Esophageal schwannoma: a case report

Kitada, Masahiro; Matsuda, Yoshinari; Hayashi, Satoshi; Ishibashi, Keiichiro; Oikawa, Kensuke; Miyokawa, Naoyuki

doi:10.1186/1477-7819-11-253

Cited by 38 publications

(47 citation statements)

References 10 publications

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“…A few cases of primary esophageal schwannomas have been reported [3, 4]. Gastrointestinal schwannomas account for 0.4 to 1.0 % of all submucosal tumors of the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

Resection of an esophageal schwannoma with thoracoscopic surgery: a case report

et al. 2016

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BackgroundEsophageal schwannomas are rare primary submucosal esophageal tumors. We herein report a case of an esophageal schwannoma that was difficult to diagnose.Case presentationA 39-year-old woman presented with chief complaints of difficulty swallowing and epigastric pain. Enhanced computed tomography of her chest revealed a tumor mass at the upper thoracic esophagus with internal heterogeneity. 18-Fluorodeoxyglucose positron emission tomography/computed tomography showed a hypermetabolic appearance matching the tumor mass; the accumulation had a maximum standardized uptake value of 5.5. We performed endoscopic ultrasound-guided fine-needle aspiration biopsy under general anesthesia, but the small specimens obtained prevented a definitive diagnosis. Thoracoscopic esophagectomy was performed due to the large size of the tumor, suspicion of its malignant potential, and the patient’s symptoms. Histopathological examination revealed spindle-shaped cells in a fasciculated and disarrayed architecture in the proper muscle layer. Immunohistochemical studies showed S100 protein positivity and the absence of CD34 and c-kit. We diagnosed the tumor as a benign schwannoma.ConclusionsWe herein report a relatively rare case of schwannoma of the esophagus that was diagnosed with difficulty.

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“…A few cases of primary esophageal schwannomas have been reported [3, 4]. Gastrointestinal schwannomas account for 0.4 to 1.0 % of all submucosal tumors of the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

Resection of an esophageal schwannoma with thoracoscopic surgery: a case report

et al. 2016

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“…The final diagnosis of benign esophageal schwannoma is based on histopathology and Otherwise, there are two tumors in the first case and there were no related reports in the previous studies. Chemotherapy and radiation therapy are ineffective, and the most common treatment is enucleation by surgery or endoscopy (1,9). In the cases we report here, we enucleated the tumor under thoracoscopy in the first patient and through right thoracotomy in the other two patients.…”

Section: Discussionmentioning

confidence: 99%

“…Benign schwannoma of the esophagus is rare, with leiomyomas accounting for 80% of cases (1). There have been only 28 reported cases in China in the literature.…”

