Resection of perihilar biliary schwannoma Journal Article

Authors: Panait, L.; Learn, P.; Dimaio, C.; Klimstra, D.; Do, K. G.; Schwarz, T.; D'Angelica, M.; DeMatteo, R.; Kingham, P.; Allen, P.; Fong, Y.; Jarnagin, W. R.
Article Title: Resection of perihilar biliary schwannoma
Abstract: Introduction: Schwannomas are usually benign nerve sheath tumors, which typically arise in the head, neck, spinal cord and extremities. Schwannoma of the biliary tract is an extremely rare finding. Patients generally lack symptoms and seek medical attention when tumor growth causes obstructive jaundice. Preoperative diagnosis is difficult and resection is the treatment of choice. Methods: A 54 year-old female with history of back and right labia minor melanoma for which she underwent complete excision and right inguinal lymph node dissection more than 10 years ago, was evaluated for new onset gastroesophageal reflux symptoms and found to have markedly abnormal liver enzymes. Imagining studies revealed intrahepatic ductal dilatation and a 5.2 cm mass in the porta hepatis that was not consistent with cholangiocarcinoma or hepatocellular carcinoma. Multiple percutaneous biopsies of the mass failed to provide a definitive diagnosis. With a high clinical suspicion of metastatic melanoma and no other evident sites of disease, operative intervention was undertaken for diagnosis and definitive treatment. Results: Diagnostic laparoscopy was performed initially, but access to the mass was difficult, given its location. Subsequently, the patient underwent laparotomy, with tumor excision, common bile duct resection and hepato-jejunostomy. Pathologic examination and analysis were consistent with cellular schwannoma. Postoperatively, the patient recovered uneventfully, and liver function studies returned to normal. Conclusion: Schwannomas are uncommon tumors, which very rarely arise from the biliary tract and cause biliary obstruction. Exploration is indicated in order to establish the diagnosis and to render definitive treatment. © 2011 Elsevier Ltd. All rights reserved.
Keywords: middle aged; cancer surgery; histopathology; review; liver cell carcinoma; cancer diagnosis; lymph node dissection; laparoscopy; laparotomy; melanoma; computer assisted tomography; cancer size; bile duct carcinoma; bile duct neoplasms; liver function test; inguinal lymph node; liver enzyme; gastroesophageal reflux; percutaneous biopsy; rare disease; neurilemoma; neurilemmoma; common bile duct; hepatic schwannoma; intrahepatic benign tumors; neurolemoma; s-100; hepatojejunostomy; perihilar biliary schwannoma
Journal Title: Surgical Oncology
Volume: 20
Issue: 4
ISSN: 0960-7404
Publisher: Elsevier Inc.  
Date Published: 2011-12-01
Start Page: e157
End Page: e159
Language: English
DOI: 10.1016/j.suronc.2011.05.002
PROVIDER: scopus
PUBMED: 21665464
Notes: --- - "Export Date: 2 November 2011" - "CODEN: SUOCE" - "Source: Scopus"
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MSK Authors
  1. Christopher Dimaio
    17 Dimaio
  2. Ronald P DeMatteo
    599 DeMatteo
  3. Peter A Learn
    4 Learn
  4. David S Klimstra
    849 Klimstra
  5. Peter Allen
    440 Allen
  6. William R Jarnagin
    590 Jarnagin
  7. Kinh Gian Do
    115 Do
  8. Yuman Fong
    745 Fong
  9. T Peter Kingham
    288 Kingham
  10. Lucian Panait
    1 Panait