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Souza LCDA, Pinto TDA, Cavalcanti HODF, Rezende AR, Nicoletti ALA, Leão CM, Cunha VC. Esophageal schwannoma: Case report and epidemiological, clinical, surgical and immunopathological analysis. Int J Surg Case Rep 2019; 55:69-75. [PMID: 30710876 PMCID: PMC6357786 DOI: 10.1016/j.ijscr.2018.10.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Schwannoma is a tumor of the peripheral nervous system originated in the Schwann cells of the neural sheath. PRESENTATION OF CASE A 43-years-old male complained of odynophagia, dysphagia and hemoptysis. The upper gastrointestinal endoscopy showed a smooth elevated lesion, 20 cm from the incisor teeth, occupying the entire lumen of the esophagus. The chest computed tomography (CT) scan showed a lesion of 7 cm and superior mediastinal, lower paraesophageal and cardiac enlarged lymph nodes. A posterolateral thoracotomy was performed with total esophagectomy without intraoperative complications. The anatomopathological analysis revealed fusocellular mesenchymal neoplasia of low malignancy potential. The immunohistochemical study showed positivity for S-100 protein and KI67 antibodies and absence of staining for CD117, CD34, ALK protein, SMA and Desmin. Thus, the morphological and immunohistochemical findings pointed to the diagnosis of esophageal Schwannoma. DISCUSSION Although rare and indolent, Schwannoma occurs in the peripheral nervous system, being uncommon in the esophagus. CONCLUSION The immunohistochemical study is essential for the diagnosis, which is based on the positivity for S-100 protein and absence of staining for CD34 and CD117.
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Affiliation(s)
- Luiz Carlos de Araújo Souza
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil.
| | - Thiago David Alves Pinto
- Physician Anatomopathologist of Diagnose laboratory and Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | | | - Alexandre Rezende Rezende
- Physician Anatomopathologist of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | - Ana Luiza Alves Nicoletti
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | - Cinthia Mares Leão
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | - Vinícius Carvalhêdo Cunha
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
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Uhr A, Singh AP, Munoz J, Aka A, Sion M, Jiang W, Goldstein SD, Rosato EL. Colonic Schwannoma: A Case Study and Literature Review of a Rare Entity and Diagnostic Dilemma. Am Surg 2016. [DOI: 10.1177/000313481608201224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
An asymptomatic 73-year-old woman was found to have a submucosal mass in the descending colon on routine colonoscopy. A CT scan revealed a 31 X 28 X 31 mm lesion in the same location. Previous biopsy proved to be nondiagnostic, and the patient underwent a laparoscopic descending colon resection. Histologic evaluation of the tumor revealed a low grade spindle cell neoplasm with strong, diffuse positivity for S-100 protein by immunohistochemistry, leading to the diagnosis of schwannoma. A review of the literature revealed intestinal schwannoma to be a rare disease entity, with only about 50 cases previously reported.
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Affiliation(s)
- Alex Uhr
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Awinder P. Singh
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jose Munoz
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Allison Aka
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Melanie Sion
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Wei Jiang
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Ernest L. Rosato
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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3
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Wang WB, Chen WB, Lin JJ, Xu JH, Wang JH, Sheng QS. Schwannoma of the colon: A case report and review of the literature. Oncol Lett 2016; 11:2580-2582. [PMID: 27073520 DOI: 10.3892/ol.2016.4271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/12/2016] [Indexed: 11/06/2022] Open
Abstract
Colonic schwannomas are rare gastrointestinal mesenchymal tumors, and only a limited number of cases has been reported. The occurrence of these tumors is less common in the large intestine than in the stomach. The present study reports a case of colonic schwannoma in a 62-year-old female patient with no specific symptoms. The patient was diagnosed with a mass in the ascending colon by colonoscopy and abdominal computed tomography scanning. A right hemicolectomy was performed. The postoperative pathological diagnosis was ascending schwannoma. This case is noteworthy as colonic schwannomas are rare and are typically treated as colon cancer. No recurrence of the lesion was observed after 24 months of follow-up.
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Affiliation(s)
- Wei-Bing Wang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Wen-Bin Chen
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Jian-Jiang Lin
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Jia-He Xu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Jin-Hai Wang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Qin-Song Sheng
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
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Daley MJ, Trust MD, Peterson EJ, Luftman K, Miller AH, Ali S, Clark A, Aydelotte JD, Coopwood TB, Brown CV. Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. Am Surg 2016. [DOI: 10.1177/000313481608200224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity.
