Primary hepatic schwannoma: A case report

INTRODUCTION: A hepatic schwannoma is extremely rare and difficult to diagnose preoperatively. PRESENTATION OF CASE: We report the case of a 47-year-old male patient who was referred to our hospital for the close investigation of a hepatic tumor which had not been detected two years earlier. An enhanced computed tomography revealed a well-circumscribed and encapsulated tumor with a size of 50 mm which was adjacent to the inferior vena cava (IVC) and the right hepatic vein. The tumor was heterogeneously enhanced until the equilibrium phase. A magnetic resonance image showed a hypointense area on a T1-weighted image and a hyperintense area on a T2-weighted image. These findings differed from those of common malignant hepatic tumors, such as hepatocellular carcinoma and colorectal liver metastases. The tumor was most likely a mucus-producing tumor or a liquefactive degenerated adenocarcinoma. Although we could not confirm an exact diagnosis of the tumor, we performed a surgical resection in view of the possibility of malignancy. The patient underwent a limited liver resection with resection of the IVC. Histologically, the tumor was diagnosed as a benign schwannoma comprised of Antoni A and B areas. The nuclear palisading formation of the tumor showed Verocay bodies. DISCUSSION: 15 cases of hepatic schwannoma are reviewed to clarify the typical radiological features. The radiological findings of the present case were consistent with those of the hepatic schwannoma when considering retrospectively. CONCLUSION: A precise preoperative diagnosis of hepatic schwannoma is difficult, and liver resection is recommended when a hepatic schwannoma is suspected.