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Mu YZ, Zhang Q, Zhao J, Liu Y, Kong LW, Ding ZX. Total removal of a large esophageal schwannoma by submucosal tunneling endoscopic resection: A case report and review of literature. World J Clin Cases 2023; 11:2510-2520. [PMID: 37123315 PMCID: PMC10130983 DOI: 10.12998/wjcc.v11.i11.2510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/14/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Primary schwannoma is a rare submucosal tumor of the esophagus, which is most often benign, and surgery is the only effective treatment. So far, only a few cases have been reported. Herein, we reported a single case diagnosed with primary esophageal schwannoma that was totally removed by submucosal tunneling endoscopic resection (STER).
CASE SUMMARY A 62-year-old man presented to the hospital with a history of resection of a malignant gastric tumor and mild dysphagia. Endoscopic examination revealed a large submucosal elevated lesion in the esophagus 25-30 cm from the incisors. Endoscopic ultrasonography detected a 45 mm × 35 mm × 31 mm hypoechoic lesion; chest computed tomography showed a mass of approximately 55 mm × 35 mm × 29 mm. A preliminary examination showed features suggestive of a stromal tumor. Pathological findings indicated esophageal schwannoma. Next, STER alone was performed to completely resect the mass, and the patient recovered well post-surgery. Afterward, the patient was discharged and showed no tumor recurrence at 33 mo of follow-up.
CONCLUSION Endoscopic resection is still an effective treatment for large esophageal schwannomas (> 30 mm) under meticulous morphological evaluation.
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Affiliation(s)
- Yu-Zhu Mu
- Department of Radiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Qi Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Jing Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Yan Liu
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Ling-Wei Kong
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Zhong-Xiang Ding
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Gupta P, Rana S, Dey P. Cytomorphological and immunocytochemical diagnosis of an oesophageal mass in a 62-year-old female with dysphagia. Cytopathology 2021; 33:281-284. [PMID: 34525230 DOI: 10.1111/cyt.13059] [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: 08/05/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Abstract
Oesophageal schwannoma is an extremely rare benign neoplasm. Cytological diagnosis of oesophageal schwannoma has been sporadically reported in the literature. Herein, we present a case of oesophageal schwannoma in an older woman that could be accurately diagnosed based on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology accompanied by cell block immunocytochemistry.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Khan U, Simone C, Safieddine N, Gazala S. Video-assisted thoracoscopic resection of a giant esophageal schwannoma: A case report. Int J Surg Case Rep 2021; 85:106202. [PMID: 34388894 PMCID: PMC8350491 DOI: 10.1016/j.ijscr.2021.106202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intrathoracic schwannomas are rare and difficult to diagnose. However, they are the most common type of neurogenic tumor in the chest. Most patients are incidentally diagnosed or develop symptoms from mass effect, such as chest pain, dysphagia or dyspnea. Larger tumors have been resected using open approaches, while smaller ones are often excised with minimally invasive approaches. CASE PRESENTATION A 60-year-old woman with a prior Roux-en-Y gastric bypass and a history of dysphagia, decreased appetite, and weight loss was referred for evaluation. CT chest revealed an 8 cm soft tissue mass centered in the distal esophagus. Gastroscopy showed the tumor to be 8 cm as well, with 2 cm of normal esophagus prior to the gastric pouch. A right-sided video-assisted thoracoscopic (VATS) approach for enucleation was successfully completed with primary esophageal repair for an 8.0 × 5.5 × 6.5 cm schwannoma. CLINICAL DISCUSSION Surgical resection for schwannomas is often indicated due to symptoms from mass effect (Moro et al., 2017). There are reports of VATS and robotic-assisted thoracic surgery approaches for small tumors. These techniques are appealing due to shorter length of stays and less post-operative pain. None have been described for lesions larger than 6 cm. CONCLUSION Minimally invasive approaches such as VATS for large schwannomas are technically feasible and safe to perform without the need for a thoracotomy.
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Affiliation(s)
- Usman Khan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Carmine Simone
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada
| | - Najib Safieddine
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada
| | - Sayf Gazala
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada,Corresponding author at: University of Toronto, Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada; Chest Centre, Michael Garron Hospital, 825 Coxwell Avenue, East York, ON M4C 3E7, Canada.
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Li B, Wang X, Zou WL, Yu SX, Chen Y, Xu HW. Endoscopic resection of benign esophageal schwannoma: Three case reports and review of literature. World J Clin Cases 2020; 8:5690-5700. [PMID: 33344562 PMCID: PMC7716328 DOI: 10.12998/wjcc.v8.i22.5690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/15/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal schwannomas are uncommon esophageal submucosal benign tumors and are usually treated with surgery.
