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1
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Zhang YJ, Yuan MX, Wen W, Jian Y, Zhang CM, Yuan J, He L. Endoscopic full-thickness resection of rectal schwannoma: A case report. World J Gastrointest Endosc 2025; 17:102075. [PMID: 39989859 PMCID: PMC11843040 DOI: 10.4253/wjge.v17.i2.102075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/06/2024] [Accepted: 01/18/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Rectal schwannoma (RS) is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity. The absence of typical symptoms, specific signs, and distinctive radiographic findings often hinders clinicians from reaching a definitive diagnosis before surgical intervention. Herein, we report a case of RS who underwent complete resection through endoscopic full-thickness resection (EFTR) and discuss the clinical, imaging, and pathological features for differential diagnosis. CASE SUMMARY A 71-year-old Chinese woman presented to our outpatient clinic with a 4-year history of a rectal mucosal mass for a follow-up surveillance colonoscopy. A neurogenic tumor with extraluminal growth was considered based on the imaging findings. Resection was required, and an EFTR was performed. On endoscopic exploration, a smooth surface extruding mass was identified at the rectum. The patient was discharged 48 hours after the operation without infection or bleeding. Based on the pathological and immunohistochemical findings of the resected mass, a rectal benign schwannoma was diagnosed. The patient did not undergo any adjuvant therapy. Nearly one year later, a follow-up surveillance colonoscopy and an abdominal and pelvic plain plus enhancement scan were performed, and no tumor recurrence or metastasis was noted. CONCLUSION EFTR is safe and effective for resecting gastrointestinal stromal tumors, especially those with extraluminal growth and no lymph node involvement.
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Affiliation(s)
- Ying-Jie Zhang
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Meng-Xia Yuan
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Wu Wen
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Yi Jian
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Chuan-Ming Zhang
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Jing Yuan
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Lin He
- Department of Pathology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
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2
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Zainaldeen BA, Alaus AS, AlKooheji M, Alkhuzaie J, Alshaikh S. Schwannoma of the Sigmoid Colon: A Rare Case. Cureus 2024; 16:e53140. [PMID: 38420095 PMCID: PMC10901039 DOI: 10.7759/cureus.53140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Schwannoma is a type of peripheral nerve sheath tumor that is often found in the head and neck. Schwannomas in the digestive system, particularly the colon and rectum, are exceptionally rare, and they are mostly non-malignant and asymptomatic although sometimes patients can present with symptoms similar to those observed in patients with other gastrointestinal tumors like abdominal pain, fullness, nausea, vomiting, and change in bowel habits. For diagnosis and treatment, surgical resection along with biopsy is the gold standard. In this paper, we describe a rare case of sigmoid schwannoma that was successfully treated in our department by surgical resection.
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Affiliation(s)
| | - Amr S Alaus
- Department of Surgery, Salmaniya Medical Complex, Manama, BHR
| | | | | | - Safa Alshaikh
- Department of Pathology, Salmaniya Medical Complex, Manama, BHR
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3
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Gazivoda V, Wang D, Siddique M, Zeng J, Robert ME, Pantel H, Mongiu A. Rare cases of colonic schwannomas. J Surg Case Rep 2023; 2023:rjac438. [PMID: 38163055 PMCID: PMC10757069 DOI: 10.1093/jscr/rjac438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/03/2022] [Indexed: 01/03/2024] Open
Abstract
Schwannomas of the gastrointestinal tract are rare spindle cell tumors that account for 2-6% of mesenchymal tumors. An elderly male was found to have a left colon mass on CT scan and colonoscopy with pathology of fibrotic tissue. A laparoscopic-assisted left hemi-colectomy with primary anastomosis was performed. Pathology demonstrated spindle cell neoplasm arranged in short fascicles that were strongly and diffusely positive for S100. An elderly female was found to have a submucosal lesion on surveillance colonoscopy in the proximal transverse colon. Biopsy with jumbo forceps revealed spindle cell neoplasm positive for S100. Patient underwent an uncomplicated limited non-oncologic segmental transverse colectomy. We report only the ninth case of left and sixth in the transverse colon described in the literature. As is true for other mesenchymal tumors, mucosal biopsy is usually inconclusive and deep biopsy or submucosal resection is required, making pre-operative surgical decision difficult.
