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Lu ZY, Zhao DY. Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture: A case report. World J Gastroenterol 2021; 27:3940-3947. [PMID: 34321856 PMCID: PMC8291012 DOI: 10.3748/wjg.v27.i25.3940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schwannomas, also known as neurinomas, are tumors that derive from Schwann cells. Gastrointestinal schwannomas are extremely rare, but the stomach is the most common site. Gastric schwannomas are usually asymptomatic. Endoscopy and imaging modalities might offer useful preliminary diagnostic information. However, to diagnose schwannoma, the immunohistochemical positivity for S-100 protein is essential, whereas CD117, CD34, SMA, desmin, and DOG-1 are negative.
CASE SUMMARY A 45-year-old female was found to have a gastric mass during a medical examination, which was diagnosed as a gastric schwannoma. We performed endoscopic full-thickness resection and endoscopic purse-string suture. Pathology and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 protein. Furthermore, to exclude the misdiagnosis of gastrointestinal stromal tumor, we performed a mutational detection of the c-Kit and PDGFRA genes. Postoperative follow-up revealed that the patient recovered well.
CONCLUSION Immunohistochemical staining is essential for the diagnosis of schwannoma. Endoscopic full-thickness resection is an effective treatment method for gastric schwannoma.
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Affiliation(s)
- Zhi-Yu Lu
- Departments of Gastroenterology, Institute of Digestive, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
| | - Dun-Yong Zhao
- Departments of Gastroenterology, Institute of Digestive, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
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Lauricella S, Valeri S, Mascianà G, Gallo IF, Mazzotta E, Pagnoni C, Costanza S, Falcone L, Benvenuto D, Caricato M, Capolupo GT. What About Gastric Schwannoma? A Review Article. J Gastrointest Cancer 2021; 52:57-67. [PMID: 32964322 DOI: 10.1007/s12029-020-00456-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Gastric schwannomas (GSs) are rare mesenchymal neoplasms of the gastrointestinal tract. Diagnosis is often achieved postoperatively, based on pathology reports of retrieved specimens. The aim of the present study is to follow up all patients with gastric schwannoma (Gs) undergoing endoscopic, partial, or more extended surgery and to evaluate the appearance of local or distant recurrence. METHODS A PubMed, Cochrane, and Embase systematic review of the literature has been performed. Original papers, review articles, and case reports published between 1988 and 2019 were considered eligible. All the studies who met the inclusion criteria were analyzed. Statistical analysis of data has been performed using GraphPad Prism 7 software. RESULTS Three hundred twenty-eight articles were found, and a total of 102 were included and analyzed in depth. Fifty-three papers reported the follow-up information, ranging from 1 to 417 months across different studies. Among them, 31 patients underwent endoscopic removal of the gastric lesions; 140 patients underwent local surgery, including wedge resection or partial gastrectomy; and 148 patients underwent subtotal or total gastrectomy. The median follow-up was of 27-38-33 months, respectively. No recurrence or distant metastasis was detected in the endoscopy group. Among local surgery group, liver metastasis was reported in one case; in extended surgery group, one patient died for multiple liver metastases. CONCLUSIONS Local or more extended surgery involved a larger cohort of patients and reported satisfactory long-term results compared with endoscopy group. Surgery in absence of a definite preoperative diagnosis is considered the gold standard treatment for resectable Gs.
