Gastric schwannomas revisited: has precise preoperative diagnosis become feasible?

Abstract

Background Gastric schwannomas are not common but are clinically important in terms of differential diagnosis from other submucosal lesions. The precise preoperative diagnosis, however, has been challenging mainly owing to the lack of specific findings in conventional imaging studies. The aim of this study was to revisit the possibilities and limitations of modern preoperative diagnostic modalities for gastric schwannomas. Methods Fourteen consecutive patients with a final pathological diagnosis of gastric schwannoma were retrospectively analyzed. Data included demographics, preoperative imaging studies/diagnosis, surgery, histopathology, and follow-up results.Results The series included 6 males and 8 females, with a median age of 49 years (range 26-68 years). No symptoms were presented, except for 1 patient with epigastric pain. The tumors were located in the upper (n = 5), middle (3), and lower stomach (6), with a median size of 41 mm (range 20-75 mm). Twelve schwannomas (86 %) showed homogeneous enhancement on computed tomography. Ulceration was seen on endoscopy in 4 of 12 available cases (33 %). Positron emission tomography was performed in the last 4 patients, showing fluorodeoxy-glucose uptake in all cases (100 %). A preoperative diagnosis of schwannoma was not obtained in the majority of cases (13/14, 93 %); only 1 case was correctly diagnosed, by endoscopic aspiration cytology. Laparoscopic partial gastrectomy was attempted and completed in 13 cases. The patients have been followed up for 4.7 years (range 2.1-20.3 years), with no recurrencesor metastases and acceptable gastrointestinal function. Conclusions The precise preoperative diagnosis of gastric schwannomas remains difficult even with modern imaging studies. Surgery, therefore, should be positively considered for patients without a conclusive preoperative diagnosis.

Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma

“…[6] However, patients with gastric schwannoma may present with gastrointestinal hemorrhage, epigastric discomfort, and even gastroduodenal intussusceptions. [7,8] Two-thirds of our patients were symptomatic, similar to one previous study.…”

Endosonographic Features of Gastric Schwannoma: A Single Center Experience

“…Schwannomas in the gastrointestinal tract are rare (approximately 3% of all gastrointestinal mesenchymal tumors), and typically occur in the stomach [3,4]. Gastric schwannomas arise from the sheath of Auerbach’s plexus or, less frequently, from Meissner’s plexus [5]. Schwannomas are generally benign, usually asymptomatic, slow-growing mesenchymal tumors with a very low malignant potential, and they have an excellent prognosis after surgical resection [3].…”

Ileal schwannoma causing intussusception in an adult

“…These tumours rarely occur in the gastrointestinal tract. Of those that do, they tend to occur in the stomach 12. Ileal schwannoma is a very rare occurrence, with very few cases reported in the literature 1 3.…”