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Monday, 27 April 2020



Schwannoma is a benign peripheral nerve sheath tumor. 

Schwannomas are usually solitary.

Cell of origin of Schwannoma - Differentiated Schwann cells.

Pathologically Schwannomas are unique, because  schwannomas do not infiltrate the parent nerve. 

Surgical significance of this unique feature is that schwannoma  can  be  enucleated  in toto by preserving  the adjacent nerve. 

Longitudinal Incision

Schawannoma Enucleation

Thinned Out Nerve Sheath After Enucleation

Histological characteristics of schwannoma – Areas of cellular component (Antoni A) and areas of hypocellular component (Antoni B).

Most Important Differential Diagnosis of schwannoma is Neurofibroma.

Neurofibromas are usually multiple.

Cell of origin of Neurofibroma- Transformed Schwann cells.

Pathologically neurofibroma infiltrates the parent nerve. 

Surgical significance – Neurofibroma is  resected along with the parent nerve and  nerve  grafting is done  to  preserve the nerve function

Discussion on Neurofibromatosis

Two Types of Neurofibromatosis- Type 1& Type 2

Type 1 Neurofibromatosis is associated with
Café au lait patches
Lisch nodules
Optic glioma

Type 2 Neurofibromatosis is associated with
Bilateral acoustic neuromas
Glioma multiforme
Carcinoma of Breast
Carcinoma Colorectum,
 Renal Cell Carcinoma
Hepato Cellular Carcinoma
Prostatic Carcinoma
Cutaneous malignancy

 Image Courtesy- Trivandrum Surgical Club

Friday, 24 April 2020

Hepatic Adenoma

                                    Hepatic Adenoma 
Pedunculated Hepatic Adenoma

Hepatic adenomas are benign liver tumors.
Commonly seen in women of  Age group-25-50 years.
Associated with intake of Oral contraceptive pills.
10% of adenomas can turn malignant .

Liver Bed After Excision

Excised Tumor

Q1. What is the Differential Diagnosis of this condition?

      Pedunculated Hepatocellular Carcinoma.

Q2. Other than Insulinoma which tumor can present with Hypoglycemia?

Hepatoma/ Hepatocellular Carcinoma (Hypoglycemia is a well-established paraneoplastic manifestation of hepatocellular carcinoma).

Q3. What are the other benign tumors of liver
1.     Liver Haemangioma
2.     Focal Nodular Hyperplasia of Liver

Q4. What is Kasabach–Merritt syndrome?

Large Haemangioma can result in platelet destruction leading to bleeding manifestations. This is called Hemangioma thrombocytopenia syndrome or Kasabach–Merritt syndrome.