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Affiliation(s)
- Sara Lauricella
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Sergio Valeri
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University, Rome, Italy
| | - Gianluca Mascianà
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ida Francesca Gallo
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University, Rome, Italy
| | - Erica Mazzotta
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Chiara Pagnoni
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Saponaro Costanza
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Falcone
- Department of Pathology, Campus Bio-Medico University, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
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Suzuki K, Saito K, Yamada T, Arizono E, Kumita H, Kasahara K, Katsumata K, Tasaki K, Matsubayashi J, Nagao T. Perilesional Lymph Node Swelling Might Be a Radiologic Clue for Appendiceal Schwannoma: A Case Report. Curr Med Imaging 2021; 17:1266-1270. [PMID: 34102981 DOI: 10.2174/1573405617666210608152957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastrointestinal schwannoma is not a common type of tumor, and lesions originating from the appendix are extremely rare. Herein, we report a patient with appendiceal schwannoma characterized by lymph node swelling. CASE REPORT A 67-year-old male patient who had diabetes complained of weight loss. A computed tomography scan revealed a mass in the right side of the pelvic cavity. Moreover, a contrast-enhanced computed tomography scan showed perilesional lymph node swelling measuring up to 28 mm. A low-intensity mass was observed on T1-weighted imaging, heterogeneous high-intensity mass on T2-weighted imaging, and restricted diffusion on diffusion-weighted imaging. There were no abnormal findings on colonoscopy. Based on a preoperative examination, a differential diagnosis of either appendiceal schwannoma, carcinoid, or gastrointestinal stromal tumor was considered. During surgery, a large appendiceal mass and multiple swollen perilesional lymph nodes were observed. Therefore, ileocecal resection and D3 lymph node dissection were performed. Pathological and immunohistochemical analyses confirmed the diagnosis of appendiceal schwannoma. There were numerous swollen lymph nodes in the mesenteric region. The lymph nodes revealed reactive lymphoid hyperplasia, with enlarged follicles of various sizes and shapes with an irregular distribution. Almost all lymphocytes, except those at the germinal centers, were small. CONCLUSION Gastrointestinal schwannoma is characterized by lymph node swelling. Appendiceal schwannoma may have characteristics, including peritumoral lymph node swelling, similar to other types of gastrointestinal schwannoma such as that in the stomach. Thus, this characteristic can be a diagnostic clue for appendiceal schwannoma.
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Affiliation(s)
- Kunihito Suzuki
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Elly Arizono
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Hidehiro Kumita
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kenta Kasahara
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koichiro Tasaki
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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Yoo J, Kim SH, Han JK. Multiparametric MRI and 18F-FDG PET features for differentiating gastrointestinal stromal tumors from benign gastric subepithelial lesions. Eur Radiol 2019; 30:1634-1643. [PMID: 31781931 DOI: 10.1007/s00330-019-06534-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate whether multiparametric magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET) can be helpful in differentiating gastrointestinal stromal tumors (GISTs) from non-GISTs and high-risk GISTs from low-risk GISTs. METHODS This retrospective study included 56 patients with pathologically confirmed GISTs (n = 39), leiomyoma (n = 8), schwannoma (n = 5), heterotopic pancreas (n = 3), and glomus tumor (n = 1) who underwent MRI and/or PET examinations. Two radiologists reviewed MRI regarding location, shape, contour, growth pattern, margin, signal intensity (SI) on T1- (T1WI) and T2-weighted images (T2WI), degree and pattern of enhancement, hemorrhage, and necrosis. Mean apparent diffusion coefficient (ADC) and maximum standardized uptake value (SUVmax) were measured. Imaging features were compared among non-GISTs, low-risk GISTs, and high-risk GISTs using uni- and multivariate statistical analyses. RESULTS Size, longitudinal location, shape, contour, growth pattern, SI on T1- and T2WI, enhancement pattern, hemorrhage, necrosis, ADC, and SUVmax were significantly different among non-GISTs, low-risk GISTs, and high-risk GISTs (p < 0.05). On multivariate analysis, SI on T2WI (hazard ratio [HR], 66.0; p = 0.002) was