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Affiliation(s)
| | - Donghai Wang
- Yale University School of Medicine, New Haven, CT, United States
| | | | | | - Marie E Robert
- Yale University School of Medicine, New Haven, CT, United States
| | - Haddon Pantel
- Yale University School of Medicine, New Haven, CT, United States
| | - Anne Mongiu
- Yale University School of Medicine, New Haven, CT, United States
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4
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Selntigia A, Neri B, Russo C, Martire FG, Soreca G, Biasutto D, Matteo FMD, Exacoustos C. A Rare Sigmoid-Colon Schwannoma in a Premenopausal Woman: A Case Report. Acta Med Litu 2023; 30:188-193. [PMID: 38516511 PMCID: PMC10952420 DOI: 10.15388/amed.2023.30.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 03/23/2024] Open
Abstract
Background Schwannomas of the gastrointestinal tract are a rare type of spindle cell tumor of peripheral nerve. Commonly, schwannomas are discovered incidentally, as they are usually asymptomatic. Case 46-year-old female patient, suffering from secondary amenorrhea and nonspecific intermittent pelvic pain associated with constipation. During gynecological visit an ultrasonographic systematic transvaginal examination was performed. At the sigmoid-rectal level an intraluminal solid mass was described and an urgent colonoscopy was prescribed. Endoscopic submucosal dissection was performed with en-bloc resection. On immunohistochemical analysis, S100 was strongly positive in tumor cells. Finally, a benign schwannoma of the sigmoid colon was diagnosed. Conclusion Our case highlights the importance of an adequate transvaginal pelvic examination with the evaluation of all pelvic organs. It could be challenging to make diagnosis in an early stage on asymptomatic patients.
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Affiliation(s)
- Aikaterini Selntigia
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Benedetto Neri
- Department of Systems Medicine, Gastroenterological Unit, University “Tor Vergata” of Rome, Italy
| | - Consuelo Russo
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Francesco Giuseppe Martire
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Giorgia Soreca
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Dario Biasutto
- Operative Endoscopy Department, Campus Bio-Medico, University Hospital, Rome, Italy
| | | | - Caterina Exacoustos
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
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5
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Muacevic A, Adler JR, Owais M, Haseeb M, Kharal F. Schwannoma of the Ascending Colon in a 22-Year-Old Male: A Case Report. Cureus 2022; 14:e31946. [PMID: 36582566 PMCID: PMC9795079 DOI: 10.7759/cureus.31946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Schwannoma of the ascending colon is an extremely rare neoplasm that is often discovered incidentally in the asymptomatic older population on surveillance colonoscopy. We present the case of a symptomatic 22-year-old male presenting with one month of discomfort in the right lower abdominal quadrant, abdominal bloating, and hematochezia. A sessile polyp measuring 0.5 cm was identified in the ascending colon on the colonoscopy. The polyp was completely resected using cold snare polypectomy. Histological examination of the resected polyp with hematoxylin-eosin staining revealed small nodules of bland spindle cells with focal nuclear condensation. The lesional cells tested positive for S-100 and SOX-10 on immunohistochemical analysis, establishing the diagnosis of benign schwannoma. Since this lesion was submucosal, its diagnosis required an endoscopic biopsy that could only be performed on the mucosa. It was difficult to distinguish it from other mesenchymal tumors (gastrointestinal stromal tumor or leiomyoma), and this makes the differential diagnosis exceedingly challenging. If the immunohistochemistry is positive for S-100 and negative for C-KIT, CD-34, actin, and desmin, it aids in diagnosis. These tumors have non-specific radiological features and are asymptomatic.
