Gastric schwannoma—a rare benign mimic of gastrointestinal stromal tumor

Sunkara, Tagore; Then, Eric O.; Reddy, Madhavi; Gaduputi, Vinaya

doi:10.1093/omcr/omy002

Cited by 13 publications

(15 citation statements)

References 12 publications

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“…Most GS are discovered incidentally during routine health examination or on cross-sectional imaging. For gastric schwannomas, upper endoscopy is the most common method of discovery [3]. The results of this study also support the above findings; more than half of the patients were asymptomatic and diagnosed incidentally.…”

Section: Discussionsupporting

confidence: 87%

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Clinical Characteristics and Surgical Management of Gastrointestinal Schwannomas

Zheng

et al. 2020

BioMed Research International

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Objectives. Schwannomas are tumors arising from Schwan cells of the neural sheath. Gastrointestinal schwannomas (GS) are rare and easily confused with a heterogeneous group of neuroectodermal or mesenchymal neoplasms. The aim of the present study is to analyze the clinicopathological features, surgical management methods, and long-term prognoses of GS patients. Methods. Between August 2004 and July 2019, 51 patients with GS were treated at the Peking Union Medical College Hospital. The medical records were reviewed retrospectively. A database containing demographic characteristics, clinical symptoms, imaging tests, operation details, pathological results, and prognoses was constructed and analyzed. Results. GS accounted for 2.0% of all schwannomas. The cohort comprised 19 men (37.3%) and 32 women (62.7%). The mean age was 55.7±11.4 years. The most common symptom was abdominal pain (29.4%). Twenty-seven patients (52.9%) were asymptomatic and diagnosed incidentally. The most common tumor location of GS was the stomach (90.2%). S-100 had the highest positive rate (100%) in immunohistochemical staining. Forty-six patients (90.2%) were followed-up at a mean period of 49.5±41.4 months. Forty-four patients (95.7%) survived without tumor, 1 patient survived with tumor, and 1 patient died. The 5-year cumulative overall survival rate and cumulative disease-free survival rate were 97.5% and 95.2%, respectively. Conclusion. GS are rare gastrointestinal tumors with favorable prognoses after surgical resection. Stomach is the most common site. Definitive diagnosis is determined by postoperative pathology. S-100 expression has diagnostic significance.

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Section: Discussionsupporting

confidence: 87%

“…They are most commonly found in the central nervous system, spinal cord, and peripheral nerves in the extremities [ 2 ]. Gastrointestinal schwannomas (GS), which originate from Auerbach's nerve plexus in the muscularis propria, are extremely rare [ 3 , 4 ]. They were first described by Daimaru et al in 1988 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Surgical Management of Gastrointestinal Schwannomas

Zheng

et al. 2020

BioMed Research International

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“…The main differential diagnosis for an exophytic lesion arising in the wall of the GI tract is a GIST, as it is the most common mesenchymal tumor located in GI tract [ 7 , 31 , 32 ]. Voltaggio et al estimated that the ratio of gastric GIST to gastric schwannoma is approximately 45 to 1 [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal schwannomas: a rare but important differential diagnosis of mesenchymal tumors of gastrointestinal tract