the only independent variable for differentiating GISTs from non-GISTs whereas enhancement pattern (HR, 56.0; p = 0.041), ADC (HR, 0.997; p = 0.01), and SUVmax (HR, 2.08; p = 0.027) were significant features for differentiating between high-risk and low-risk GISTs. CONCLUSIONS Several qualitative and quantitative MRI and PET features including ADC and SUVmax values are significantly different among non-GISTs, low-risk GISTs, and high-risk GISTs. Multiparametric information obtained from MRI with or without PET can be useful for differentiation of gastric subepithelial tumors as well as for determining patients' management and prognosis. KEY POINTS • Several qualitative MRI features are helpful in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs as well as high-risk GISTs from low-risk GISTs. • Apparent diffusion coefficient value on diffusion-weighted imaging can be useful in distinguishing GISTs from non-GISTs as well as high-risk GISTs from low-risk GISTs. • PET has the potential to distinguish between high-risk and low-risk GISTs.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Morales-Maza J, Pastor-Sifuentes FU, Sánchez-Morales GE, Ramos ESG, Santes O, Clemente-Gutiérrez U, Pimienta-Ibarra AS, Medina-Franco H. Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review. World J Gastrointest Oncol 2019; 11:750-760. [PMID: 31558979 PMCID: PMC6755107 DOI: 10.4251/wjgo.v11.i9.750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/29/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach´s plexus or less frequently from Meissner´s plexus. The main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors (GISTs), which are classified by their immunohistochemistry. The treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important role. Wedge resection, subtotal or total gastrectomy can be done. In its counterpart, esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2% of all esophageal tumors. The main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor, followed by GIST. The treatment consists on tumoral enucleation or esophagectomy.
AIM To review the available literature about gastrointestinal schwannomas; especially lesions from de stomach and esophagus, including diagnosis, treatment, and follow up, as well as, reporting our institutional experience.
METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. The following databases were used for reviewing process: PubMed, Ovid, MEDLINE, and Scopus. Only English language manuscripts were included. All gastrointestinal schwannomas specifically located in the esophagus and stomach were included. Cases that did not report long-term follow-up were excluded.
RESULTS Gastric localization showed a higher prevalence in both, the literature review and our institution: 94.95% (n = 317) and 83% (n = 5) respectively. With a follow-up with disease-free survival greater than 36 mo in most cases: 62.01% (n = 80) vs 66.66% (n = 4). In both groups, the median size was > 4.1 cm. Surgical treatment is curative in most cases
CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal tumors. It has a good prognosis, and most are benign. A disease-free survival of more than 36 mo can be achieved by surgery.
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Affiliation(s)
- Jesús Morales-Maza
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | | | - Germán E Sánchez-Morales
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | - Emilio Sanchez-Garcia Ramos
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | - Oscar Santes
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | - Uriel Clemente-Gutiérrez
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | | | - Heriberto Medina-Franco
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
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Differentiation of Gastric Schwannoma From Gastric Gastrointestinal Stromal Tumor With Dual-Phase Contrast-Enhanced Computed Tomography. J Comput Assist Tomogr 2019; 43:741-746. [DOI: 10.1097/rct.0000000000000902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kahng DH, Kim GH, Park SG, Lee SJ, Park DY. A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma. Clin Endosc 2018; 51:587-590. [PMID: 29764009 PMCID: PMC6283761 DOI: 10.5946/ce.2018.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023] Open
Abstract
Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare among mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas are usually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from other subepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas have not been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas from gastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health check-up endoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patient underwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesion was a benign schwannoma.
