Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors

Hu, Baoguang; Feng-jie, WU; Zhu, Jun; Li, Xiaomei; Li, Yuming; Feng, Yanqiu; He-sheng, LI

doi:10.1155/2017/9615359

Cited by 24 publications

(45 citation statements)

References 57 publications

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“…Only about 0.4% to 1% of all gastrointestinal submucosal tumors are GS, and a majority of them are in the stomach [15]. For gastric schwannomas, the most common lesion location is the gastric body (59.3%), followed by the antrum (26.7%), fundus (12%), and cardia (2%) [19,29]. In the present study, gastric schwannomas accounted for 90.2% (46/51) of all GS.…”

Section: Discussionsupporting

confidence: 45%

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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: 45%

“…In our series, the mean age of GS patients was 55.7 ± 11.4 years, which is consistent with the literature. Due to the indolent growth pattern, the majority of GS cases are asymptomatic [ 19 , 20 ]. Some symptomatic patients may present with abdominal pain, gastrointestinal bleeding, or palpable mass [ 16 ].…”

Section: Discussionmentioning

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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“…Such procedures include endoscopic submucosal dissection, endoscopic full-thickness resection, and ligation-assisted endoscopic enucleation. 33,34 Lymph node dissection is not required because gastric schwannomas, which are usually benign, are unlikely to metastasize to the lymph nodes. Almost no metastasis is encountered in enlarged regional lymph nodes of patients with gastric schwannoma; instead, the lymph node enlargement is usually caused by inflammatory hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

Gastric schwannoma: a case report and literature review

Zhang

2020

J Int Med Res

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Background Gastric schwannoma is a rarely seen gastric tumor accounting for only 0.2% of all gastric tumors. It is difficult to distinguish a gastric schwannoma from other gastric tumors preoperatively. Case presentation: A 30-year-old man with no significant medical history or physical examination findings presented with a 1-month history of right upper abdominal discomfort. The preoperative diagnosis was a gastrointestinal stromal tumor, but the postoperative pathologic and immunohistochemical examinations confirmed a gastric schwannoma. The patient underwent laparoscopic wedge resection of the stomach without additional postoperative treatment, and his postoperative recovery was uneventful. No recurrence or metastasis was found at the 2-year follow-up examination. Conclusion Although gastric schwannomas are usually not malignant, they are difficult to distinguish from other malignant stromal tumors preoperatively. Surgical resection should be recommended when a schwannoma is malignant or considered to be at risk of becoming malignant.

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Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors

Cited by 24 publications

References 57 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

Gastric schwannoma: a case report and literature review

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