A case report of benign esophageal schwannoma with FDG uptake on PET-CT and literature review of 42 cases in Japan

Sato, Shinsuke; Takagi, Masakazu; Watanabe, Masaya; Nagai, Eishi; Kyoden, Yusuke; Ohata, Ko; Oba, Noriyuki; Fukuchi, Kazuki; Iseki, Jouji

doi:10.1007/s10388-012-0311-2

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…The most common among them are leiomyomas, with esophageal schwannomas accounting for 2%-3.4% of all esophageal SMTs[ 5 , 13 ]. Enucleation is considered as the treatment of choice for benign tumors that are symptomatic or rapidly increasing in size[ 1 ]. Video-assisted thoracoscopic surgery including thoracoscopic enucleation is described as a minimally invasive surgical procedure for esophageal SMT[ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the possibility of thoracoscopic enucleation may be limited by the tumor location and size. Sato et al reported that cases with tumor size of 50 mm or more, and tumor location at the upper esophagus, usually required thoracotomy[ 1 ]. Watanabe et al[ 6 ] reported the need to convert from thoracoscopic enucleation to thoracoscopic subtotal esophagectomy owing to the location of an esophageal schwannoma at the upper thoracic esophagus, and its size being in excess of 50 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal schwannoma is a relatively rare benign esophageal submucosal tumor (SMT). Enucleation is the treatment of choice, and minimally invasive surgery using thoracoscopy has been the usual approach[ 1 - 4 ]. The left thoracic approach, although considered better for tumors involving the left esophageal wall, is limited by the presence of the aortic arch and the trachea.…”

Section: Introductionmentioning

confidence: 99%

“…The left thoracic approach, although considered better for tumors involving the left esophageal wall, is limited by the presence of the aortic arch and the trachea. In addition, the choice between thoracoscopy or thoracotomy is made depending on the size and/or location of the tumor[ 1 , 5 , 6 ]. Submucosal endoscopic tumor resection (SET) for esophageal SMT, was recently reported by Inoue et al[ 7 ], using the technique of submucosal tunnel described for per-oral endoscopic myotomy (POEM) for esophageal achalasia[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Combined thoracoscopic and endoscopic surgery for a large esophageal schwannoma

Onodera

Nakano

Takeyama

et al. 2017

WJG

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A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined thoracoscopic and endoscopic surgery for a large esophageal schwannoma

Onodera

Nakano

Takeyama

et al. 2017

WJG

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“…CT and esophagography just provide the location of the lesion. Fluorodeoxyglucose (FDG) positron emission tomography (PET) is useless for assessing whether these lesions are benign or malignant because the FDG accumulation level in malignant schwannomas has not been clarified (5,6). EUS-FNA might be able to provide a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

A report of three cases of surgical removal of esophageal schwannomas

et al. 2016

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Esophageal schwannomas are rarely observed, and the most frequent presenting symptom is dysphagia. In such cases, esophageal endoscopy shows a mucosal protrusion with normal esophageal mucosa. Esophagography shows a protruding smooth mass in the middle thoracic esophagus. Both fluorodeoxyglucose (FDG) positron emission tomography (PET) and endoscopic ultrasonography-fine needle aspiration (EUS-FNA) are limited for diagnosing the case. Diagnosis of this condition before surgery is difficult. The most common and effective treatment is enucleation through surgery or endoscopy.Thoracoscopic surgery is gradually becoming used more often, and the prognosis is particularly good. In comparison, thoracoscopy surgery is less invasive, with a shorter length of hospital stay, and reduced pain at the surgical wound site. Extended lymph node dissection was not performed. The positive expression of S-100 on immunohistochemistry examination indicates the nature of the schwannoma. In the present cases, the postoperative course was uneventful, and no evidence of recurrence has been noted. a 30-degree left lateral recumbent position, used a single lumen endotracheal intubation and two-lung ventilation, and then provided the thoracic cavity with carbon dioxide positive pressure using an enclosed trocar to make the lungs collapse. For the incision, we chose the mid-axillary line the 4th and 7th intercostal space, and the lower edge of the subscapula and the 9th intercostal space scapula line, which can be adjusted according to the specific circumstances of the patient. Two small tumors were found adjacent to the mid-thoracic esophagus without lymph glands. The muscle of the esophagus was detached and the tumor was excised. Intraoperative endoscopy was used for careful examination of the mucosa. We closed the muscular layer after enucleation by hand-sewing. KeywordsThe two tumors were well-demarcated and had a globular appearance, measuring 30 mm × 20 mm × 17 mm and 30 mm × 18 mm × 15 mm. Histopathological findings revealed spindle-shaped cells in long fascicles ( Figure 1E). Immunohistochemical staining revealed the tumor was positive for S-100 protein ( Figure 1F), but negative for smooth muscle actin (SMA), Dog-1, CD117, musclespecific actin (MSA), cytokeratin (CK), anaplastic lymphoma kinase (ALK), c-Kit, and CD34, and had a low proliferation rate (Ki-67 index of less than 10%). The patient started oral feeding at post-operative day (pod) 1 and was discharged on pod 5. The patient remains free of recurrence 1 year after the operation, and esophagography findings are normal. Case 2A 42-year-old woman had been suffering from dysphagia for 2 months. Her medical and family histories were unremarkable. Esophageal endoscopy demonstrated a submucosal tumor without ulceration, extending 17-19 cm from the incisors (Figure 2A). Immunohistochemical staining revealed the tumor was positive for S-100 protein ( Figure 2B), vimentin, nestin, and CD68, but was negative for Dog-1, CD117, CK, desmin, ALK, c-Kit, and SMA. The blood vesse...

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