Giant ancient schwannoma of pancreatic head treated by extended pancreatoduodenectomy

Abstract

We report a case of a 55-year-old woman who was transferred from another center to our university clinic after diagnostic laparotomy with a pancreatic head tumor which was seen to encase the portal vein. Although intraoperative biopsies were performed, a histologic diagnosis of the tumor was not possible before giving suspect to a malignant tumor being resectable only with a vascular resection. In a second operation we performed a pylorus-preserving pancreatoduodenectomy. Due to adhesion of the tumor to the portal vein, a segmental resection and end-to-end anastomosis of the portal vein was necessary. Postoperative histologic diagnosis revealed an ancient schwannoma which was removed in toto being a rare report of this benign tumor in the pancreatic head. Ten months after the operation the patient is without any health problems. Partial resection of the portal vein, which is considered to be a safe procedure in high volume centers, stands in contrary to surgical nihilism of pancreatic head tumors suspecting advanced tumors with vascular involvement.