Upper gastrointestinal bleeding due to a malignant Schwannoma of the stomach

Loffeld, R.J.L.F.; Balk, T. G.; Oomen, J. L. T.; Putten, A.B.M.M. van der

doi:10.1097/00042737-199802000-00012

Cited by 23 publications

(19 citation statements)

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“…The biological behaviors, appropriate treatments and prognoses vary between GIST and gastrointestinal schwannomas. 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).…”

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%

“…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%

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Zhang²,

Peng

et al. 2017

Oncology Letters

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“…Gastric schwannoma contributes to 0.2 % of all gastric tumors overall, 6.3 % of gastric mesenchymal tumours and 4 % of all benign tumors of the stomach [3]. Malignant schwannoma are very rare, as only 8 cases have been reported in the literature till date [4,5]. These are encapsulated tumors that grow slowly.…”

Section: Discussionmentioning

confidence: 99%

Gastric Schwannoma: A Case Report and Review of Literature

Sreevathsa

Pipara

2015

Indian J Surg Oncol

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Schwannomas are usually benign, slow growing tumors, that originate from any nerve that has a Schwann cell sheath. Here, we report the case of a 40 year-old female patient with an incidentally noted submucosal gastric tumor while being evaluated for cervical lymphadenopathy as a part of workup for lymphoma. She underwent sleeve resection of the stomach under suspicion of a gastrointestinal stromal tumor, but postoperative histopathological and immunohistochemical findings confirmed the diagnosis of shwannoma. Although schwannomas are mostly benign, they are often indistinguishable preoperatively from malignant tumors such as gastrointestinal stromal tumors. Therefore, resection is the treatment of choice for all such tumors.Keywords Gastric schwannoma . GIST . Immunohistochemistry . Sleeve resection Case ReportA 48 year old lady with cervical lymphadenopathy was subjected to ultrasound of the abdomen for ruling out splenomegaly as a part of work up for lymphoma. Ultrasound of the abdomen (Fig. 1) revealed a well defined lobulated hypoechoic mass lesion in the epigastric region located between the left lobe of liver and gastric wall. It was 4.2 × 4.1 cm in size. Computed tomography scan showed well defined uniformly enhancing gastric fundal wall mass, (Fig. 2) most likely to be GIST (gastrointestinal stromal tumour) with celiac axis and periportal nodal enlargement. The mass was partly exophytic and partly projecting into the lumen causing smooth indentation. The patient then underwent upper GI endoscopy which showed a sub mucosal bulge on the anterior wall of the fundus of the stomach. An endosonography was done using a linear scope which showed a large submucosal mixed echoic mass with few areas of necrosis in body of stomach mainly on greater curvature measurng 5 × 4 cm arising from muscularis propria. Two celiac nodes, hypoechoic round with uniform echotexture were also seen. FDG pet scan showed metabolically active tumor mostly representing GIST (Gastrointestinal stromal tumour) from body of the stomach (Fig. 3).A provisional diagnosis of submucosal mass, which could be most likely GIST, was made and fine needle aspiration cytology was done from both the lesion and the nodes with endosonoguidance. The FNA from gastric submucosal lesion showed features suggestive of spindle cell tumor while the celiac nodes showed reactive hyperplasia. A preoperative diagnosis of GIST arising from anterior wall of proximal stomach was made. The patient was subjected to laparoscopic examination which revealed an exophytic solid tumor measuring 6 × 7 cm arising from the anterior wall of the junction of body and fundus. The medial margin was at the lesser curvature and lateral margin was just short of greater curvature. In order to get a good tumor negative margin laparoscopy was converted to minilaparotomy and sleeve resection of the tumor was done using linear staplers. Histopathology revealed a submucosal tumor with features suggestive of spindle cell tumor (Fig. 4). IHC done showed positivity

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“…In our review of the literatures on MPNST from 1964 to the present, only 13 cases were reported [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The summary of these reports are listed in Table 1.…”

Section: Discussionmentioning

confidence: 99%