Benign gastric schwannoma: how long should we follow up to monitor the recurrence? Int Surg. 2015;100:744-747. [PMID: 25875559 DOI: 10.9738/intsurg-d-14-00106.1]

A Case Report of a Rare Mesenteric Schwannoma: A Diagnostic Challenge

Schwannomas, also known as neurilemmomas, are neurogenic, benign tumors of Schwann cells arising from peripheral nerve sheaths that may be present at almost any anatomical site. A primary mesenteric schwannoma is an extremely rare tumor, with only 12 cases reported in the literature to date. Preoperative diagnosis of mesenteric schwannomas is almost impossible because of the rarity of the case and their nonspecific symptoms. Instead, we made the diagnosis postoperatively using histopathological examination (HPE) and immunohistochemistry (IHC) following the complete surgical resection of the mass. We present the case of a 39-year-old female with painless, progressively increasing abdominal mass for two years. Her preoperative clinical diagnosis was inconclusive, and a diagnosis of a primary mesenteric schwannoma was made after HPE and IHC reports following en bloc resection of the mass.

Gastric schwannoma: A retrospective analysis of clinical characteristics, treatments, and outcomes

BACKGROUND

This study aimed to investigate the clinical characteristics, treatment options, and prognosis of patients with gastric schwannoma (GS).

METHODS

Patients who were pathologically diagnosed with GS between April 2011 and October 2022 were enrolled. The data of clinical characteristics, pathological features, treatment options, and clinical outcomes were collected and compared between GS patients who underwent endoscopic resection (ER) and surgical resection (SR).

RESULTS

Of the 32 cases, 23 underwent SR and nine underwent ER. The median tumor size was significantly smaller in ER group than in SR group (12.0 vs. 40.0 mm, P < 0.001), while patients in SR group were older than those in ER group (54.5 ± 10.6 vs. 45.3 ± 10.9 years, P = 0.036). Moreover, tumors in ER group were more likely to exhibit an intraluminal pattern (100% vs. 26.1%, P < 0.001). Patients in ER group had significantly lower hospitalization cost (25859.2 ± 8623.9 vs. 44953.0 ± 13083.8 RMB, P = 0.011) than those in SR group. No differences were found between the two groups in terms of R0 resection rate, operative time, estimated blood loss, adverse events, and recurrence rate. All patients were followed up for 4-96 months (mean: 35 months; median: 23 months), during which no evidence of recurrence or metastasis was observed.

CONCLUSIONS

Both ER and SR are safe and effective treatment modalities for the management of GS, with ER being associated with lower medical costs compared to SR. The majority of GS are benign and do not recur, with little possibility of malignant transformation.

Computed tomographic imaging features to differentiate gastric schwannomas from gastrointestinal stromal tumours: a matched case-control study

To investigate clinical data and computed tomographic (CT) imaging features in differentiating gastric schwannomas (GSs) from gastric stromal tumours (GISTs) in matched patients, 31 patients with GSs were matched with 62 patients with GISTs (1:2) in sex, age, and tumour site. The clinical and imaging data were analysed. A significant (P < 0.05) difference was found in the tumour margin, enhancement pattern, growth pattern, and LD values between the 31 patients with GSs and 62 matched patients with GISTs. The GS lesions were mostly (93.5%) well defined while only 61.3% GIST lesions were well defined.The GS lesions were significantly (P = 0.036) smaller than the GIST lesions, with the LD ranging 1.5-7.4 (mean 3.67 cm) cm for the GSs and 1.0-15.30 (mean 5.09) cm for GIST lesions. The GS lesions were more significantly (P = 0.001) homogeneously enhanced (83.9% vs. 41.9%) than the GIST lesions. The GS lesions were mainly of the mixed growth pattern both within and outside the gastric wall (74.2% vs. 22.6%, P < 0.05) compared with that of GISTs. No metastasis or invasion of adjacent organs was present in any of the GS lesions, however, 1.6% of GISTs experienced metastasis and 3.2% of GISTs presented with invasion of adjacent organs. Heterogeneous enhancement and mixed growth pattern were two significant (P < 0.05) independent factors for distinguishing GS from GIST lesions. In conclusion: GS and GIST lesions may have significantly different features for differentiation in lesion margin, heterogeneous enhancement, mixed growth pattern, and longest lesion diameter, especially heterogeneous enhancement and mixed growth pattern.

Laparoscopic resection for gastric schwannoma larger than 30 mm with long-term outcomes

BACKGROUND AND AIMS

Laparoscopic resection has been reported as effective and safe for gastric schwannoma (GS) in the form of case reports. However, study on laparoscopic surgery in patients with GS larger than 30 mm has been rarely reported. To this end, the present study aimed to evaluate the safety and efficacy of laparoscopic resection for the treatment of GS larger than 30 mm and its long-term outcomes.

METHODS

This is a retrospective case series study of patients with GS larger than 30 mm who underwent laparoscopic resection at our hospital between January 2014 and December 2020. Clinical pathology, surgical and follow-up data were collected and analyzed.

RESULTS

A total of 10 patients with a mean age of 51.6 years were included. Seven tumors were located in gastric body, 2 in antrum and 1 in fundus. Laparoscopic gastric wedge resection was performed in 7 patients, while laparoscopic gastric local resection was performed in 3 patients. All patients achieved complete resection. The mean operation time was 112.6 ± 34.3 min, and the mean postoperative hospital stay was 13.8 ± 5.1 days. Postoperative gastroplegia occurred in 2 patients and was treated with conservative therapy. No recurrence, metastasis or residue was found during the follow-up of mean 45.1 months.

CONCLUSIONS

Laparoscopic resection is a safe and effective method for treating GS larger than 30 mm with favorable long-term follow-up outcomes. Laparoscopic resection may be considered as the first-line treatment for GS larger than 30 mm.

Incidental finding of a gastric schwannoma: a case report

Gastric schwannomas are rare peripheral nerve sheath tumors which are usually found incidentally while undergoing workup for other conditions. Despite their benign nature, they require surgical resection with negative margins. It is important to differentiate gastric schwannomas from gastrointestinal stromal tumors prior to surgical excision, as this can alter the recommended surgical plan. This can be achieved with endoscopic ultrasound and fine needle aspiration with analysis of the sampled tissue using immunohistochemical stains. We present the case of a 68-year-old female patient with an incidental finding of a gastric fundus schwannoma. Laparoscopic gastric wedge resection was performed with complete excision of the tumor and negative margins. Pathology was confirmed with immunohistochemical stains positive for S-100 and negative for CD117 and DOG1. Post-operative recovery was uneventful without tumor recurrence.

Laparoscopic treatment of a series of rare tumors, gastric schwannoma with chronic iron deficiency anemia: A case report

Introduction and importance

Gastric schwannoma is a rare and slow-growing gastrointestinal mesenchymal tumor. Gastric neurilemmoma accounts for less than 1% of all gastric tumors. Without specific clinical manifestations, it is easy to be misdiagnosed before the operation, and rupture and bleeding will lead to persistent anemia in patients. The diagnosis can only be confirmed by pathological examination.

Case presentation

A 55-year-old woman was admitted to The Second Hospital of Lanzhou University due to abdominal distension, pain, acid regurgitation, and belching. The tumor was completely removed by laparoscopy. The postoperative specimens were diagnosed as gastric neurilemmoma by pathological examination.

Clinical discussion

Schwannoma is a benign neurogenic tumor. Complete surgical resection with a negative cutting edge is an effective method for the treatment of gastric schwannoma. Because the lesion is benign, the prognosis of the patient is good.

Conclusion

Laparoscopic tumor resection is a choice for the treatment of gastric schwannoma, and the therapeutic effect is good.

•

This study reports a rare 55-year-old woman with gastric iron deficiency anemia with schwannoma, which was confirmed by laparoscopy and finally pathologically.

•

This case report shows that although gastric schwannoma has no specific clinical manifestations of the digestive tract, it can cause chronic iron deficiency anemia in patients

•

Our successful cases show that laparoscopic surgery to remove tumors is an option for the treatment of this disease.

Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture: A case report

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.

What About Gastric Schwannoma? A Review Article

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.

Gastric schwannoma: a case report and literature review

BACKGROUND

Gastric schwannoma is a rarely seen gastric tumor accounting for only 0.2% of all gastric tumors. It is difficult to distinguish a gastric schwannoma from other gastric tumors preoperatively.Case presentation: A 30-year-old man with no significant medical history or physical examination findings presented with a 1-month history of right upper abdominal discomfort. The preoperative diagnosis was a gastrointestinal stromal tumor, but the postoperative pathologic and immunohistochemical examinations confirmed a gastric schwannoma. The patient underwent laparoscopic wedge resection of the stomach without additional postoperative treatment, and his postoperative recovery was uneventful. No recurrence or metastasis was found at the 2-year follow-up examination.

CONCLUSION

Although gastric schwannomas are usually not malignant, they are difficult to distinguish from other malignant stromal tumors preoperatively. Surgical resection should be recommended when a schwannoma is malignant or considered to be at risk of becoming malignant.

Occult follicular lymphoma in a swollen regional lymph node of gastric schwannoma

BACKGROUND

Regional lymphadenopathy is more commonly noted in gastric schwannomas than in other gastric submucosal tumors. Most of the swollen lymph nodes associated with gastric schwannomas are non-metastatic lymphadenopathy.

CASE PRESENTATION

A 69-year-old Japanese woman was referred to our hospital with a chief complaint of abdominal discomfort. Contrast-enhanced computed tomography (CT) of the abdomen revealed an extraluminal tumor with heterogeneous enhancement at the middle stomach on the lesser curve, accompanied with one swollen lymph node approximately 10 mm in size and several small lymph nodes in the perigastric region. These lymph nodes were flat; therefore, we considered them to be non-metastatic. The main tumor was removed via wedge resection. Soft and slightly swollen lymph nodes, which were compatible with the lymph nodes noted in the preoperative CT, were found near the main tumor in the fatty tissue at the lesser curvature of the stomach. An excisional biopsy of the largest lymph node was performed for the diagnosis. Based on pathological findings, a diagnosis of gastric schwannoma and follicular lymphoma (FL) was confirmed. The patient is doing well without recurrence of either the gastric schwannoma or FL 28 months postsurgery.

CONCLUSIONS

The present report detailed an extremely rare case of FL coincidentally discovered in the swollen regional lymph node of gastric schwannoma.

Gastric tumors in children: single-center study with emphasis on treatment of repeated recurrence

PURPOSE

Analysis of surgical management and survival of pediatric patients with gastric tumors treated at our institution.

METHODS

A retrospective study of patients with primary gastric tumors treated between 1993 and 2018 was conducted.

RESULTS

Eight patients, five girls and three boys, were diagnosed with gastric tumors at an average age of 10.4 years (1 day-15.4 years). Surgical management included Billroth type I procedure in five and tumor excision in three patients. Histology revealed gastrointestinal stromal tumor (GIST) in four patients and one of each of schwannoma, myofibroblastic tumor, hamartoma and teratoma. Microscopically clear margins were reported in six patients. Repeated local recurrence occurred in three patients (2 × GIST, 1 × myofibroblastic tumors) who consequently underwent three, four and six reoperations. One of these patients had liver metastases, which were managed with ligation of the hepatic arteries. This patient was also diagnosed with a lung hamartoma, which was treated with a lobectomy. Survival rate was 100% with a median follow-up of 8.6 years (7 months-25.5 years).

CONCLUSIONS

Gastric tumors are rare in children and represent a management challenge. Repeated recurrence of GISTs and myofibroblastic tumors remains frequent even after complete resection and may necessitate multiple surgeries, therefore patients require a lifelong follow-up.

A Rare Case of Gastric Schwannoma: A Case Report and Literature Review

In general, schwannoma is a benign and slow-glowing neoplasm that rarely occurs in the gastrointestinal tract as a submucosal tumor (SMT), with the most common site being the stomach. As gastric schwannoma (GS) is a rare tumor, there is limited data in the literature about its clinical features. The diagnosis of schwannoma can only be made by pathological examination with positive staining for S-100 protein. It is necessary to obtain an accurate diagnosis to introduce optimal treatment options preoperatively. However, a precise diagnosis of GS is difficult, even with modern imaging techniques. On the other hand, a complete resection with a negative surgical margin (R0) of GS is considered the best treatment, with an excellent prognosis. We present a case of a 66-year-old female patient who underwent laparoscopic-assisted wedge gastrectomy for gastric SMT, pathologically diagnosed as GS, with positive staining for S-100 protein and negative for c-kit and CD34. At 12-month follow-up after surgery, there was no recurrence or metastasis of GS. Our treatment is appropriate and effective in case of GS exceeding 50 mm.

Gastric schwannoma: a diagnosis that should be known in 2019

Gastric schwannoma (GS) is a rare neoplasm of the stomach deriving from Schwann cells of the peripheral nerves in 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. Preoperatively, GSs are difficult to differentiate from other mesenchymal tumors, such as gastrointestinal stromal tumor (GIST) or leiomyoma, which develop from mesenchymal stem cells. The optimal management of GS is based on the symptoms of the patient, tumor size and histologic grading. Here, we report the case of a GS in a 73-year-old female who underwent a wedge gastric resection following a clinical diagnosis of GIST. A histological and immunohistochemical study was performed excluding the misdiagnosis of GIST. The histomorphological features of the lesion and absence of c-Kit and strong positivity of S100 indicated the diagnosis of GS.

Endoscopic submucosal excavation and endoscopic full-thickness resection for gastric schwannoma: five-year experience from a large tertiary center in China

BACKGROUND AND AIMS

Endoscopic resection (ER) is an effective and safe method for gastric submucosal tumors, mostly composed of gastrointestinal stromal tumors and leiomyomas. The role of ER in gastric schwannoma (GS) has rarely been described. Our aim was to evaluate the efficacy and safety of ER for GS.

METHODS

This is a retrospective study in consecutive patients who underwent ER for GS from March 2013 to October 2018 at our center. Clinicopathological, endoscopic, and follow-up data were collected and analyzed.

RESULTS

A total of 16 consecutive patients (9 females, 56.3%) were included, with a mean age of 50.4 years (range 25-75 years). The mean tumor size was 22.9 ± 15.1 mm (range 10-55 mm). Thirteen tumors (81.3%) were located in the middle third of the stomach and 12 tumors (75%) grew with intraluminal pattern. Endoscopic submucosal excavation (ESE) was performed in 7 patients while endoscopic full-thickness resection (EFTR) was done in 9 patients. R0 resection was achieved in 14 patients (87.5%). The mean operative time was 91.6 ± 52.8 min (range 36-203 min) and the mean postoperative length of hospital stays was 8.3 ± 2.7 days (range 6-13 days). No adverse events were encountered except for fevers in 2 patients. No patients required surgical resection or intervention. During long-term follow-up of mean 21.8 months (range 6-62 months), no residue, recurrence, or metastasis was observed.

CONCLUSIONS

ER is effective and safe for patients with GS with favorable long-term outcomes.

Laparoscopic resection of gastric schwannoma: A case report

•

This is one of only 220 cases of reported cases of gastric Schwannoma.

•

This is one of the very few cases of these rare tumors that has been managed with a laparoscopic approach.

•

We present images of the preoperative evaluation (CT) and of the laparoscopic approach (intraoperative photos).

•

The patient has over a one-year follow-up and the patient is in perfect condition with no evidence of disease.

•

We accompany the case report with a thorough current review on this subject.

Introduction

Gastric schwannomas are an extremely rare presentation of mesenchymal tumors originating from Schwann cells, accounting for 0.2% of all gastric tumors. Patients are usually asymptomatic, so these tumors are frequently detected incidentally.

Presentation of case

68-year old male patient found to have a 5 cm mass in the lesser curvature of the stomach. After a careful preoperative evaluation, complete laparoscopic resection was performed. Pathology review confirmed a completely resected gastric Schwannoma. The patient’s recovery was uneventful. At a one-year follow-up he remains asymptomatic and with no evidence of disease.

Discussion

We present the uncommon case of a gastric schwannoma that was appropriately treated with a laparoscopic approach and present a current literature review focusing on diagnostic and treatment methods of these rare tumors.

Conclusion

Schwannomas should be included in the differential diagnosis of gastric tumors and can be appropriately treated with a laparoscopic approach.

Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review

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.

Gastric schwannoma-a rare benign mimic of gastrointestinal stromal tumor

Schwannomas most commonly manifest as acoustic neuromas in the vestibulo-cochlear nerve (CN VIII). These may occur unilaterally as primary tumors, or bilaterally secondary to neurofibromatosis type 2. More rarely, they present in extra-cranial sites, including the gastrointestinal tract. Gastrointestinal schwannomas are believed to arise from Auerbach’s plexus in the muscularis propria, and are classified as mesenchymal tumors. Here, we report a rare case of a 49-year-old woman who had surgical resection of a gastric mass which was eventually diagnosed as gastric schwannoma.

Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors

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.