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Affiliation(s)
- Dong Hwahn Kahng
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Gyu Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Jeong Lee
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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8
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Abstract
Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the "gold standard." We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Hu J, Liu X, Ge N, Wang S, Guo J, Wang G, Sun S. Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. Medicine (Baltimore) 2017; 96:e7175. [PMID: 28640097 PMCID: PMC5484205 DOI: 10.1097/md.0000000000007175] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022] Open
Abstract
Endoscopic ultrasound (EUS) and endoscopic resection play an important role in gastric submucosal tumor. However, there were few articles regarding EUS and endoscopic resection of gastric schwannomas. Our aim was to evaluate the role of EUS and endoscopic resection in treating gastric schwannomas.We retrospectively reviewed 14 patients between March 2012 and April 2016 with gastric schwannomas and who received EUS and endoscopic resection. EUS characteristics, endoscopic resection, tumor features, and follow-up were evaluated in all the patients.Fourteen patients were enrolled in the present study. The patients' ages ranged from 25 to 72 years (mean age, 52.6 years). On EUS, all tumors were originating from muscularis propria and hypoechoic. Ten tumors have the extraluminal growth patterns and 4 tumors have the intraluminal growth patterns. Marginal halos were observed in 7 lesions. No cystic change and calcification were found inside the lesions. Complete endoscopic resection was performed in all the patients with no complications occurring in any patients. No recurrence or metastases was found in all patients during the follow-up period.Gastric schwannoma has some characteristics on EUS, but it is difficult to differentiate gastric schwannoma from gastrointestinal stromal tumor. Endoscopic resection is an effective and safe treatment for gastric schwannoma with an excellent follow-up outcome.
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10
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Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors. Case Rep Gastrointest Med 2017; 2017:9615359. [PMID: 28573055 PMCID: PMC5440794 DOI: 10.1155/2017/9615359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022] Open
Abstract
Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians, and the precise differential diagnosis between GS and other gastric submucosal tumors remains difficult preoperatively. The present study reports a case of GS misdiagnosed as gastrointestinal stromal tumor and reviews the clinical, imaging, and pathological features, treatment, and follow-up of 221 patients with GS previously reported in the English literature. Although GS is rare, the case reported in the current study highlights the importance of including GS in differential diagnoses of gastric submucosal tumors. Furthermore, the findings of the review suggest that although many cases are asymptomatic, the most common symptoms are abdominal pain or discomfort, not gastrointestinal bleeding, and malignant GSs present with clinical symptoms more commonly. Although large-sample multicenter studies on the efficacy, safety, and oncological outcomes of minimally invasive techniques are required, the findings presented herein may be helpful for clinicians when diagnosing or treating GS.
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Park HC, Son DJ, Oh HH, Oak CY, Kim MY, Chung CY, Myung DS, Kim JS, Cho SB, Lee WS, Joo YE. Endoscopic ultrasonographic characteristics of gastric schwannoma distinguished from gastrointestinal stromal tumor. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 65:21-6. [PMID: 25603850 DOI: 10.4166/kjg.2015.65.1.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. METHODS A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. RESULTS GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada's classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. CONCLUSIONS The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.
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Affiliation(s)
- Hyung-Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Jun Son
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung-Hoon Oh
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chan-Young Oak
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi-Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Cho-Yun Chung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dae-Seong Myung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Sun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Wan-Sik Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Eun Joo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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12
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Gong EJ, Choi KD. Is Endoscopic Ultrasonography Adequate for the Diagnosis of Gastric Schwannomas? Clin Endosc 2016; 49:498-499. [PMID: 27853129 PMCID: PMC5152789 DOI: 10.5946/ce.2016.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoon JM, Kim GH, Park DY, Shin NR, Ahn S, Park CH, Lee JS, Lee KJ, Lee BE, Song GA. Endosonographic Features of Gastric Schwannoma: A Single Center Experience. Clin Endosc 2016; 49:548-554. [PMID: 26975861 PMCID: PMC5152784 DOI: 10.5946/ce.2015.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/01/2015] [Accepted: 12/05/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Gastric schwannomas are rare benign mesenchymal tumors that are difficult to differentiate from other mesenchymal tumors with malignant potential, such as gastrointestinal stromal tumors. This study aimed to evaluate the characteristic findings of gastric schwannomas via endoscopic ultrasonography (EUS). METHODS We retrospectively reviewed the EUS findings of 27 gastric schwannoma cases that underwent surgical excision at Pusan National University Hospital during 2007 to 2014. RESULTS Gastric schwannomas were mainly located in the middle third of the stomach with a mean tumor size of 32 mm. All lesions exhibited hypoechoic echogenicity, and 24 lesions (88.9%) exhibited heterogeneous echogenicity. Seventeen lesions (63.0%) exhibited decreased echogenicity compared to the normal proper muscle layer. Distinct borders were observed in 24 lesions (88.9%), lobulated margins were observed in six lesions (22.2%), and marginal haloes were observed in 24 lesions (88.9%). Hyperechogenic spots were observed in 21 lesions (77.8%), calcifications were observed in one lesion (3.7%), and cystic changes were observed in two lesions (7.4%). CONCLUSIONS During EUS, gastric schwannomas appear as heterogeneously hypoechoic lesions with decreased echogenicity compared to the normal proper muscle layer. These features may be helpful for differentiating gastric schwannomas from other mesenchymal tumors.