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Affiliation(s)
| | - Marc D. Trust
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | | | - Kevin Luftman
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Andrew H. Miller
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Sadia Ali
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Adam Clark
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | | | | | - Carlos V.R. Brown
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
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Gastrointestinal autonomic nerve tumors: a clinical review. J Gastrointest Surg 2015; 19:1144-56. [PMID: 25805400 DOI: 10.1007/s11605-015-2798-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/07/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Gastrointestinal autonomic nerve tumors (GANTs) are believed to be rare accounting for 1 % of all malignant gastrointestinal tumors. Many gastrointestinal surgeons and gastroenterologists are unaware of this entity. This review aims to highlight the salient clinical features and prognosis of GANTs. METHODS Using the common search engines and manual cross-referencing, a search of the English literature was conducted for "gastrointestinal autonomic nerve tumor." RESULTS All of the published literature on GANTs is either case reports or small case series. From 49 retrieved articles, a total of 107 GANT cases were collected with a mean age of 54 years and equal male to female preponderance. The most commonly affected site was small bowel followed by stomach. Esophageal and colorectal GANTs were less frequent. Clinical presentation was variable ranging from non-specific symptoms, abdominal pain, weight loss, iron-deficiency anemia, to obstruction and gastrointestinal bleeding. Acute presentation due to free rupture or perforation with subsequent peritonitis was extremely rare. Endoscopic and radiological investigations were valuable in tumor localization and determination of distant spread. Thirteen patients were lost to or had no follow-up, leaving 94 patients for long-term outcome analysis. All patients were treated by radical surgical resection of the involved organ as this offered the only hope of cure. Local recurrence, metastases, or both developed in 40 % of cases despite radical surgical resection. Resection for local recurrences and hepatic metastases was feasible in some selected cases. Response to adjuvant chemoradiation was poor and imatinib mesilate was effective in cases of metastatic or inoperable CD117-positive GANTs. CONCLUSION Radical surgical resection of GANTs is the mainstay of treatment. The aggressive behavior after radical resection coined with the poor response to adjuvant chemotherapy call for the urgent need to develop new adjuvant therapies.
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A case of benign schwannoma of the ascending colon treated with laparoscopic-assisted wedge resection. Int Surg 2015; 98:315-8. [PMID: 24229016 DOI: 10.9738/intsurg-d-13-00015.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Isolated colonic schwannomas are rare gastrointestinal mesenchymal tumors. Only a small number of cases have been reported. Occurrence of these tumors is more common in the stomach than in the large intestine. These spindle cell lesions are distinct from leiomyoma, leiomyosarcoma, and gastrointestinal stromal tumors because the tumor cells have a distinct immunophenotype, with strong diffuse positivity for S-100 and vimentin, as well as corroborative negative staining of CD117 and smooth muscle markers. We present a case of colonic schwannoma in a 70-year-old woman who had no specific symptoms. The patient was diagnosed with a submucosal tumor in the ascending colon on colonoscopy and abdominal computed tomography. Laparoscopic-assisted wedge resection of colon was performed. The very rare pathologic diagnosis of ascending schwannoma was made postoperatively. This case is interesting because schwannomas of the colon and rectum are extremely rare and are treated by laparoscopic-assisted wedge resection.
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7
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Esophageal schwannoma: report of a case and review of the literature. Eur Surg 2014. [DOI: 10.1007/s10353-014-0252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Meshikhes AWN, Al-Garni AA, Al-Momen SA, Al-Nahawi M, Abu Subaih J. Gastrointestinal autonomic nerve tumor of the stomach. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:7-12. [PMID: 24454975 PMCID: PMC3894914 DOI: 10.12659/ajcr.889835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/17/2013] [Indexed: 12/31/2022]
Abstract
Patient: Female, 32 Final Diagnosis: Gastrintestinal Autonomic Nerve Tumor (GANT) Symptoms: anemia • anorexia • fatigue • fever • hearburn • nausea • weight loss Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Abdul-Wahed N Meshikhes
- Section of General and Minimally Invasive Surgery, Department of Surgery, King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia
| | - Ayed A Al-Garni
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia
| | - Sami A Al-Momen
- Section of Gastroenterology, Department of Medicine, King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia
| | - Mamdouh Al-Nahawi
- Section of General and Minimally Invasive Surgery, Department of Surgery, King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia
| | - Jawad Abu Subaih
- Section of Gastroenterology, King Fahad Hospital, Hofouf, Saudi Arabia
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9
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A case report of benign esophageal schwannoma with FDG uptake on PET-CT and literature review of 42 cases in Japan. Esophagus 2012. [DOI: 10.1007/s10388-012-0311-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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10
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Shien K, Nozaki I, Kobatake T, Ohta K, Kubo Y, Tanada M, Kurita A. Two Case Reports of Esophageal schwannoma and Literature Review of Case Reports. ACTA ACUST UNITED AC 2010. [DOI: 10.5833/jjgs.43.1106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Abstract
Schwannomas are neoplasms originating from Schwann cells, which are the cells forming nerve sheaths. These neoplasms generally involve peripheral nerves. They rarely affect the gastrointestinal tract and primary colon involvement is extremely rare. The objective of the present paper was to present a case of primary schwannoma of the sigmoid colon, unassociated with von Recklinghausen disease, that was histopathologically confirmed by means of an immunohistochemical panel. The patient was a 71-year-old woman who had had rectal bleeding when evacuating, with pain and tenesmus, for 4 months. She underwent colonoscopy, which identified a raised submucous lesion of 2.8 cm in diameter, located in the sigmoid colon, 30 cm from the anal margin. During examination, loop polypectomy with lesion excision was performed. Histopathological evaluation showed that this was a tumor of stromal origin. Its resection margins were compromised by neoplasia, and colon resection by means of videolaparoscopy was indicated. Conventional histopathological examination using the hematoxylin-eosin technique suggested that the neoplasm was of mesenchymal origin. An immunohistochemical panel was run for etiological confirmation, using anti-CD34 antibodies, desmin, cytokeratins (AE1/AE3), cKit, chromogranin and S-100 protein. The panel showed intense immunoexpression of S-100 protein. Investigation of the proliferative activity rate using Ki-67 antibodies showed that there was a low rate of mitotic activity, thus confirming the diagnosis of primary benign schwannoma of the colon. The patient's postoperative evolution was uneventful and she remains in good health, without signs of tumor recurrence, 15 months after surgical excision.
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Affiliation(s)
- Ronaldo Nonose
- Assistant Professor in General Surgery, Medical Course, São Francisco University, Bragança Paulista, Brazil
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12
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Abstract
Since the discovery of activating KIT mutations in gastrointestinal stromal tumors (GISTs) in 1998 and the subsequent demonstration that some malignant GISTs respond to targeted therapy with imatinib, it has become increasingly important for pathologists to correctly diagnose GISTs and separate them from their potential mimics in the gastrointestinal tract and abdominal cavity. Some mesenchymal tumors, such as leiomyomas of the muscularis mucosae, are easily distinguished from GIST on the basis of their anatomic location and morphologic appearance. Others, such as gastrointestinal schwannomas, can significantly overlap with GIST in their gross appearance and morphology and require a panel of immunostains for correct diagnosis. This article will review the most common mimics of GISTs: desmoid tumors, smooth muscle tumors (leiomyomas and leiomyosarcomas), gastrointestinal schwannomas, inflammatory fibroid polyps, and solitary fibrous tumors. Pertinent differences between each of these tumors and GIST in terms of gross appearance, histologic features, and immunophenotype will be emphasized. It is important to separate GISTs from these potential mimics because their treatment and prognosis can differ markedly.
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Affiliation(s)
- Susan C Abraham
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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13
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Marin VP, Yu P, Weber RS. Isolated cervical esophageal reconstruction for rare esophageal tumors. Head Neck 2006; 28:856-60. [PMID: 16835909 DOI: 10.1002/hed.20442] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Isolated defects in the cervical esophagus in patients who have not undergone total laryngectomy are uncommon. We report 2 cases of rare esophageal tumors requiring reconstruction of the cervical esophagus after tumor resection. METHODS AND RESULTS The patients were a 51-year-old woman with an esophageal granular cell tumor and a 54-year-old woman with an esophageal schwannoma. Both defects were reconstructed with a radial forearm flap. A small subclinical leak developed in 1 patient and healed spontaneously within 2 weeks. At 1 year and 2 years of follow-up, both patients were consuming a normal diet and had normal voices. CONCLUSIONS A thin and well-vascularized flap such as the radial forearm flap is essential for reconstructing an isolated cervical esophageal defect so as to maximize functional outcome.
