Pancreatic schwannoma with cystic degeneration: a rare tumor mimicking cystic neoplasm

Abstract

Pancreatic schwannomas are rare benign nerve sheath tumours, accounting for <1% of pancreatic neoplasms. Their radiological and clinical presentation often mimics cystic pancreatic neoplasms, leading to diagnostic uncertainty. Authors present the case of a 56-year-old female with early satiety and anorexia for four months. CECT abdomen revealed a 9×8 cm lobulated, septated, hypodense cystic lesion with peripheral wall calcifications, arising from the head and uncinate process of the pancreas, suggestive of macrocystic neoplasm. Exploratory laparotomy revealed a well-encapsulated, exophytic, solid-cystic mass arising from the pancreatic head, abutting but not infiltrating adjacent duodenum, SMV and SMA. Complete excision was performed. Histopathology showed spindle cell lesion, and immunohistochemistry confirmed schwannoma with ancient change (S100+, SOX10+, CD117–, DOG1–, CD34–, Desmin–, Ki67 <1%). Postoperative course was uneventful. Pancreatic schwannomas, though rare, should be considered in the differential diagnosis of cystic pancreatic lesions. Immunohistochemistry is essential for definitive diagnosis. Complete surgical excision offers excellent outcomes.