Primary Hepatic Schwannoma

Youn I Choi; Yun Seob Kim; Ju Hyun Kim; Seong Hee Lee; Seong Gak Shin; Yun Soo Kim; Duck Joo Choi; Seung Joon Choi; Dong Hae Chung; Oh Sang Kwon

doi:10.4166/kjg.2018.72.3.150

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Choi, Kim, Kim, Lee, Shin, Kim, Choi, Choi, Chung, and Kwon: Primary Hepatic Schwannoma

Case Report

Korean J Gastroenterol 2018;72(3):150-154.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.72.3.150

Primary Hepatic Schwannoma

Youn I Choi, Yun Seob Kim, Ju Hyun Kim, Seong Hee Lee, Seong Gak Shin, Yun Soo Kim, Duck Joo Choi, Seung Joon Choi¹, Dong Hae Chung², Oh Sang Kwon

Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

¹Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea

²Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea

Correspondence to: Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-3778, Fax: +82-32-460-3408, E-mail: jhkim@gilhospital.com, ORCID: https://orcid.org/0000-0001-8981-135X

Received 16 December 2017 Revised 24 April 2018 Accepted 24 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A primary benign schwannoma of the liver is extremely rare. Only 30 cases have been reported in the medical literature worldwide, and only one case has been reported in Korea previously. A 56-year-old man was admitted to Gil Medical Center with incidental findings of a hepatic mass by abdominal computed tomography. The computed tomography and magnetic resonance image revealed a 3×2 cm-sized solid mass in the left lobe of the liver. Histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117, and smooth muscle actin. We report a primary benign schwannoma of the liver and review the literature.

Keywords: Neurilemmoma, Peripheral nervous system neoplasms

References

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Fig. 1.

Abdominal ultrasonography (US). US revealed an about 3 cm-sized, low echoic mass with homogeneous pattern in the left lobe of the liver.

Fig. 2.

Dynamic abdominal computed tomography (CT). (A) Arterial phase (arrow), (B) portal phase (arrow), (C) venous phase: CT showed a well-defined, rounded (arrow), low-attenuating mass with homogeneous attenuation in the left lobe of the liver.

Fig. 3.

Liver magnetic resonance imaging. (A) T1-WI. A 35 mm suspicious enhancing lesion (white arrow) in the left liver: a mass that is mildly hypointense or isointense on non-contrasted T1-WI. (B) T2-WI. Lesion (white arrow) was heterogeneously hyperintense. (C) Hepatobiliary phase. Gadoxetic-acid enhanced heaptobiliary phase images show hypointense lesion (white arrow). WI, weighted image.

Fig. 4.

Histologic examination. (A) The sections show a moderately cellular schwannoma. Mitoses are inconspicuous (H&E, ×200). (B) The tumor is composed of bundles of compact spindle cells that are immunoreactive to S-100 protein, brown particles (immunohistochemical stain, ×200).

Table 1.

Summary of Clinicopathological Data from 30 Cases of Hepatic Schwannoma

	Value
Mean follow up (months)	14.6±2.7
Age (years)	50.8±15.7
Male	19 (63.3)
Symptoms
Asymptomatic	9 (30.0)
Symptomatic	21 (70.0)
Anorexia, Nausea, Vomiting	0 (0)
Abdominal discomfort	20 (66.5)
Jaundice	1 (3.4)
Weight loss	0 (0)
Primary diagnosis
Schwannoma	3 (10.0)
Malignant liver tumor (adenoma, HCC)	8 (26.7)
Benign liver tumor (cyst, liver hydatid cyst,	5 (16.7)
hematoma)
Intrahepatic cholangiocarcinoma	4 (13.3)
Metastatic cancer	2 (6.7)
Mesenchymal tumor (GIST, myxoid liposarcoma,	8 (26.7)
hepatosarcoma, spindle tumor)
Tumor size (cm)	12.0±8.5
Single	27 (90)
Location
Right lobe	13 (43.3)
Left lobe	14 (46.7)
Both	3 (10.0)
Pathology
Benign	21 (70.0)
Malignant	9 (30.0)
Treatment
Surgery	25 (83.3)
TACE	2 (6.7)
Untreated	3 (10.0)
Outcome
Survival	24 (80.0)
Death	6 (20.0)

Values are presented as mean±standard deviation or n (%).

HCC, hepatocelullar carcinoma; GIST, gastrointestinal stromal tumors; TACE, transcatheter arterial chemoembolization.

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ORCID iDs: Ju Hyun Kim
https://orcid.org/0000-0001-8981-135X
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