胰头部神经鞘瘤1例

One Case: Pancreatic Head Schwannoma

摘要: 胰腺神经鞘瘤是临床罕见的来源于神经鞘细胞的肿瘤，多发生于中枢神经系统，消化系统少见，术前极易与胰腺恶性肿瘤或其他囊性病变混淆，误诊率高。云南省大理大学第一附属医院近期收治1例因体检发现胰头占位7天入院的39岁女性患者，腹部增强计算机断层扫描(CT)提示胰头部直径约2.3 cm类圆形病灶，增强扫描边缘环形强化，实质强化水平低于胰腺，初步诊断为胰腺神经内分泌肿瘤可能。患者行腹腔镜下胰十二指肠切除术，术后病理检查考虑胰腺神经鞘瘤，免疫组化结果显示酸性蛋白S-100蛋白(+)、波形蛋白Vimentin (+)，符合神经鞘瘤病理特征。由此，胰腺神经鞘瘤影像学缺乏特异性，确诊依赖病理及免疫组化检查，S-100与Vimentin联合检测可提高诊断准确性，手术完整切除是首选治疗方式，预后良好。

Abstract: Pancreatic schwannoma is a clinically rare tumor originating from Schwann cells. It predominantly occurs in the central nervous system, and its incidence in the digestive system is relatively low. Preoperatively, it is highly likely to be confused with pancreatic malignancies or other cystic lesions, resulting in a high misdiagnosis rate. Recently, the First Affiliated Hospital of Dali University in Yunnan Province admitted a 39-year-old female patient. The patient was hospitalized, because a pancreatic head mass was detected during a physical examination seven days prior. Abdominal enhanced computed tomography (CT) indicated a round-like lesion with a diameter of approximately 2.3 cm in the pancreatic head. During the enhanced scan, the lesion exhibited annular enhancement at the margin, and the enhancement level of the parenchyma was lower than that of the pancreas. The initial diagnosis considered the possibility of pancreatic neuroendocrine tumor. The patient underwent laparoscopic pancreaticoduodenectomy. Postoperative pathological examination led to the consideration of pancreatic schwannoma. The immunohistochemical results demonstrated that S-100 protein was positive (+) and vimentin was positive (+), which were consistent with the pathological characteristics of schwannoma. Consequently, pancreatic schwannoma lacks specific imaging features. The definitive diagnosis relies on pathological and immunohistochemical examinations. The combined detection of S-100 and vimentin can enhance the diagnostic accuracy. Complete surgical resection is the preferred treatment approach, and the prognosis is favorable.