An Individual with Gastric Schwannoma with Pathologically Malignant Potential Surviving Two Years after Laparoscopy-Assisted Partial Gastrectomy

Watanabe, Akira; Ojima, Hitoshi; Suzuki, Shigemasa; Mochida, Yasushi; Hirayama, Isao; Hosouchi, Yasuo; Nishida, Yasuji; Kashiwabara, Kenji; Ohno, Tetsuro; Mochiki, Erito; Kuwano, Hiroyuki

doi:10.1159/000331561

Cited by 16 publications

(16 citation statements)

References 9 publications

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“…Gastrointestinal schwannomas generally grow slowly and are associated with an excellent prognosis compared with GIST (8). The benefit of surgical resection for benign gastrointestinal tumors remains debatable (8)(9)(10). By contrast, GISTs are potentially malignant, and early surgical resection is recommended, regardless of the tumor size.…”

Section: Introductionmentioning

confidence: 99%

“…Unlike mucosal gastrointestinal tumors, including gastric carcinoma and colorectal carcinoma, gastrointestinal mesenchymal tumors are difficult to definitively diagnose with endoscopy prior to surgery (9). In patients with gastrointestinal mesenchymal tumors, endoscopy typically reveals undamaged mucosa and an insert image suggesting extrinsic compression of the gastrointestinal lumen.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with gastrointestinal mesenchymal tumors, endoscopy typically reveals undamaged mucosa and an insert image suggesting extrinsic compression of the gastrointestinal lumen. However, all mesenchymal tumors have similar endoscopic image characteristics (9). In addition, a biopsy guided by endoscopy may be insufficient to collect the amount of tissue required to inform a correct diagnosis (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Zhang²,

Peng

et al. 2017

Oncology Letters

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Abstract. The aim of the present study was to identify computed tomography (CT) features to assist in differentiating gastrointestinal schwannomas from gastrointestinal stromal tumors (GISTs). CT images of gastrointestinal schwannomas (n=15) and GISTs (n=50) were analyzed. The absolute CT values of tumor/aorta during plain scan/arterial phase/venous phase were recorded as tumor plain scan (Tp)/aorta plain scan (Ap), tumor arterial phase (Ta)/aorta arterial phase (Aa) and tumor venous phase (Tv)/aorta venous phase (Av), respectively, and normalized CT values of the three phases were calculated as Sp=Tp/Ap, Sa=Ta/Aa and Sv=Tv/Av, respectively. The difference in tumor CT value between arterial and venous phases was calculated and recorded as Tv-a. CT data including tumor size, contour, margin, growth pattern, presence of calcification, cystic change, hemorrhage, ulceration, perilesional lymph nodes (PLNs), local invasion to surrounding structures, metastasis, ascites, vasculatures, enhancement pattern/degree, Tp/Ta/Tv and Sp/Sa/Sv were evaluated for each patient. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the CT data to differentiate gastrointestinal schwannomas from GISTs. Compared with GISTs, gastrointestinal schwannomas more frequently demonstrated round contouring, relatively smaller tumor size, a homogeneous enhancement pattern, with the presence of PLNs and a higher level of vasculature (P<0.05), whilst the presence of cystic changes were more common in GISTs compared with gastrointestinal schwannomas (P<0.05). The Sa, Ta and Tv-a of gastrointestinal schwannomas were less compared with those of GISTs (P<0.05). The difference in margin, growth pattern, intra-tumoral calcifications and hemorrhage were insignificant (P>0.05). ROC analysis indicated that tumor size, cystic change, the presence of PLNs, tumor enhancement pattern and Sa demonstrated improved diagnostic potential compared with others [area under the curve (AUC) >0.7], amongst which cystic change demonstrated the best diagnostic ability (AUC=0.82). Size exhibited the highest sensitivity, 90%, and cystic change, Sa exhibited the best specificity, 87%. Quantitative analysis indicated that certain features aided the differentiation between gastrointestinal schwannomas and GISTs using CT imaging. IntroductionSchwannoma are benign tumors arising from Schwann cells in the sheaths of peripheral nerves. Schwannoma are homogeneous tumors and may occur in any tissue of the body. The head and neck region is the most prevalent location for schwannoma to occur; they are rarely observed in the gastrointestinal tract (1). Conventional schwannoma usually arise from peripheral skin nerves and connective tissue, whereas gastrointestinal schwannoma tumors are derived from Schwann cells of the Auerbach's plexus within the gastrointestinal tract wall (1-3) and were first reported by Daimaru et al in 1988 (1)

