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

Abstract

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.

Clinicopathological study of gastric schwannoma and review of related literature

“…In comparison to GIST, GS shows distinct signs, and it appears to be a low-density mass with a clear boundary on EUS compared with the surrounding muscularis propria. It appears to be an uneven hypoechoic lesion, with most of it originating from the muscularis propria [ 11 ], whereas more than half of GISTs show enhanced or identical echo [ 8 ]. In our study, all masses had distinct borders.…”

Gastric schwannoma misdiagnosed as gastrointestinal stromal tumor by ultrasonography before surgery: A case report

“…It is a rare tumor of gastric stromal origin, accounting for 0.2% of all gastric tumors and 6.3% of all gastric stromal tumors. GS has a good prognosis and rarely relapses, but malignant lesions have been reported[ 3 , 5 , 6 ]. GIST is the most common gastric tumor, accounting for about 80% of all[ 7 ], followed by gastric leiomyoma, lymphoma, etc.…”

“…Preoperative differential diagnosis of GS and GIST is difficult, and the auxiliary examinations lack specificity. So far, only pathological and immunohistochemical results are reliable, and genetic tests can be performed when necessary[ 5 ].…”

“…According to literature reports, a small number of patients have symptoms, such as upper abdominal pain or discomfort, melena, hematemesis, anemia, weight loss, etc., which are mostly seen in female patients aged 50-60 years[ 5 , 6 , 10 ]. However, most GS patients have no obvious complaints of discomfort.…”

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

“…On the other hand, Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) may help diagnosis. However, there is no consensus on the accuracy rate; in addition, according to the guidelines of the National Comprehensive Cancer Network (NCCN), it is not recommended to use conventional EUS-FNA for initial resectable GIST [7] . On CT examination, gastric schwannomas show homogeneous attenuation and enhancement, which was consistent with our case.…”