Clinicopathological study of gastric schwannoma and review of related literature

Abstract

Background This study aimed to investigate the clinical features, diagnostic criteria, treatment options, and prognosis of patients with gastric schwannoma (GS). Methods We collected the clinical data of all patients pathologically diagnosed with GS in Zhejiang Provincial People's Hospital from May 2012 to October 2021. Results A total of 26 cases of GS were analyzed clinicopathologically, where the sizes of the tumor were found to be in the range of 1–6 cm (mean: 3.16 cm, median: 3.05 cm). A computed tomography (CT) scan analysis revealed that most masses were either moderately progressive or uniformly enhanced. According to ultrasound gastroscopy results, most of them were hypoechoic masses. There were 23 cases of surgery and three cases of endoscopic submucosal tumor dissection. Immunohistochemistry demonstrated that S100 was positive in 26 patients, immunomarker SOX10 was positive in five, whereas CD34, CD117, and SMA were negative in most patients. CK (Pan), Dog-1, and Desmin were also found negative. All 26 cases were followed up after the conclusion of the study where no evidence of recurrence or metastasis was observed. Conclusions GS is a unique form of peripheral schwannoma. The diagnosis of this type of tumor depends on the pathology and immunohistochemistry of the individual. The key to treating this type of tumor is endoscopy and surgery. Follow up and related literature review showed that GS was a benign tumor with little possibility of malignant transformation.

Clinicopathological characteristics of gastrointestinal schwannomas: A retrospective analysis of 78 cases

“…However, CD117 (usually positive in GIST) and SMA (usually positive in leiomyoma) were positive in 6.4% (5/78) and 17.9% (14/78) of the patients, respectively, suggesting that a single IHC parameter could not differentiate GISs from GIST and leiomyoma, and a combination of several parameters is necessary. Other studies also reported a positive expression of CD117 and SMA in GISs (20,22). No patient in the present study had c-KIT or PDGFRA mutation; therefore, we do not know the mutation status of c-KIT or PDGFRA in GISs.…”

“…In the present study, the positive expression rate of S100 was 100%, and Dog-1 staining was negative in all the cases. We found that the expression of SOX-10 and Vimentin was positive in 97.2% (35/36) and 100% (32/32), respectively, which was rarely reported (22,(28)(29)(30), suggesting that these two markers may serve as important indicators for diagnosis of GISs (31). The Ki-67 index may help predict the malignancy of GISs; usually, Ki-67 > 10% is considered to be malignant (3).…”

“…Gastrointestinal endoscopy, EUS, and CT were useful for the detection of GISs and differentiating GISs from other gastrointestinal SMTs. Usually, the covering mucosa of GISs are smooth and intact; erosion or even ulceration was reported in few patients (0%–26.92%) ( 3 , 4 , 7 , 8 , 16 , 22 , 27 ). In the present study, 2.6% (2/78) had ulceration, while the other 76 had intact covering mucosa.…”

“…EUS characteristics such as tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion were also useful to differentiate GISs from GISTs ( 7 ). GISs are more likely to present as low echo on EUS (87.7%–100%), originating from the muscularis propria layer (85.7%–100%) ( 7 , 8 , 16 , 17 , 21 , 22 ). In the present study, 38 cases received preoperative EUS, and 36 (94.7%) of the GISs were presented as low-echo lesions; 93.7% (74/79) of the GISs originated from the muscularis propria layer, which is consistent with the literature.…”

Two giant connected retroperitoneal schwannomas: a rare case report

“…Schwannomas that occur in the stomach are generally benign tumors. 14 Although there are individual case reports of concurrent gastric adenocarcinoma and gastric schwannoma, this event is rare, 15 , 16 and the extremely low incidence does not support a relationship between these tumors.…”