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6
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Çolak Ş, Gürbulak B, Çelik G, Bektaş H, Dursun N. Gastrointestinal tract schwannomas and brief review of literature. Turk J Surg 2021; 37:408-412. [PMID: 35677484 PMCID: PMC9130950 DOI: 10.47717/turkjsurg.2021.4286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
Abstract
Schwannomas originating from Schwann cells arise from the peripheral nerve sheath and are slow-growing, benign tumors that originate mostly from the mesenchyme. It appears equally in both sexes. Schwannomas are often seen in the 3rd and 5th decades of life. Schwannomas can be seen everywhere where peripheral nerves are seen. Gastrointestinal schwannomas constitute 2-6% of all submucosal masses, and the stomach is the most common region (60-70%). Endoscopic Ultrasound (EUS)-guided sampling of gastrointestinal submucosal lesions has made it possible to achieve preop- erative differential diagnosis. Patients diagnosed with gastrointestinal schwannomas between January 2005 and December 2017 were included in this study. Three out of six patients were females. Median age was 52.5 (44-76) years. Schwannomas were found in two patients in the gastric region, one patient in the appendiceal region, two patients in the colon and one patient in the perianal region. Primary schwannomas are usually benign. Radical resection with free margin is necessary because of the risk of malignant degeneration; chemo and radiotherapy response is indeterminate, and local recurrence rates are high.
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Affiliation(s)
- Şükrü Çolak
- Clinic of General Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Bünyamin Gürbulak
- Clinic of General Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Gürhan Çelik
- Clinic of General Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Hasan Bektaş
- Clinic of General Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nevra Dursun
- Department of Pathology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
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7
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Qi Z, Yang N, Pi M, Yu W. Current status of the diagnosis and treatment of gastrointestinal schwannoma. Oncol Lett 2021; 21:384. [PMID: 33777207 PMCID: PMC7988712 DOI: 10.3892/ol.2021.12645] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal schwannoma is a rare, slow-growing and benign tumor that mostly originates in the Auerbach myenteric nerve plexus in the gastrointestinal tract. The clinical manifestations may be associated with the location, size, differentiation type, and degree of malignancy of the tumor. Endoscopy, ultrasound and imaging examinations serve an important auxiliary role in the clinical identification, diagnosis and differential diagnosis of lesions; assessment of risk; and preparation for surgery. S-100 positivity is a hallmark of schwannoma. CD34, CD117, discovered on GIST-1, P53, ALK, β-catenin, smooth muscle actin and Desmin negativity are helpful for the identification of other gastrointestinal stromal tumors. Surgical removal of the tumor is the main treatment for schwannoma. Benign gastrointestinal schwannoma has a good prognosis without recurrence and metastasis; malignant transformation is extremely rare and has a poor prognosis.
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Affiliation(s)
- Zhiyong Qi
- Department of Gastrointestinal, Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Naixv Yang
- Department of Gastrointestinal, Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Mengqi Pi
- Department of Gastrointestinal, Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Wei Yu
- Department of Gastrointestinal, Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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8
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Kojima Y, Yamaguchi T, Taguchi S, Kondo E, Yokoyama M, Shirayama S, Nikaido T, Yanagida O. Ascending Colon Schwannoma Surgically Treated after Accurate Preoperative Diagnosis. Case Rep Gastroenterol 2020; 14:483-490. [PMID: 33250686 PMCID: PMC7670325 DOI: 10.1159/000509542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Colorectal schwannomas are rare and usually benign gastrointestinal mesenchymal tumors. However, these tumors are often overtreated, possibly owing to misleading malignant potential. To our knowledge, there have been no previous reports of ascending colon schwannoma preoperatively diagnosed as benign schwannoma. Herein, we report a case of ascending colon schwannoma accurately diagnosed by endoscopic biopsy and successfully treated by wedge resection. The patient was a 76-year-old woman with complaints of bloody stool. She had no relevant past medical history. Radiological findings revealed a protruded mass in the ascending colon, and colonoscopy revealed a submucosal tumor measuring approximately 3 cm in diameter with a reddish and uneven surface. Histological and immunohistochemical analysis for vimentin and S100 protein of the specimen obtained by endoscopic biopsy confirmed the diagnosis of schwannoma. Thus, we performed laparoscopy-assisted endoscopic full-thickness resection of the ascending colon wall, as appropriate for a benign soft tissue tumor. The postoperative course has been uneventful for 2 years. This case demonstrates that colonic schwannoma can be successfully treated with adequate resection if an accurate preoperative diagnosis is made, thereby avoiding overtreatment, such as surgery for colorectal tumor including lymph node dissection. Preoperatively diagnosed schwannomas should be treated by wedge resection, with postoperative pathological findings confirming the presence or absence of malignancy. Additional resection should be considered for very rare cases of coexisting malignant tissue.