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Zhang²,

Peng

et al. 2017

Oncology Letters

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“…Schwannomas usually exhibit positive reactivity for S-100, vimentin and glial fibrillary acidic protein, and no reactivity for CD117, CD34, actin or cytokeratins, which appear more typically in GISTs, gastrointestinal autonomic tumors or muscle tumors (15,16). Following diagnosis, treatment options include polypectomy or segmental colectomy with free margins due to the low risk of malignancy (17,18). The benign nature of the tumor is responsible for the good prognosis of patients with schwannoma; recurrence and metastasis are considered rare events.…”

Section: Discussionmentioning

confidence: 99%

Schwannoma of the colon: A case report and review of the literature

et al. 2016

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Abstract. Colonic schwannomas are rare gastrointestinal mesenchymal tumors, and only a limited number of cases has been reported. The occurrence of these tumors is less common in the large intestine than in the stomach. The present study reports a case of colonic schwannoma in a 62-year-old female patient with no specific symptoms. The patient was diagnosed with a mass in the ascending colon by colonoscopy and abdominal computed tomography scanning. A right hemicolectomy was performed. The postoperative pathological diagnosis was ascending schwannoma. This case is noteworthy as colonic schwannomas are rare and are typically treated as colon cancer. No recurrence of the lesion was observed after 24 months of follow-up.

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“…8 Indicators of malignant potential on histologic diagnosis include nuclear atypia, abnormal mitosis, and invasion. 9 The microcystic/reticular variant of schwannoma is extremely rare and tends to localize in the gastrointestinal tract. It needs to be recognized, as both malignant and nonmalignant entities enter the differential diagnosis.…”

Section: Commentmentioning

confidence: 99%

Microcystic/Reticular Schwannoma of the Proximal Sigmoid Colon: Case Report With Review of Literature

Trivedi

Ligato

2013

Archives of Pathology &Amp; Laboratory Medicine

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We report a case of microcystic/reticular schwannoma of the proximal sigmoid colon in a 61-year-old man. A 12-mm polyp was detected while the patient was undergoing screening for colorectal neoplasm. This rare variant of schwannoma was initially described in 2008 and shows a predilection for the visceral organs, predominantly the gastrointestinal tract. We also review 11 other reported cases of microcystic/reticular schwannomas in the gastrointestinal tract. Unlike conventional gastrointestinal schwannomas, which are more common in the stomach, this variant appears to be more common in the large intestine. Histologic examination of this polyp showed predominant lipoblast-like vacuolated cells within a myxoid stroma with focal spindle cell areas. Features suggestive of malignancy, like nuclear pleomorphism, mitosis, or necrosis, were absent. Immunohistochemistry for S100 protein showed strong nuclear and cytoplasmic positivity, whereas cytokeratin and CD117 stains were negative. It is important to entertain microcystic/reticular schwannoma in the differential diagnosis of a signet ring cell adenocarcinoma or a myxoid gastrointestinal stromal tumor, particularly on small biopsy specimens.

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An Individual with Gastric Schwannoma with Pathologically Malignant Potential Surviving Two Years after Laparoscopy-Assisted Partial Gastrectomy

Cited by 16 publications

References 9 publications

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Schwannoma of the colon: A case report and review of the literature

Microcystic/Reticular Schwannoma of the Proximal Sigmoid Colon: Case Report With Review of Literature

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