Section: Discussionmentioning

confidence: 99%

A report of three cases of surgical removal of esophageal schwannomas

et al. 2016

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Esophageal schwannomas are rarely observed, and the most frequent presenting symptom is dysphagia. In such cases, esophageal endoscopy shows a mucosal protrusion with normal esophageal mucosa. Esophagography shows a protruding smooth mass in the middle thoracic esophagus. Both fluorodeoxyglucose (FDG) positron emission tomography (PET) and endoscopic ultrasonography-fine needle aspiration (EUS-FNA) are limited for diagnosing the case. Diagnosis of this condition before surgery is difficult. The most common and effective treatment is enucleation through surgery or endoscopy.Thoracoscopic surgery is gradually becoming used more often, and the prognosis is particularly good. In comparison, thoracoscopy surgery is less invasive, with a shorter length of hospital stay, and reduced pain at the surgical wound site. Extended lymph node dissection was not performed. The positive expression of S-100 on immunohistochemistry examination indicates the nature of the schwannoma. In the present cases, the postoperative course was uneventful, and no evidence of recurrence has been noted. a 30-degree left lateral recumbent position, used a single lumen endotracheal intubation and two-lung ventilation, and then provided the thoracic cavity with carbon dioxide positive pressure using an enclosed trocar to make the lungs collapse. For the incision, we chose the mid-axillary line the 4th and 7th intercostal space, and the lower edge of the subscapula and the 9th intercostal space scapula line, which can be adjusted according to the specific circumstances of the patient. Two small tumors were found adjacent to the mid-thoracic esophagus without lymph glands. The muscle of the esophagus was detached and the tumor was excised. Intraoperative endoscopy was used for careful examination of the mucosa. We closed the muscular layer after enucleation by hand-sewing. KeywordsThe two tumors were well-demarcated and had a globular appearance, measuring 30 mm × 20 mm × 17 mm and 30 mm × 18 mm × 15 mm. Histopathological findings revealed spindle-shaped cells in long fascicles ( Figure 1E). Immunohistochemical staining revealed the tumor was positive for S-100 protein ( Figure 1F), but negative for smooth muscle actin (SMA), Dog-1, CD117, musclespecific actin (MSA), cytokeratin (CK), anaplastic lymphoma kinase (ALK), c-Kit, and CD34, and had a low proliferation rate (Ki-67 index of less than 10%). The patient started oral feeding at post-operative day (pod) 1 and was discharged on pod 5. The patient remains free of recurrence 1 year after the operation, and esophagography findings are normal. Case 2A 42-year-old woman had been suffering from dysphagia for 2 months. Her medical and family histories were unremarkable. Esophageal endoscopy demonstrated a submucosal tumor without ulceration, extending 17-19 cm from the incisors (Figure 2A). Immunohistochemical staining revealed the tumor was positive for S-100 protein ( Figure 2B), vimentin, nestin, and CD68, but was negative for Dog-1, CD117, CK, desmin, ALK, c-Kit, and SMA. The blood vesse...

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“…Esophageal schwannomas are exceedingly rare with only a handful of cases reported in the literature [3]. A literature review performed for the past decade, 2005 -2015, revealed a total of 21 cases of which two cases were of concurrent esophageal schwannomas [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The surgical approaches to these include four thoracoscopic, six thoracotomy, five cervical approaches, and five esophagectomies or partial esophagectomies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Enucleation of Schwannoma Masquerading as a Leiomyoma

2017

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We present a case, literature review, and video of a transabdominal laparoscopic enucleation of an esophageal schwannoma. A 53-yearold female with dysphagia was found to have a 23 × 27 mm mass in the lower esophagus, which was initially diagnosed as a leiomyoma on endoscopic ultrasound without biopsy. At the time of her laparoscopic enucleation 12 months later, the lesion had grown to 60 × 55 × 30 mm and was excised with a full-thickness segment of the esophageal wall, with closure of the resulting defect over a bougie. Postoperatively, the patient's recovery was complicated by an esophageal leak which was successfully managed with endoscopic drainage. Esophageal schwannomas are rare esophageal lesions that have historically been treated with esophagectomy. Thoracoscopic or laparoscopic enucleations of smaller lesions have been more recently reported but larger lesions have usually required open surgery. Internally placed endoscopic drains have previously been shown to be a valid alternative to external drainage in patients with contained collections after resection surgery. They have the advantage of allowing patients to continue oral fluids during the recovery phase rather than relying on enteral or parenteral feeding. We propose that laparoscopic transabdominal enucleation of esophageal schwannoma with closure of the resulting full-thickness defect be considered as an organ and function sparing alternative for the management of large lower esophageal schwannomas. We further propose that contained leaks resulting from esophageal operations can successfully be managed with internal endoscopic drainage.

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Esophageal schwannoma: a case report

Cited by 38 publications

References 10 publications

Resection of an esophageal schwannoma with thoracoscopic surgery: a case report

Resection of an esophageal schwannoma with thoracoscopic surgery: a case report

A report of three cases of surgical removal of esophageal schwannomas

Laparoscopic Enucleation of Schwannoma Masquerading as a Leiomyoma

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