Laparoscopic Resection of a Diaphragmatic Phrenic Neurilemmoma Compressing the Suprahepatic Inferior Vena Cava - A Case Report

Sep 30, 2026

Surgical resection of tumors compressing the suprahepatic inferior vena cava (IVC) is technically demanding and may require vascular resection, reconstruction, or extracorporeal circulation. The case involves a diaphragmatic phrenic neurilemmoma severely compressing the suprahepatic IVC and right hepatic vein, successfully resected laparoscopically with thoracoscopic assessment to confirm origin and plan safety measures. Operative details included port placement, careful dissection avoiding vascular invasion, and uneventful recovery.

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SURGICAL CASE REPORTS Surg Case Rep 2026; 12: 25-0678 Case Report Laparoscopic Resection of a Diaphragmatic Phrenic Neurilemmoma Compressing the Suprahepatic Inferior Vena Cava Following Thoracoscopic Exploration: A Case Report Masashi Tsunematsu, Koichiro Haruki, Ryoga Hamura, Norimitsu Okui, Shinji Onda, Taro Sakamoto, Tomohiko Taniai, Kenei Furukawa, Jungo Yasuda, and Toru Ikegami ABSTRACT INTRODUCTION: Surgical resection of tumors compressing the suprahepatic inferior vena cava (IVC) is challenging, as such lesions may require vascular resection, reconstruction, or extracorporeal circulation. We present a case of a diaphragmatic phrenic neurilemmoma severely compressing the suprahepatic IVC and right hepatic vein, which was successfully resected laparoscopically with both thoracoscopic and laparoscopic assessment. CASE PRESENTATION: A 54-year-old woman was referred for evaluation of a thoracic mass detected during a health check-up. Enhanced CT revealed a 2.7-cm, well-circumscribed, heterogeneously enhancing round tumor compressing the suprahepatic IVC and right hepatic vein. Thoracoscopic exploration suggested that the tumor was not intrathoracic, and the right diaphragmatic nerve was identified near the lesion. Laparoscopic resection was then performed with preparation for possible open conversion. After establishing pneumoperitoneum, 4 additional ports were inserted. Dissection of the falciform and coronary ligaments exposed a well-encapsulated tumor originating from the diaphragm. The inferior diaphragmatic vein was transected using ultrasonic shears. The tumor was carefully dissected from the diaphragm without invasion into the IVC or hepatic vein. Complete resection was achieved without removal of adjacent organs, including the diaphragm. The specimen was retrieved via the umbilical incision. Operative time was 54 min, and blood loss was 2 mL. The postoperative course was uneventful. Histopathology revealed benign spindle cells arranged in a storiform pattern, confirming a benign neurilemmoma. CONCLUSIONS: Laparoscopic resection of diaphragmatic phrenic neurilemmoma compressing the suprahepatic IVC can be safe and feasible when combined with careful intraoperative assessment. Thoracoscopic evaluation and preparation for potential vascular involvement are crucial to guide safe resection and manage possible adhesion or invasion. KEYWORDS: diaphragm, neurilemmoma, suprahepatic vena cava Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan Corresponding author: Masashi Tsunematsu. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan E-mail: [tsunematsu@jikei.ac.jp](tsunematsu@jikei.ac.jp) Received: October 28, 2025; Accepted: December 14, 2025 DOI: 10.70352/scrj.cr.25-0678 Supplementary materials are available online. © 2026 The Author(s) . Published by Japan Surgical Society This article is licensed under a Creative Commons Attribution 4.0 International License. Tsunematsu M. et al. Abbreviation IVC inferior vena cava INTRODUCTION Surgical resection of tumors compressing the suprahepatic inferior vena cava (IVC) can be challenging, as such lesions may require vascular resection, reconstruction, or the use of extracorporeal circulation.1,2) Tumors originating from the diaphragm are particularly rare and may be difficult to distinguish from hepatic or retroperitoneal masses preoperatively. In addition to their rarity, lesions arising from the diaphragm often present a diagnostic challenge because conventional imaging alone may not clearly differentiate whether the tumor is located in the thoracic or abdominal cavity. Accurate identification of the tumor’s origin is crucial for determining the optimal surgical approach, particularly when the lesion lies adjacent to major vessels such as the suprahep

FAQs

Why is resection of tumors compressing the suprahepatic IVC challenging?

Such lesions may necessitate vascular resection, reconstruction, or the use of extracorporeal circulation, and their origin can be difficult to determine preoperatively.

How was the tumor’s anatomical origin clarified before the laparoscopic procedure?

Thoracoscopic exploration showed the tumor was covered by the central tendon of the diaphragm, supporting an abdominal origin and guiding the subsequent laparoscopic approach.

What were the key surgical outcomes and pathology findings?

Complete laparoscopic resection was achieved without invasion into the IVC or hepatic vein, the postoperative course was uneventful, and histopathology confirmed a benign neurilemmoma with benign spindle cells arranged in a storiform pattern.

Sep 30, 2026

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