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Affiliation(s)
- Vincent P Marin
- Department of Plastic Surgery, Unit 443, FC8.2000, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
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Mulchandani MH, Chattopadhyay D, Obafunwa JO, Joypaul VB. Gastrointestinal autonomic nerve tumours--report of a case and review of literature. World J Surg Oncol 2005; 3:46. [PMID: 16026628 PMCID: PMC1182401 DOI: 10.1186/1477-7819-3-46] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Accepted: 07/19/2005] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Gastrointestinal autonomic nerve tumours are uncommon stromal tumours of the intestinal tract. They can involve any part of the gastrointestinal system, but are very rarely seen in the rectum. CASE PRESENTATION We report a unique case of rectal schwannoma with associated synchronous adenocarcinoma of the splenic flexure and adenoma of the descending colon. A 70-year-old patient was admitted with complaint of bleeding per rectum and investigations revealed the presence of a large submucosal rectal lesion in addition to the colonic pathologies. Following panproctocolectomy with permanent spout ileostomy, histopathology and immunohistochemistry confirmed the rectal lesion to be a schwannoma. CONCLUSION Literature review of the few reported cases has suggested radical surgical excision to be the best approach. Prognosis tends to be favourable after resection.
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Affiliation(s)
- Manoj H Mulchandani
- Department of Surgery, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 OPL, UK
| | - Dipankar Chattopadhyay
- Department of Surgery, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 OPL, UK
| | - John O Obafunwa
- Department of Pathology, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 OPL, UK
| | - Vickram B Joypaul
- Department of Surgery, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 OPL, UK
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15
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Naus PJ, Tio FO, Gross GW. Esophageal schwannoma: first report of successful management by endoscopic removal. Gastrointest Endosc 2001; 54:520-2. [PMID: 11577324 DOI: 10.1067/mge.2001.116884] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- P J Naus
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floud Curl Drive, San Antonio, TX 78284-7878, USA
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Kobayashi N, Kikuchi S, Shimao H, Hiki Y, Kakita A, Mitomi H, Ohbu M. Benign esophageal schwannoma: report of a case. Surg Today 2000; 30:526-9. [PMID: 10883464 DOI: 10.1007/s005950070120] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report herein the case of an otherwise asymptomatic 62-year-old woman who was found to have an incidental esophageal lesion during endoscopic follow-up of an unrelated disorder. An esophageal submucosal tumor was diagnosed, and the patient was subsequently monitored on a regular yearly basis. As the diameter of the tumor doubled over a 4-year period, the possibility of a malignant lesion could not be excluded, and she was admitted to our hospital for further investigations. Esophagography, endoscopy, endoscopic ultrasonography, and computed tomography confirmed a submucosal tumor, 35 mm in length, in the thoracic midesophagus. A leiomyoma or leiomyosarcoma was suspected based on the known incidence of such tumors, and tumor enucleation was performed. Gross inspection revealed a solid tumor arising from the wall of the esophagus. Histopathologic examination showed intertwined bundles of spindle cells with spiral-like proliferation, and immunohistochemical studies were positive for S-100 protein, whereby a diagnosis of esophageal schwannoma was established. The patient experienced no postoperative complications, and her clinical course to date has been satisfactory. To date, 2 years 8 months after surgery, she has shown no sign of tumor recurrence and remains in good health.
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Affiliation(s)
- N Kobayashi
- Department of Surgery, School of Medicine, Kitasato University, Kanagawa, Japan
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Abstract
We report a patient with a plexiform schwannoma located in the cervical part of the esophagus. A large pedunculated intraluminal polyp, originating in the postcricoid region and protruding into the oropharynx, was found in association with multiple submucosal nodules. Both the intraluminal polyp and submucosal nodules consisted of cellular schwannomatous tissue. The patient showed no signs of neurofibromatosis or schwannomatosis. Plexiform schwannomas are uncommon tumors, mainly confined to the dermis and subcutis of trunk, head, and neck region and upper extremities. Visceral examples are vanishingly rare, and a location in the esophagus has not yet been described. The intruiging mode of presentation in the present case, mimicking that of so-called giant esophageal fibrovascular polyp, probably relates to mechanical factors inherent to the unique esophageal location, Int J Surg Pathol 8(4):353-357, 2000
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Affiliation(s)
- K. Cokelaere
- Department of Pathology, University Hospital Gasthuisberg, Catholic University of Leuven, Belgium
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Abstract
A rare case of esophageal schwannoma is presented. A 63-year-old woman was admitted to our hospital with a 5-year history of dysphagia. The barium esophagogram showed a protrusive smooth tumor in the upper thoracic esophagus. The tumor was removed through right thoracotomy. There was no anatomical relationship between the tumor and vagal nerve trunk. From pathologic findings and positive immunohistochemical staining for S-100 protein, the diagnosis of esophageal schwannoma was made.
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Affiliation(s)
- R Saito
- Second Department of Surgery, Akita University School of Medicine, Japan.
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