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Unsuspected schwannomas of the gallbladder
G Model
ARTICLE IN PRESS
YDLD-3560; No. of Pages 1
Digestive and Liver Disease xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Unsuspected schwannomas of the gallbladder Yi-Xin Lin a , Zi-Ming Liu a , Yi-Yun Fu b , Qian-Bin Jia a,∗ a b
Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
A 70-year-old man with a 3-day history of epigastric pain and jaundice was admitted to the hospital. Laboratory tests showed: total bilirubin, 47.8 mol/L (normal, 5–28 mol/L); direct bilirubin, 30.1 mol/L (normal, <8.8 mol/L). Ultrasonography revealed high echoic lesions in the gallbladder and a disappearance of bile sonolucent area (Fig. 1A). Magnetic resonance imaging showed multiple hypointense nodules in the common bile duct (CBD) (Fig. 1B). He underwent laparoscopic CBD exploration and cholecystectomy. Pigmented stones were found and the gallbladder was noted to have a thickened wall. Microscopically, it was composed of spindle-shaped cells with both hypocellular and hypercellular areas (Fig. 1C). Immunohistochemically, these cells were positive for S-100 (Fig. 1D). Finally, the diagnosis was unsuspected schwannomas of the gallbladder, combined with cholecystolithiasis and choledocholithiasis. He was followed-up for 19 months without recurrence. Schwannomas are neurogenic tumors that originate from Schwann cells of nerve sheaths. Schwannomas arising from the digestive tract are uncommon, and mostly occur in the stomach [1]. Our case is unique in its rarely cholecystic location. Moreover, it was shown to be associated with cholecystitis and cholangitis while others were mainly asymptomatic. Schwannomas of the gallbladder have an excellent prognosis after a surgical resection. Although the relationship between cholecystic schwannomas and gallbladder stones is unknown, raising awareness of schwannomas of the gallbladder is important for both physician and surgeon. Ethical approval The presented case was approved by the Human Rights Committee of the West China Hospital of Sichuan University.
Fig. 1. (A) Conventional ultrasound showed high echoic lesions in the gallbladder and a disappearance of bile sonolucent area. (B) Coronal T2-weighted magnetic resonance imaging revealed multiple hypointense nodules in the common bile duct. (C) Microscopic examination showed the gallbladder was composed of spindle-shaped cells with both hypocellular and hypercellular areas (HE, ×200). (D) Immunohistochemical analysis revealed the tumor cells were stained strongly positive for S-100 (×200). HE: hematoxylin and eosin.
Conflict of interest None declared. Acknowledgement The presented case is part of a research granted by “Sichuan Provincial Health and Family Commission, No. 16ZD010”. Reference [1] Voltaggio L, Murray R, Lasota J, Miettinen M. Gastric schwannoma: a clinicopathologic study of 51 cases and critical review of the literature. Hum Pathol 2012;43:650–9.
∗ Corresponding author. E-mail address: [email protected] (Q.-B. Jia). https://doi.org/10.1016/j.dld.2017.10.003 1590-8658/© 2017 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
Please cite this article in press as: Lin Y-X, et al. Unsuspected schwannomas of the gallbladder. Dig Liver Dis (2017), https://doi.org/10.1016/j.dld.2017.10.003
ARTICLE IN PRESS
YDLD-3560; No. of Pages 1
Digestive and Liver Disease xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Unsuspected schwannomas of the gallbladder Yi-Xin Lin a , Zi-Ming Liu a , Yi-Yun Fu b , Qian-Bin Jia a,∗ a b
Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
A 70-year-old man with a 3-day history of epigastric pain and jaundice was admitted to the hospital. Laboratory tests showed: total bilirubin, 47.8 mol/L (normal, 5–28 mol/L); direct bilirubin, 30.1 mol/L (normal, <8.8 mol/L). Ultrasonography revealed high echoic lesions in the gallbladder and a disappearance of bile sonolucent area (Fig. 1A). Magnetic resonance imaging showed multiple hypointense nodules in the common bile duct (CBD) (Fig. 1B). He underwent laparoscopic CBD exploration and cholecystectomy. Pigmented stones were found and the gallbladder was noted to have a thickened wall. Microscopically, it was composed of spindle-shaped cells with both hypocellular and hypercellular areas (Fig. 1C). Immunohistochemically, these cells were positive for S-100 (Fig. 1D). Finally, the diagnosis was unsuspected schwannomas of the gallbladder, combined with cholecystolithiasis and choledocholithiasis. He was followed-up for 19 months without recurrence. Schwannomas are neurogenic tumors that originate from Schwann cells of nerve sheaths. Schwannomas arising from the digestive tract are uncommon, and mostly occur in the stomach [1]. Our case is unique in its rarely cholecystic location. Moreover, it was shown to be associated with cholecystitis and cholangitis while others were mainly asymptomatic. Schwannomas of the gallbladder have an excellent prognosis after a surgical resection. Although the relationship between cholecystic schwannomas and gallbladder stones is unknown, raising awareness of schwannomas of the gallbladder is important for both physician and surgeon. Ethical approval The presented case was approved by the Human Rights Committee of the West China Hospital of Sichuan University.
Fig. 1. (A) Conventional ultrasound showed high echoic lesions in the gallbladder and a disappearance of bile sonolucent area. (B) Coronal T2-weighted magnetic resonance imaging revealed multiple hypointense nodules in the common bile duct. (C) Microscopic examination showed the gallbladder was composed of spindle-shaped cells with both hypocellular and hypercellular areas (HE, ×200). (D) Immunohistochemical analysis revealed the tumor cells were stained strongly positive for S-100 (×200). HE: hematoxylin and eosin.
Conflict of interest None declared. Acknowledgement The presented case is part of a research granted by “Sichuan Provincial Health and Family Commission, No. 16ZD010”. Reference [1] Voltaggio L, Murray R, Lasota J, Miettinen M. Gastric schwannoma: a clinicopathologic study of 51 cases and critical review of the literature. Hum Pathol 2012;43:650–9.
∗ Corresponding author. E-mail address: [email protected] (Q.-B. Jia). https://doi.org/10.1016/j.dld.2017.10.003 1590-8658/© 2017 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
Please cite this article in press as: Lin Y-X, et al. Unsuspected schwannomas of the gallbladder. Dig Liver Dis (2017), https://doi.org/10.1016/j.dld.2017.10.003