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Affiliation(s)
- Jong Min Yoon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Na Ri Shin
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Sangjeong Ahn
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Chul Hong Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin Sung Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Key Jo Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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14
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Mohanty SK, Jena K, Mahapatra T, Dash JR, Meher D, John A, Nayak M, Bano S. Gastric GIST or gastric schwannoma-A diagnostic dilemma in a young female. Int J Surg Case Rep 2016; 28:60-64. [PMID: 27689519 PMCID: PMC5043394 DOI: 10.1016/j.ijscr.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 12/17/2022] Open
Abstract
Gastric Schwannoma is a rare neoplasm of stomach. It mimic clinically and radiologically with Gastric GIST. Immunohistochemical study can differentiate these two tumors. Introduction Gastrointestinal stromal tumor (GIST) is the commonest mesenchymal tumor of GI tract and 60–70% of it seen in the stomach, whereas Gastric schwannoma is a benign, slow growing and one of the rare neoplasms of stomach. Age distribution, clinical, radiological features and gross appearance of both tumors are similar. Presentation of case We report a rare case of gastric schwannoma in a 20-year-old girl, who underwent subtotal gastrectomy with the suspicion of a GIST preoperatively but later confirmed to be gastric schwannoma postoperatively after immunohistochemical study. Discussion Accordingly, the differential diagnosis for gastric submucosal mass should be gastric schwannoma. Furthermore, Gastric schwannoma is a benign neoplasm with excellent prognosis after surgical resection, whereas 10–30% of GIST has malignant behavior. Therefore, it is important to distinguish between gastric schwannoma and GIST so as to make an accurate diagnosis for optimally guide treatment options. Conclusion Due to the paucity of gastric schwannoma, the index of suspicion for this diagnosis is low. So it is important to include gastric schwannoma in the differential diagnosis when preoperative imaging studies reveal submucosal exophytic gastric mass and after resection of the tumor with a negative margin, it should be sent for immunohistochemical study for confirmation of diagnosis.
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Affiliation(s)
- Sudhir Kumar Mohanty
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Kumarmani Jena
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Tanmaya Mahapatra
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Jyoti Ranjan Dash
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Dibyasingh Meher
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Ajax John
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Manjushree Nayak
- Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Shafqat Bano
- Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
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15
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Gong EJ, Kim DH. Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions. Clin Endosc 2016; 49:425-433. [PMID: 27744661 PMCID: PMC5066408 DOI: 10.5946/ce.2016.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022] Open
Abstract
Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.
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Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Sreevathsa MR, Pipara G. Gastric Schwannoma: A Case Report and Review of Literature. Indian J Surg Oncol 2015; 6:123-6. [PMID: 26405419 DOI: 10.1007/s13193-014-0367-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 12/11/2014] [Indexed: 11/25/2022] Open
Abstract
Schwannomas are usually benign, slow growing tumors, that originate from any nerve that has a Schwann cell sheath. Here, we report the case of a 40 year-old female patient with an incidentally noted submucosal gastric tumor while being evaluated for cervical lymphadenopathy as a part of workup for lymphoma. She underwent sleeve resection of the stomach under suspicion of a gastrointestinal stromal tumor, but postoperative histopathological and immunohistochemical findings confirmed the diagnosis of shwannoma. Although schwannomas are mostly benign, they are often indistinguishable preoperatively from malignant tumors such as gastrointestinal stromal tumors. Therefore, resection is the treatment of choice for all such tumors.
