Schwannomas are benign tumors originating from Schwann cells, which are the main component of the neural sheath. Biliary schwannomas are extremely rare. We report the case of a 78-year-old man who presented with no abdominal symptoms or jaundice. CT imaging showed a hyperdense mass extending along the extrahepatic bile duct, and the upstream bile ducts were dilated. We performed extrahepatic bile duct resection under a preoperative diagnosis of the extrahepatic bile duct cancer. A histopathological examination of the resected specimen revealed that the tumor consisted of spindle cells which exhibited a palisading arrangement. Immunohistochemical staining was positive for protein S-100 and vimentin. Based on these pathological findings, we diagnosed the patient with schwannoma of the extrahepatic bile duct. Our search of the relevant literature revealed 19 case studies of biliary schwannomas. In our case, the surgical findings showed that the tumor was noninvasive and mobile. During surgery, a fast frozen section analysis was performed, and no malignant findings were observed. These results enabled us to avoid extrahepatic bile duct resection with major hepatectomy. We experienced a case of biliary schwannoma that was difficult to distinguish from bile duct cancer.
Case Rep Gastroenterol 2021;15:578–586

中文翻译：

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需要与胆管癌鉴别的胆管神经鞘瘤

神经鞘瘤是起源于神经鞘的主要成分雪旺细胞的良性肿瘤。胆管神经鞘瘤极为罕见。我们报告了一名 78 岁男性的病例，他没有腹部症状或黄疸。CT成像显示沿肝外胆管延伸的高密度肿块，上游胆管扩张。我们在术前诊断为肝外胆管癌的情况下进行了肝外胆管切除术。切除标本的组织病理学检查显示肿瘤由梭形细胞组成，呈栅栏状排列。S-100 蛋白和波形蛋白免疫组化染色呈阳性。基于这些病理结果，我们诊断出该患者患有肝外胆管神经鞘瘤。我们对相关文献的搜索揭示了 19 例胆管神经鞘瘤病例研究。在我们的案例中，手术结果显示肿瘤是非侵入性的和可移动的。术中进行快速冰冻切片分析，未见恶性发现。这些结果使我们能够避免在主要肝切除术中切除肝外胆管。我们经历了一个难以与胆管癌区分的胆管神经鞘瘤病例。
Case Rep Gastroenterol 2021；15:578–586