Successful preoperative diagnosis and minimally invasive surgery of bile duct schwannoma
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CASE REPORT
Successful preoperative diagnosis and minimally invasive surgery of bile duct schwannoma Naoki Ishimaru1 · Hirohisa Fujikawa2,3 · Yoshifumi Kobayashi1 Received: 28 August 2020 / Accepted: 5 October 2020 © Japanese Society of Gastroenterology 2020
Abstract Bile duct schwannomas are rare benign tumors that frequently mimic more life-threatening tumors. Till date, only a few of these tumors have been diagnosed preoperatively. Herein, we report the case of a 68-year-old man who presented with a 1-day history of epigastralgia. The patient was preoperatively diagnosed with bile duct schwannoma using transpapillary biliary forceps biopsy and underwent local resection without major complications. The findings of our study indicate that endoscopic tumor biopsy may be helpful in diagnosing bile duct schwannoma before surgery; thus, enabling surgeons to plan an appropriate surgery while avoiding overtreatment. Keywords Schwannoma · Transpapillary biliary forceps biopsy · Endoscopic tumor biopsy · Bile duct · Biliary schwannoma
Introduction
Case report
Although cholangiocarcinoma is the most common malignant biliary tract tumor, benign tumors of the bile duct, such as adenomas, granular cell tumors, leiomyomas, and schwannomas are uncommon [1]. Biliary schwannoma is a rare benign bile duct tumor that often mimics cholangiocarcinoma. It is difficult to diagnose a biliary schwannoma preoperatively. However, if it is not identified before surgery, the patient may have to undergo invasive therapy. In this report, we have described an uncommon case of biliary schwannoma. It was successfully diagnosed before the operation, which allowed us to perform a local resection alone.
A 68-year-old man presented to the emergency department with a 1-day history of abdominal pain. The patient’s previous medical diagnoses included hypertension, dyslipidemia, and type 2 diabetes. On examination, he had tachycardia (102 beats/minute). His abdomen was soft with moderate right hypochondrium discomfort on deep palpation. Laboratory tests showed an abnormal liver profile (aspartate aminotransferase 33 U/L, alanine aminotransferase 122 U/L, lactate dehydrogenase 171 U/L, alkaline phosphatase 502 U/L, gamma-glutamyl transpeptidase 900 U/L, and total bilirubin 32.5 μmol/L). Abdominal ultrasound (Fig. 1a) and contrast-enhanced computed tomography (CT) demonstrated slight dilation of the common bile duct (CBD) and intrahepatic bile duct. CT also detected a mass in the lower part of the CBD with contrast enhancement (Fig. 1b) and mild lymphadenopathy around the abdominal aorta (Fig. 1c, diameter of 13 mm, oval shape). On magnetic resonance cholangiopancreatography, the lesion in the lower CBD exhibited T1 low signal, T2 slightly high signal, and restricted diffusion (Fig. 1d, e). Endoscopic retrograde cholangiopancreatography revealed a papillary lesion in the lower CBD (Fig. 1f). The upper border of the lesion was located distal to the junction of the cystic duct, while the inferior border was proximal to the Vater papilla. Because w
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