET, and increased FDG uptake in the schwannomas is associated with malignancy [26, 27]. However, accurate preoperative diagnosis is difficult due to its nonspecific imaging characteristics and clinical symptoms. A definitive diagnosis of schwannomas can be made by histopathological and immunohistochemical examinations. Notably, only one report preoperatively diagnosed the schwannoma in the hepatoduodenal ligament by endoscopic ultrasound-fine needle aspiration [21]. The main components of the schwannomas include spindle-shaped cells and mixed hypercellular and hypocellular areas [14]. Such variation in cell density contributes to the heterogeneous and hyperintense images on T2-weighted MRI. Schwannomas test positive for S-100 protein and negative for desmin, smooth muscle actin, CD34, and CD117 [28, 29].

The main treatment of schwannomas is surgical resection. There was one case where a benign schwannoma turned malignant [28]. Notably, benign schwannomas rarely recur [30]. Complete excision without lymph node dissection is important for curative treatment [18, 31]. In 2016, Tao et al. [17] reported the first case treated by laparoscopic surgery. The previous case reports (Table 1) show that only three cases underwent laparoscopic resection, and their tumor sizes were less than 50 mm. In our case, a preoperative diagnosis was not made. We planned the laparoscopic approach to observe whether the origin of the tumor was intrahepatic or extrahepatic. During the surgery, laparoscopic surgery could be continued, because the tumor was surrounded by a fibrous capsule and no other organs were infiltrated. If there is infiltration in the surrounding organs, it is important to convert the laparoscopic surgery to laparotomy surgery for curative treatment. The traction of blood vessels surrounding the tumor proved extremely useful in expanding the surgical field. With the laparoscopic operative method, the surgery proceeded smoothly and safely.

Conclusions

We encountered a rare case of schwannoma in the hepatoduodenal ligament that was laparoscopically resected. Depending on the clinical conditions, such as tumor size and no findings of infiltration in the surrounding organs, laparoscopic surgery for schwannomas in the hepatoduodenal ligament can be extremely useful.

Availability of data and materials

No applicable.

Abbreviations

CT:: Computed tomography
MRI:: Magnetic resonance imaging
PET:: Positron emission tomography
FDG:: Fludeoxyglucose

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Acknowledgements

This case report was not supported by any grants. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

Department of Surgery, Chugoku Rosai Hospital, Hirotagaya 1-5-1, Kure, Hiroshima, Japan
Tomoaki Bekki, Koichi Oishi, Takeshi Tadokoro, Yosuke Namba, Sho Okimoto, Shoichiro Mukai, Yasufumi Saito, Seiji Fujisaki & Toshikatsu Fukuda
Department of Pathology, Chugoku Rosai Hospital, Hiroshima, Japan
Toshihiro Nishida
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Japan
Hideki Ohdan & Toshikatsu Fukuda

Authors

Tomoaki Bekki
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Koichi Oishi
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Takeshi Tadokoro
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Yosuke Namba
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Sho Okimoto
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Shoichiro Mukai
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Yasufumi Saito
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Seiji Fujisaki
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Toshihiro Nishida
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Hideki Ohdan
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Toshikatsu Fukuda
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Contributions

TB, KO, SO, SF and TF performed the operation. TB, KO, and SO managed the perioperative course. TB, and KO wrote the manuscript. All authors read and approved the final manuscript.

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Correspondence to Koichi Oishi.

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Bekki, T., Oishi, K., Tadokoro, T. et al. Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report. surg case rep 7, 187 (2021). https://doi.org/10.1186/s40792-021-01271-y

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Received: 21 May 2021
Accepted: 12 August 2021
Published: 19 August 2021
DOI: https://doi.org/10.1186/s40792-021-01271-y

Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report