US QUIZ AUGUST 2021

31/07/2021   0 Comments

Case Report A 62 years-old female patient with a personal medical history of a JAK2 mutation-negative essential thrombocythemia under hydroxyurea was referred for an endoscopic ultrasound (EUS) due to a perihepatic hypodense ovoid lesion on abdominal computed tomography. The lesion measured 20×16 mm, and was mildly enhanced in arterial phase and moderately enhanced in portal phase. Apart from a mild abdominal pain in the previous months, the patient did not report any other symptoms. She denied past abdominal trauma or surgeries. Laboratory studies were unremarkable. The EUS revealed in the periportal region, a nodular lesion with 18x14mm, isoechogenic in relation to the liver parenchyma, with distinct margins and well-demarcated from the surrounding organs (Fig. 1). No enlarged hilar lymph nodes or left liver masses were recognized. Tissue sampling was obtained through fine needle biopsy (FNB), 3 passages, using an AcquireTM 22G needle (Boston Scientific) (Fig. 2). Histopathological analysis (Fig. 3A) identified a mesenchymal tumor with spindle cells arranged in bundles and palisades with no nuclear atypia. Immunohistochemical staining (Fig. 3B) was diffusely positive for S-100 protein, and with no expression for DOG1, CD117, alpha-actin, smooth muscle actin, desmin and CD34.  Quiz Discussion The histopathological analysis was compatible with a schwannoma. A schwannoma is a tumor that arises from Schwann cells, which form the inner portion of the peripheral nerve sheath(1). Intraperitoneal schwannomas are relatively uncommon, and porta hepatic schwannomas are even rarer, with very few (<20) cases described in the literature(1). Tumors in this region can be associated to symptoms by compressing […]

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