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Affiliation(s)
- M R Sreevathsa
- Department of General Surgery, M.S. Ramaiah Medical College and Hospitals, M.S.R.I.T Post, M.S.R. Nagar, Bangalore, 560054 Karnataka India
| | - Gotam Pipara
- M.S. Ramaiah Medical College and Hospitals, Bangalore, 560054 India
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17
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Dabkowski K, Chosia M, Starzyńska T. Odd-looking gastric tumor. Gastroenterology 2014; 146:619-872. [PMID: 24462991 DOI: 10.1053/j.gastro.2013.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/21/2013] [Accepted: 10/28/2013] [Indexed: 12/02/2022]
Affiliation(s)
- Krzysztof Dabkowski
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Maria Chosia
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
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18
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Zhong DD, Wang CH, Xu JH, Chen MY, Cai JT. Endoscopic ultrasound features of gastric schwannomas with radiological correlation: A case series report. World J Gastroenterol 2012; 18:7397-7401. [PMID: 23326151 PMCID: PMC3544048 DOI: 10.3748/wjg.v18.i48.7397] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 09/13/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023] Open
Abstract
Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract. They are usually misdiagnosed as other submucosal tumors preoperatively. Experience of the imaging features of gastric schwannomas is extremely limited. In this report, we summarize the features of a series of endoscopic ultrasound (EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate. We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results. Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity, and a well-demarcated margin. The tumors originated from the fourth layer. Cystic changes and calcification were uncommon. Marginal hypoechoic haloes were observed in two patients. The results described here were different from those of previous studies. In the EUS evaluation, the internal echogenicity of gastric schwannomas was heterogeneous and low, but slightly higher than that of muscularis propria. These features might help us differentiate gastric schwannomas from other submucosal tumors. Further investigation is needed to differentiate these mesenchymal tumors.
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19
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Rodriguez E, Tellschow S, Steinberg DM, Montgomery E. Cytologic findings of gastric schwannoma: a case report. Diagn Cytopathol 2012; 42:177-80. [PMID: 24436245 DOI: 10.1002/dc.22913] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/16/2012] [Indexed: 11/06/2022]
Abstract
Spindle cell lesions of the stomach are rare. They usually affect the submucosa or muscularis propria and therefore can be sampled by endoscopic fine needle aspiration. The most common tumor in this category is gastrointestinal stromal tumor (GIST), followed by leiomyoma and gastric schwannoma. Gastric schwannoma is a benign tumor of neuroectodermal origin that has overlapping morphologic/cytologic features with GIST and leiomyoma. Gastric schwannomas differ from peripheral schwannomas by lacking a capsule, Verocay bodies, Antoni B areas, and thick-walled vessels. They are characterized morphologically by poorly defined borders, cuffs of lymphoid tissue and a haphazard spindle cell proliferation. We present here the cytologic and histopathologic features of a gastric schwannoma. The tumor was composed of spindle cells with delicate eosinophilic cytoplasm and wavy nuclei, with an associated conspicuous lymphoid backdrop. The latter feature raised the possibility of a lymphoid lesion, a problem cytopathologists should be aware of.