Mekras¹,

Krenn

Perrakis

et al. 2018

BMC Surg

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BackgroundSchwannomas of gastrointestinal tract are rare, mostly benign and notably different neoplasms from conventional schwannomas that arise in soft tissue or the central nervous system. These tumors are of clinical importance since they should always be considered in the differential diagnosis of submucosal lesions of gastrointestinal tract.MethodsSeven patients with a pathologically proven gastrointestinal schwannoma were identified in our series of mesenchymal tumors and reviewed retrospectively. Clinicopathological and immunohistochemical parameters along with the follow-up results were analysed.ResultsThe series included two males and five females, with a mean age 69 years (range, 39–81). Most patients were asymptomatic on presentation, except for two patients with abdominal pain. In the other cases (n = 5), the tumor was an incidental finding during other medical, imaging or surgical procedures. The tumors were located in the stomach (n = 4) and in the small intestine (n = 3) with an average size of 29 mm (range, 12–70). A preoperative diagnosis was achieved only in one case with a CT-guided core biopsy. Otherwise the clinical, intraoperative, endoscopic or radiological findings were unspecific. Patients with gastric tumor underwent either laparoscopic (n = 2) or open (n = 2) gastric wedge resection of the tumor; in the cases of intestinal tumor (n = 3) a segmentectomy was performed. Pathological examination revealed solid homogenous tumors, which were highly cellular and composed of spindle cells with positive staining for S100 protein, and confirmed the diagnosis of schwannoma. All tumors were negative for c-Kit, smooth muscle actin, desmin and DOG-1 and showed very low proliferation index. There were negative resection margins and no malignant variants were recognized. At an average follow-up of 60 months (range, 24–185) all patients were free of disease with no signs of recurrence or metastases and acceptable gastrointestinal function.ConclusionsSchwannomas are rare, slow-growing and mostly asymptomatic gastrointestinal mesenchymal tumors. They are difficult to be diagnosed preoperatively as endoscopic and radiological findings are nonspecific but histological and immunohistochemical features are of paramount importance to differentiate between benign and malignant schwannomas, or other spindle cell sarcomas. The treatment of choice is complete surgical excision without a conclusive preoperative diagnosis, and the long-term outcome is excellent as these lesions are mostly benign.

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“…Most manifest as acoustic neuromas in the vestibule-cochlear nerve (CN VIII). It can be unilateral as a primary tumor or bilaterally associated with neurofibromatosis type 2 [2]. Extracranial Schwannomas, including gastrointestinal Schwannoma, are extremely rare [2].…”

Section: Introductionmentioning

confidence: 99%

“…It can be unilateral as a primary tumor or bilaterally associated with neurofibromatosis type 2 [2]. Extracranial Schwannomas, including gastrointestinal Schwannoma, are extremely rare [2]. Gastrointestinal Schwannomas arise from Auerbach’s nerve plexus in the muscularis propria.…”

Section: Introductionmentioning

confidence: 99%

Incidental Finding of Gastric Schwannoma in a Renal Failure Patient – Managed by a Minimally Invasive Procedure: Report of a Rare Case

et al. 2019

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Patient: Female, 69 Final Diagnosis: Gastric Schwannoma Symptoms: Asymptomatic Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Schwannomas are benign tumors originating from any nerve with a Schwann cell sheath. It is an extremely rare tumor, accounting for 0.2% of all gastrointestinal tumors and 4% of all benign tumors of the stomach. Clinical differentiation of gastrointestinal mesenchymal tumors is challenging and confirmatory diagnosis requires biopsy. Surgical resection is the treatment of choice when tumor size is less than 30 mm or when it is located within the muscularis propria. Here, we present a case of a large (>50 mm) gastric Schwannoma that was resected using a new laparoscopic technique suitable for larger tumors. Case Report: A 69-year-old woman with past medical history of hypertension, diabetes mellitus, and stroke, and CKD stage 4, presented to the Emergency Department (ED) with persistent nausea, vomiting, and weakness. She was found to have uremia requiring emergent hemodialysis. Eventually, she underwent peritoneal catheter insertion for peritoneal dialysis. A mass on the gastric antrum was found incidentally during the procedure. Biopsy confirmed the diagnosis of gastric Schwannoma. The tumor was removed successfully using a minimally invasive procedure via robotic-assisted laparoscopy. Conclusions: Gastric Schwannoma is a rare submucosal tumor arising from Auerbach’s plexus in the muscularis propria. It is usually asymptomatic, but can present with symptoms such as epigastric pain, or upper gastrointestinal bleeding. Tissue biopsy and immunohistochemical staining are the criterion standard for diagnosis. It has no tendency for malignant transformation. Tumors smaller than 30 mm are removed endoscopically, while tumors larger than 30 mm can be removed surgically. In this case, the tumor was removed successfully by minimally invasive robotic-assisted laparoscopy.

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Gastric schwannoma—a rare benign mimic of gastrointestinal stromal tumor

Cited by 13 publications

References 12 publications

Clinical Characteristics and Surgical Management of Gastrointestinal Schwannomas

Clinical Characteristics and Surgical Management of Gastrointestinal Schwannomas

Gastrointestinal schwannomas: a rare but important differential diagnosis of mesenchymal tumors of gastrointestinal tract

Incidental Finding of Gastric Schwannoma in a Renal Failure Patient – Managed by a Minimally Invasive Procedure: Report of a Rare Case

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