CASE SUMMARY Here, we report three cases of middle/lower thoracic esophageal schwannoma treated successfully with endoscopic resection. These lesions were misdiagnosed as leiomyoma on preoperative imaging. During the endoscopic resection of such tumors, there is a risk of esophageal perforation due to their deep location. If possible, submucosal tunneling endoscopic resection should be used.
CONCLUSION For larger schwannomas, endoscopy combined with thoracoscopy can be considered for en bloc resection. We performed a mini literature review in order to present the current status of diagnosis and treatment for esophageal schwannoma.
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Affiliation(s)
- Bin Li
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
| | - Xue Wang
- Department of Gastroenterology,Dezhou People’s Hospital, Dezhou 253014, Shangdong Province, China
| | - Wen-Lu Zou
- Cheeloo College of Medicine, Shandong University, Jinan 250012, Shangdong Province, China
| | - Shu-Xia Yu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
| | - Yong Chen
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
| | - Hong-Wei Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
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Clinicopathological features of esophageal schwannomas in mainland China: systematic review of the literature. Int J Clin Oncol 2020; 26:284-295. [PMID: 33216242 DOI: 10.1007/s10147-020-01809-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Esophageal schwannoma (ES) are rare and mostly benign neurogenic tumors. The clinical misdiagnosis rate of it is high. In this study, the clinicopathologic features of ES in mainland China were studied to better understand the disease and improve the diagnosis and treatment rate. METHODS A systematic review was conducted in accordance with PRISMA guidelines. The keywords "esophageal schwannoma", "esophageal neurinoma" and "esophageal neurilemoma" were searched for databases such as Pubmed, EMbase, Wanfang Database and Chinese National Knowledge Infrastructure. The search time frame for database was until July 2019. Combined with our patient, the clinicopathological data and the diagnosis and treatment of ES were summarized. RESULTS ES occurs in the upper part of the mediastinum and in the thoracic esophagus in most patients in the neck, upper and middle segments. CT and PET/CT examinations can be used for diagnosis, but the differentiation value of both benign and malignant ES is similar. The histopathological findings of forceps biopsy specimens are often difficult to diagnose, and deep tissue biopsies may increase pathological accuracy. EUS-FNA is also recommended for ES diagnosis, but it may also be misdiagnosed. Pathological features include a fusiform arrangement in a palisade-like structure or a tumor cell arranged in a network to form a loose structure. ES characteristic immunohistochemistry results showed that S-100 protein has strong immunological activity. CONCLUSION The definitive diagnosis requires immunohistochemistry, especially immunological reaction with S-100 protein. The appropriate treatment plan should be selected according to the diameter of the lesion. The overall prognosis of ES is good, but attention should be paid to follow-up.
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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: 2.0] [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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Sanchez-Garcia Ramos E, Cortes R, de Leon AR, Contreras-Jimenez E, Rodríguez-Quintero JH, Morales-Maza J, Aguilar-Frasco J, Irigoyen A, Reyes F, Alfaro-Goldaracena A. Esophageal schwannomas: A rarity beneath benign esophageal tumors a case report. Int J Surg Case Rep 2019; 58:220-223. [PMID: 31102953 PMCID: PMC6525318 DOI: 10.1016/j.ijscr.2019.03.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/27/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022] Open
Abstract
Esophageal Schwannoma is a rare tumor with only few cases reported in the literature. In general, Schwanommas are rarely found in the gastrointestinal tract. Esophagic schwanommas is the least common gastrointestinal form of presentation. The knowledge about a new case of esophagic schwanomma, impacts in obtaining more information about the clinical course and surgical treatment of this tumor.
Introduction Esophageal Schwannoma is a rare tumor that represents the least frequent mesenchymal tumor of the esophagus and represents a condition with only a few cases reported in the literature Presentation of a case We report a 40-year-old female with a 5 years history of gastroesophageal reflux, repeated history of pharyngitis, odynophagia that culminated in progressive oropharyngeal dysphagia to solids. A barium esophagogram revealed a filling defect in the superior and middle thirds of the esophagus. Upper gastrointestinal endoscopy showed a smooth elevated lesion in the upper third of the esophagus, impossible to resect by this mean. An open left cervical approach revealed an 80 × 45 × 20 mm large tumor, which was resected. Discussion In general, Schwanommas are rarely found in the gastrointestinal tract (GI), while the great majority occur in the stomach, esophagic is the least common GI form of presentation. Conclusion The knowledge about a new case, impacts in obtaining more information about the clinical course and surgical treatment of this tumor.
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Affiliation(s)
- Emilio Sanchez-Garcia Ramos
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico.
| | - Rubén Cortes
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Alexandra Rueda de Leon
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Emmanuel Contreras-Jimenez
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | | | - Jesús Morales-Maza
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Jorge Aguilar-Frasco
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Alejandro Irigoyen
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Frida Reyes
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
| | - Alejandro Alfaro-Goldaracena
- Oncology Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico
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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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