Gastric schwannomas: radiological features with endoscopic and pathological correlation

Hong, Hye Suk; Ha, Hyun Kwon; Won, Hyung Jin; Byun, Jieun; Shin, Young-Lim; Kim, A.Y.; Kim, P.N.; Lee, M.-G.; Lee, G.H.; Kim, M.J.

doi:10.1016/j.crad.2007.05.026

Cited by 64 publications

(70 citation statements)

References 16 publications

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“…With the positive adoption of these modern sampling techniques, the preoperative differential diagnosis of gastric SMTs could be improved. On CT examination, gastric schwannoma displayed homogeneous enhancement in most cases and cystic change was uncommon [2]. Recently, FDG uptake on PET has been reported for schwannomas that originated from the extremities [10], retroperitoneum [11], esophagus [12], colon [13], and appendix [14].…”

Section: Discussionmentioning

confidence: 99%

“…Schwannomas of the gastrointestinal tract have rarely been reported and have occurred predominantly in the stomach [2]. It is reported that gastric schwannomas represent 0.2 % of all gastric tumors [3].…”

Section: Discussionmentioning

confidence: 99%

“…As diagnostic modalities for gastric schwannomas, endoscopy, CT, and, recently, PET have been proposed. On endoscopy, gastric schwannomas appeared as elevated submucosal masses, and a central ulcer was seen in 25-50 % [2]. Endoscopic biopsies, when performed, can lead to false-negative results because of normal mucosa overlying a submucosal lesion [7]; therefore, endoscopic biopsy has been reported to be not as effective as expected in the diagnosis of gastric schwannomas [6].…”

Section: Discussionmentioning

confidence: 99%

“…Schwannomas rarely occur in the digestive tract, but when they do the most common site is the stomach, and they represent 0.2 % of all gastric tumors [2,3]. There are several case reports of gastric schwannomas; however, each involved only a small number of patients.…”

Section: Introductionmentioning

confidence: 99%

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Gastric schwannomas revisited: has precise preoperative diagnosis become feasible?

et al. 2012

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gastric schwannomas revisited: has precise preoperative diagnosis become feasible?

et al. 2012

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“…By contrast, gastrointestinal stromal tumors (GISTs), another type of mesenchymal tumor, are the most common type of submucosal tumor in the alimentary tract. GISTs and gastrointestinal schwannomas are typically observed in 40-60 year old patients (4,5) Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography and demonstrate similar computed tomography (CT) imaging characteristics and clinical symptoms (6,7). The biological behaviors, appropriate treatments and prognoses vary between GIST and gastrointestinal schwannomas.…”

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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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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Cytologic findings of gastric schwannoma: A case report

Rodrı́guez

Tellschow

Steinberg

et al. 2012

Diagnostic Cytopathology

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Spindle cell lesions of the stomach are rare. They usually affect the submucosa or muscularis propria and therefore can be sampled by endoscopic fine needle aspiration. The most common tumor in this category is gastrointestinal stromal tumor (GIST), followed by leiomyoma and gastric schwannoma. Gastric schwannoma is a benign tumor of neuroectodermal origin that has overlapping morphologic/cytologic features with GIST and leiomyoma. Gastric schwannomas differ from peripheral schwannomas by lacking a capsule, Verocay bodies, Antoni B areas, and thick-walled vessels. They are characterized morphologically by poorly defined borders, cuffs of lymphoid tissue and a haphazard spindle cell proliferation. We present here the cytologic and histopathologic features of a gastric schwannoma. The tumor was composed of spindle cells with delicate eosinophilic cytoplasm and wavy nuclei, with an associated conspicuous lymphoid backdrop. The latter feature raised the possibility of a lymphoid lesion, a problem cytopathologists should be aware of.

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Gastric schwannomas: radiological features with endoscopic and pathological correlation

Cited by 64 publications

References 16 publications

Gastric schwannomas revisited: has precise preoperative diagnosis become feasible?

Gastric schwannomas revisited: has precise preoperative diagnosis become feasible?

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Cytologic findings of gastric schwannoma: A case report

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