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Affiliation(s)
- Erika Rodriguez
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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20
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Williamson JML, Wadley MS, Shepherd NA, Dwerryhouse S. Gastric schwannoma: a benign tumour often mistaken clinically, radiologically and histopathologically for a gastrointestinal stromal tumour--a case series. Ann R Coll Surg Engl 2012; 94:245-9. [PMID: 22613302 PMCID: PMC3957503 DOI: 10.1308/003588412x13171221590935] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gastric schwannomas are rare mesenchymal tumours that arise from the nerve plexus of the gut wall. They present with non-specific symptoms and are often detected incidentally. Pre-operative investigation is not pathognomonic and many are therefore diagnosed as gastrointestinal stromal tumours (GISTs). Operative resection is usually curative as they are almost always benign, underpinning the importance of differentiating them from GISTs. METHODS Three cases of gastric schwannomas were identified over a seven-year period. The clinical details and management were reviewed retrospectively. RESULTS There were two women and one man with a mean age of 62 years (range: 51–69 years). Two patients presented with bleeding and one with abdominal pain. The mean tumour size was 5.2cm (range: 2–10cm) and the tumours were resected completely following total or wedge gastrectomies. Histology in all cases showed spindle cells with a cuff of lymphoid tissue. Immunohistochemistry confirmed positive S100 staining and negative CD117 and DOG-1 staining in all cases. CONCLUSIONS We report our experience with these unusual primary stromal tumours of the gut and their presentations, preoperative investigations, operative findings and pathological findings are discussed. Operative resection in all cases has been considered curative, which is supported by previous series confirming the excellent prognosis of gastric schwannomas.
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Affiliation(s)
- J M L Williamson
- Department of Oesophagogastric Surgery, Gloucestershire Royal Hospital, Gloucester, UK.
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21
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Choi JW, Choi D, Kim KM, Sohn TS, Lee JH, Kim HJ, Lee SJ. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT. Korean J Radiol 2012; 13:425-33. [PMID: 22778564 PMCID: PMC3384824 DOI: 10.3348/kjr.2012.13.4.425] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 12/14/2011] [Indexed: 12/12/2022] Open
Abstract
Objective To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. Materials and Methods We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. Results Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). Conclusion Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.
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Affiliation(s)
- Jin Wook Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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22
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Voltaggio L, Murray R, Lasota J, Miettinen M. Gastric schwannoma: a clinicopathologic study of 51 cases and critical review of the literature. Hum Pathol 2012; 43:650-9. [PMID: 22137423 PMCID: PMC3305846 DOI: 10.1016/j.humpath.2011.07.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 07/02/2011] [Indexed: 12/11/2022]
Abstract
Schwannoma is a rare gastrointestinal mesenchymal tumor, as the vast majority of gastric mesenchymal tumors are gastrointestinal stromal tumors. In this study, we analyzed clinicopathologically 51 gastric schwannomas. These tumors predominantly occurred in older adults with a marked female predominance (40 women and 11 men; median and mean ages, 60 and 58 years). They variably presented with gastric discomfort, bleeding, or rarely gastric outlet obstruction; and many were incidental findings during other medical procedures. The tumors ranged from 1 to 10.5 cm (median, 4.5 cm). The typical histologic features included spindle cells usually with microtrabecular architecture and focal nuclear atypia, and peritumoral lymphoid cuff, whereas features of soft tissue schwannomas, such as encapsulation, nuclear palisading, vascular hyalinization, and dilatation, were absent or infrequent. Median mitotic count was 2/50 high-power fields, with the highest count being 13/50 high-power fields. No malignant variants were recognized, and long-term follow-up did not reveal recurrences or metastases. Immunohistochemically, all examined tumors were S100 protein positive and most were also GFAP positive, whereas CD34 and NF68 were encountered rarely and all tumors were negative for HMB45, KIT, DOG1/Ano 1, smooth muscle actin, desmin, and synaptophysin. None of the 9 tumors studied contained gastrointestinal stromal tumor-specific KIT or PDGFRA mutations. Fluorescence in situ hybridization studies revealed multiple signals with BCR probe (chromosome 22) and centromeric probes for chromosomes 2 and 18 suggesting polyploidy. These findings indicate that gastric schwannoma is a distinctive form of peripheral nerve sheath tumor that in many ways differs from soft tissue schwannoma. It should be distinguished from gastrointestinal stromal tumor and other mesenchymal tumors of the gastrointestinal tract, such as the S100 protein-positive gastrointestinal clear cell sarcoma and metastatic melanoma.