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Affiliation(s)
- Yohei Kojima
- Department of Surgery, Kosei Hospital, Tokyo, Japan.,Department of Surgery, Kyorin University Hospital, Tokyo, Japan
| | | | | | - Eri Kondo
- Department of Surgery, Kosei Hospital, Tokyo, Japan
| | | | | | - Takashi Nikaido
- Department of Diagnostic Pathology, Kosei Hospital, Tokyo, Japan
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9
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Abstract
Schwannomas are tumors comprised of schwann cells of the peripheral nervous system and infrequently present in the gastrointestinal tract. Transverse colon schwannomas are an even more rare subtype of gastrointestinal schwannomas. This study presents the case of a transverse colon schwannoma, in addition to presenting a literature review.
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Affiliation(s)
- Mridul Pansari
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Daud Lodin
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Thomas Genuit
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Jordan Moseson
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
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10
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Guaglio M, Belli F, Cesa Bianchi A, Sorrentino L, Battaglia L. Minimizing the surgical approach for a rare disease: transanal endoscopic microsurgery for rectal schwannoma. TUMORI JOURNAL 2019; 105:NP52-NP56. [PMID: 31234726 DOI: 10.1177/0300891619856704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Rectal schwannomas are extremely rare tumors and their surgical treatment is widely variable in literature. Transanal endoscopic microsurgery (TEM) approach could be a reasonable option for such lesions, offering an organ-sparing strategy, but evidence is scarce. METHODS We report a 69-year-old man with a rectal submucosal lesion at 10 cm from the anal verge, treated by TEM. A systematic literature review on surgical approaches in rectal schwannoma was performed. RESULTS The patient was successfully treated by TEM, with adequate excision of the submucosal lesion. Histopathology revealed a rectal schwannoma. No recurrence was found at 1-year endoscopic follow-up. Previous studies reported 23 cases of rectal schwannoma and several treatment options, but only 2 cases were treated by TEM. Anterior rectal resection was generally adopted in cases of large, symptomatic masses with inconclusive preoperative biopsy, while lesions with features suggestive of stromal tumors were preferentially treated by endoscopy or, if located in distal rectum, by transanal approaches. CONCLUSIONS An organ-sparing minimally invasive approach should be the standard of care for rectal schwannomas. TEM could extend the indication for their endoscopic treatment, providing adequate excision even for larger schwannomas of the middle-upper rectum.
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Affiliation(s)
- Marcello Guaglio
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Filiberto Belli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Alessandro Cesa Bianchi
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Luca Sorrentino
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Luigi Battaglia
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
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11
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Shu Z, Li C, Sun M, Li Z. Intestinal Schwannoma: A Clinicopathological, Immunohistochemical, and Prognostic Study of 9 Cases. Gastroenterol Res Pract 2019; 2019:3414678. [PMID: 31049058 PMCID: PMC6458941 DOI: 10.1155/2019/3414678] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intestinal schwannoma is a type of intestinal interstitial tumor with a very low incidence. At present, there are few studies on intestinal schwannoma. METHODS From January 2010 to January 2018, the patients diagnosed with intestinal schwannoma at the China-Japan Union Hospital of Jilin University were retrospectively reviewed. The patients' clinicopathological features and prognosis were analyzed. RESULTS This study enrolled 9 patients with intestinal schwannoma, including 3 males and 6 females. The main symptoms of the patients were abdominal pain and melena. Abdominal computed tomography showed intussusception, slightly high-density shadowing in the intestine, thickening of the intestinal wall, and an intestinal mass. Colonoscopy and endoscopic ultrasonography showed submucosal masses without ulcer formation. Two patients underwent endoscopic biopsy, and the pathological results revealed inflammation and necrosis. One patient had increased neuron-specific enolase (NSE) levels. Immunohistochemical analysis showed that the tumor cells were positive for S-100 and negative for CD117, DOG-1, desmin, and smooth muscle actin. An average of 17 lymph nodes were found around the intestines in 4 patients, all of which demonstrated reactive hyperplasia. No recurrence or metastasis occurred during postoperative follow-up. CONCLUSIONS Intestinal schwannoma is a rare tumor, and in our study its incidence was higher in women than in men. The main symptoms were abdominal pain and melena. Preoperative increases in NSE levels might contribute to a diagnosis. Complete surgical resection with free negative margins is the standard treatment for benign schwannoma. There was no recurrence or metastasis after complete surgical resection, suggesting that follow-up may not be required.
