Schwannoma in and around the porta hepatis: radiological features in eight cases and literature review

• Published in: Abdominal imaging 2022-06, Vol.47 (6), p.1917-1928
• Main Authors: Nakaya, Moto, Kurokawa, Ryo, Watadani, Takeyuki, Morisaka, Hiroyuki, Higuchi, Maika, Toda, Yusuke, Kunichika, Hideki, Kusakabe, Masashi, Okada, Yoshitaka, Ohgiya, Yoshimitsu, Okada, Masahiro, Anai, Hiroshi, Abe, Osamu, Minami, Manabu
• Format: Article
• Language: English
• Subjects: Bile ducts; Computed tomography; Emission analysis; Feature recognition; Female; Fluorodeoxyglucose F18; Gastroenterology; Ginger; Hepatobiliary; Hepatology; Histology; Humans; Imaging; Literature reviews; Liver; Liver - pathology; Localization; Magnetic Resonance Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neurilemmoma - diagnostic imaging; Neurilemmoma - pathology; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Radiology; Retrospective Studies; Schwann cells; Sheaths; Soft tissues; Tomography; Tumors; Ultrasonic imaging
• ISSN: 2366-0058; 2366-004X; 2366-0058
• DOI: 10.1007/s00261-022-03524-2

Purpose Schwannomas in and around the porta hepatis (porta hepatic schwannomas) are rare benign tumors easily misdiagnosed as other pathologies, including malignancies. We aimed to evaluate their imaging features on ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and 18 F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT). Methods We performed a multi-institutional retrospective study by reviewing the clinical and imaging findings of pathologically proven eight porta hepatic schwannomas (mean age, 55 years; range, 38–80 years; one male and seven females). Preoperative imaging included three ultrasonography, eight CT, eight MRI, and two FDG-PET/CT. Results All patients were asymptomatic. The mean tumor size was 61.9 mm (range, 30–180 mm), and all tumors demonstrated well-defined lesions on ultrasonography and their solid components showed soft tissue attenuation on non-contrast CT. MRI showed two distinct components in all cases: the component with T1-weighted hypointensities and T2-weighted hyperintensities with poor enhancement (suggestive of Antoni B histology); the component with T2-weighted hypointensities with gradually increasing enhancement (suggestive of Antoni A histology), resulting in a heterogeneous pattern on post-contrast CT or MRI (8/8, 100%). The separated deviation of surrounding bile ducts and vessels without obstruction allowed the recognition of extrahepatic localization and their benign nature. A ginger root-like morphology (2/8, 25%) seemed to be suggestive of extension along the Glisson’s sheath, although this finding was not seen frequently. Conclusion Recognizing imaging features such as extrahepatic location, benign nature with internal structures suggestive of Antoni A/B histology, and characteristic tumor extension may provide key diagnostic clues for porta hepatic schwannomas. Graphical abstract