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Affiliation(s)
- Lysandra Voltaggio
- George Washington University Hospital, Department of Pathology, Washington, DC
| | - Rebecca Murray
- George Washington University Hospital, Department of Pathology, Washington, DC
| | - Jerzy Lasota
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland
- Joint Pathology Center, Silver Spring, Maryland
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23
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Komatsu D, Koide N, Hiraga R, Furuya N, Akamatsu T, Uehara T, Miyagawa S. Gastric schwannoma exhibiting increased fluorodeoxyglucose uptake. Gastric Cancer 2010; 12:225-8. [PMID: 20047128 DOI: 10.1007/s10120-009-0526-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 10/05/2009] [Indexed: 02/07/2023]
Abstract
This is the first case of gastric schwannoma that exhibited increased accumulation of [(18)F] fluorodeoxyglucose (FDG) on positron emission tomography (PET) imaging. The patient was a 60-year-old woman in whom esophagogastroduodenoscopy showed a submucosal tumor, about 25 mm in size, in the upper body of the stomach, with ulceration at the top of the tumor. Endoscopic ultrasonography revealed a well-defined hypoechoic mass located in the proper muscle layer of the stomach. The specimen taken from the tumor showed only inflammatory degenerative tissue. Abdominal computed tomography revealed a tumor in the upper body of the stomach. FDG-PET showed FDG uptake (standardized uptake value [SUV] max 5.8) coincident with the tumor. Hence, the tumor was diagnosed initially as a gastrointestinal stromal tumor of the stomach. Laparoscopic partial gastrectomy was performed. Pathological examination showed that the tumor consisted of spindle cells with large nuclei, and mitosis was absent. The Ki-67 labeling index of the tumor cells was 4%. Immunohistochemically, the tumor cells showed a positive reaction for S-100 protein, whereas they were negative for KIT, CD 34, and alpha-smooth muscle actin protein. The tumor was diagnosed as a benign gastric schwannoma. Gastric schwannoma should be included in the differential diagnosis of submucosal tumors of the stomach with FDG uptake.
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Affiliation(s)
- Daisuke Komatsu
- Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Peripheral nerve sheath tumors of the gastrointestinal tract: a multicenter study of 58 patients including NF1-associated gastric schwannoma and unusual morphologic variants. Virchows Arch 2010; 456:411-22. [PMID: 20155280 DOI: 10.1007/s00428-010-0886-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 02/06/2023]
Abstract
The frequency and morphological spectrum of gastrointestinal peripheral nerve sheath tumors (PNSTs) from consecutive case material has not been studied in the c-KIT era. We reviewed all mesenchymal gastrointestinal (GI) lesions at our departments according to current diagnostic criteria. PNSTs formed the third commonest group of mesenchymal GI tumors with a lower frequency (< or =5%) compared to gastrointestinal stromal tumors (GISTs; approximately 50%) and smooth muscle neoplasms ( approximately 30%). Granular cell tumors (GCTs; n = 31) and schwannomas (n = 22) were the most common types of PNSTs encountered. Rare tumors included neurofibromatosis 1 (NF1)-associated PNSTs (n = 5) and gastric perineurioma (n = 1). Thirteen schwannomas (including also some recent cases) were initially diagnosed as GIST, leiomyoma, or neurofibroma. Unusual histological variants included sigmoid GCT with prominent lipomatous component (n = 1), reticular-microcystic schwannoma of small (n = 1) and large (n = 1) bowel, NF1-associated gastric schwannoma (the first case to date), and psammomatous melanotic colonic schwannoma unrelated to Carney complex (n = 1). PNSTs coexisted with GIST in four patients (three had definite NF1). In conclusion, PNSTs of the GI tract are rare uniformly benign neoplasms that may show schwannian, perineurial, fibroblastic, or mixed differentiation. Most of them (92%) occurred sporadically unassociated with NF1 or NF2. Gastrointestinal PNSTs are still underrecognized by general pathologists. Awareness of their diverse morphology will help to avoid confusing them with smooth muscle neoplasms and GIST that they may closely mimic.
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