title: Multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder: first case report.
abstract: BACKGROUND
  Schwannomas are mesenchymal neoplasms that arise from Schwann cells with low malignant potential. Schwannomas originating from the porta hepatis or intra-abdominal organs are extremely rare. To our knowledge, multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder have not been reported so far and we first report one in the present case.
  
  
  METHODS
  A 31-year-old female was referred to our hospital because of repeated abdomen discomfort, slight abdominal distension, and occasional abdominal pain for seven years. Ultrasound and computed tomography and magnetic resonance cholangiopancreatography found multiple intrahepatic and extrahepatic cystic lesions with the dilation of intrahepatic and extrahepatic bile ducts. By exploratory laparotomy, multiple tumors were found in the porta hepatis, liver, and gallbladder, the biggest one was 11 × 6 cm in size. We completely resected these tumors combined with the left lateral liver lobe, gallbladder, and the invaded left and right hepatic arteries, and then severed vessels were reconstructed. Microscopically, the tumor cells were spindle shaped and palisading arrangement. Atypical cells or signs of malignancy were not found. Immunohistochemical investigation showed the protein S-100 was positive, while SMA, CD34, and CD117 negative. Finally, these tumors were diagnosed as schwannomas in the porta hepatis, liver, and gallbladder. The patient is followed-up for 70 months and has been doing well without any complications.
  
  
  CONCLUSIONS
  We report the first patient with multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder. Accurate preoperative diagnosis of these tumors is difficult. Due to closely adhering to the surrounding important tissues, complete removal is challenging.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health Key Laboratory of Organ Transplantation Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases Department of pathology (KS), First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou,China.
authors.forename: Shao-Yan
authors.initials: SY
authors.lastname: Xu
authors.forename: Hua
authors.initials: H
authors.lastname: Guo
authors.forename: Yan
authors.initials: Y
authors.lastname: Shen
authors.forename: Ke
authors.initials: K
authors.lastname: Sun
authors.forename: Hai-Yang
authors.initials: HY
authors.lastname: Xie
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
authors.forename: Wei-Lin
authors.initials: WL
authors.lastname: Wang
mesh_terms: D000328:Adult; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D009442:Neurilemmoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed