Schwannomas occurring in the gastrointestinal tract are rare, and among them, schwannomas of the large intestine are extremely rare. In this paper, we report a case of a macroscopically atypical schwannoma of the transverse colon. The case is a female aged 67. Stool occult blood test was positive, and colonoscopy revealed a protruded lesion resembling a type 1 carcinoma measuring 4 cm with a reddish and uneven surface on the transverse colon. The surface was smooth and lobulated in observation with indigo carmine spray, and granulation tissue was revealed by biopsies. CT of the abdomen showed an irregular mass, and clinical examinations could not rule out malignancy. Therefore, partial transverse colectomy with peripheral lymph node dissection was performed. Histologically, proliferation of spindle cells was observed originating from the muscularis propria, and most of the upper part of the lesion was replaced by granulation tissue. In immunohistochemical staining, S-100 protein and NSE were positive while KIT, CD34, desmin and smooth muscle actin were negative, and the tumor was therefore diagnosed to be a schwannoma. In addition, since the MIB-1 labeling index was low and virtually no mitosis was observed, it was diagnosed as benign tumor.

The complication rates for the bipolar snare appear to be comparable with those for the monopolar snare based on comparison of the results reported in the literature. Age (<60 years), lesion size (≥ 10 mm), macroscopic type (pedunculated), and lesion location (rectum) are independent risk factors for bleeding.

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Utility and safety of EMR for colorectal lesions and lesion-lifted condition as an indicator of the tumor invasion were investigated. We investigated 672 cases and 708 lesions treated between 1993 and 2006. We classified the lesion-lifted condition at the time of submucosal fluid injection, using four categories: "completely lifted/soft", "completely lifted/hard", "incompletely lifted", and "non-lifting". The pit patterns and lifted conditions were related to tumor pathology and the extent of tumor invasion, and often corresponded to particular macroscopic types of tumors. Early colorectal cancer was treated in 231 cases by EMR alone, while 29 cases received additional colectomy after EMR because of an unfavorable pathology. Complications after EMR included bleeding in 19 cases (2.8%) and abdominal pain in 3 (0.4%). There were no cases of perforation. Recurrence occurred in 5 cases (2.2%) (4 cases were cured by re-EMR; one case required surgical resection) out of 231 cancer cases. The classification of the lesions according to their lifted condition and pit pattern was useful to determine whether EMR was indicated. Furthermore, EMR is very safe methods because of the scarcity of complications, and they provide a success rate of about 98% for the treatment of early colorectal cancer.

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