【One case per day】Hepatoduodenal ligament intracellular schwannoma

【Case Introduction】:

The patient, a 69-year-old woman, was admitted to hospital
for "abdominal distension that worsens for more than 2 years".

The patient had unprovoked abdominal distension 2 years ago, did not mind, did not have fever, and felt that abdominal distension had worsened
recently.
During the course of the disease, the patient had no nausea, vomiting, no acid reflux, belching, no chest tightness, shortness of breath, normal stools, and no significant reduction
in body weight.
Physical examination on admission: no yellowing staining of skin and sclera, flat abdomen, no gastrointestinal type and peristaltic waves, no varicose veins
of the abdominal wall.
Soft abdomen, mild tenderness in the right upper quadrant, no rebound tenderness and muscle tension, unpalpated under the hepatospleen and spleen, negative Murphy sign, tympanic sound on full abdominal percussion, negative mobile dullness, negative percussion pain in the liver and kidney area, bowel sounds about 3 times/min, no water sound and vibrating sound of qi and vibrating water are
heard.

Imaging examination: hepatobiliary and spleen multi-row CT stage III enhancement showed a mass lesion in the hilar area of the liver, which was closely related to the caudal lobe of the liver and the pancreas, and was adjacent to the inferior vena cava, portal vein, hepatic artery, common bile duct and posterior wall of the stomach, and the boundary was clear, considering the possibility of plasmacytic giant lymphadenopathy, it was recommended to combine it with clinical further examination (Fig.
1, 2).

After admission, laparotomy was performed, and the operation saw: the mass was exposed in the hilar area of the liver, the size was about 6.
0cm× 4.
0cm×4.
0cm, the boundary with the surrounding tissues was not clear, the envelope was separated, see the common hepatic artery, the artery propria, the hepatoduodenal artery, the left hepatic artery straddled the mass, lifted the artery with a rubber strip and carried out free along its surroundings, ligated small blood vessels, lifted the mass upward, saw that the portal vein was located below the mass, the mass continued downward and gradually thinned, ligated at the tail, avoiding the large blood vessels, and removed the mass ( Figures 3, 4), to stop bleeding, a peritoneal drainage
tube was placed.
On the 7th day after surgery
, the patient recovered and was discharged with stitches.

Postoperative pathological return: hepatic portal cell schwannoma with focal foam cell aggregation, diameter about 5.
5 cm
.
Immunohistochemistry results showed that the proliferating cell-associated nuclear antigen (Ki-67) +3%, acidic calcium-binding protein (S-100) positive (Figure 5), neuroprokaryotic antigen (NeuN) negative, smooth muscle actin (SMA) negative, nodule protein (Desmin) negative (Figure 6), CD34 negative
.