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Affiliation(s)
- Zhenbo Shu
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunsheng Li
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mingze Sun
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongmin Li
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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12
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Baig MMAS, Patel R, Kazem MA, Khan A. Schwannoma in the ascending colon, a rare finding on surveillance colonoscopy. J Surg Case Rep 2019; 2019:rjz046. [PMID: 30800278 PMCID: PMC6380074 DOI: 10.1093/jscr/rjz046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/31/2019] [Indexed: 11/15/2022] Open
Abstract
Schwannomas are peripheral nerve sheath tumours that can present as a rare tumour of GI tract, and even more uncommonly within the colon. We present a case of colonic schwannoma in an asymptomatic patient identified on surveillance colonoscopy. The tumour is of mesenchymal origin and is often challenging to diagnose prior to surgical resection. Endoscopy usually fails to provide adequate sample and diagnosis is usually confirmed on immunohistochemistry.
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Affiliation(s)
| | - Rikesh Patel
- Department of Colorectal Surgery, Aintree University Hospital, Liverpool L9 7AL, UK
| | - Mohamad Ali Kazem
- Consultant General and Colorectal Surgery, Leighton Hospital, Crewe CW1 4QJ, UK
| | - Arif Khan
- Consultant General and Colorectal Surgery, Leighton Hospital, Crewe CW1 4QJ, UK
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13
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Laparoscopic Resection of Appendiceal Schwannoma. Case Rep Surg 2018; 2018:9191503. [PMID: 30186657 PMCID: PMC6114066 DOI: 10.1155/2018/9191503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Schwannoma arises from Schwann's cell of the neural sheath. Schwannoma of the large intestine, particularly of the appendix, is rare. We report a case of appendiceal schwannoma resected using laparoscopic surgery. Case Presentation A 75-year-old man was referred to our hospital for abdominal fullness and nausea since 2 months. Abdominal CT revealed a well-demarcated oval mass of 25 mm at the tip of the appendix. Contrast-enhanced CT revealed a lesion with gradually enhanced contrast from the arterial phase to the equilibrium phase. Abdominal US revealed a well-demarcated hypoechoic tumor. Preoperative diagnosis indicated appendiceal mesenchymal or neuroendocrine tumor. Ileocecal resection with D3 lymph node dissection was performed. Pathological and immunohistochemical findings confirmed the diagnosis of appendiceal schwannoma. Conclusions For determining the surgical procedure of nonepithelial tumor of the appendix, preoperative diagnosis of mesenchymal or neuroendocrine tumors is required. However, appendiceal schwannoma is extremely rare, and its characteristic findings have not yet been established. Accumulating cases of appendiceal schwannomas is necessary for improving imaging diagnosis and surgical treatment.
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14
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Bohlok A, El Khoury M, Bormans A, Galdon MG, Vouche M, El Nakadi I, Donckier V, Liberale G. Schwannoma of the colon and rectum: a systematic literature review. World J Surg Oncol 2018; 16:125. [PMID: 29970075 PMCID: PMC6029403 DOI: 10.1186/s12957-018-1427-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023] Open
Abstract
Background Schwannomas of the colon and rectum are rare among gastrointestinal schwannomas. They are usually discovered incidentally as a submucosal mass on routine colonoscopy and diagnosed on pathologic examination of the operative specimen. Little information exists on the diagnosis and management of this rare entity. The aim of this study is to report a case of cecal schwannoma and the results of a systematic review of colorectal schwannoma in the literature. Main body PubMed, Scopus, and Cochrane database searches were performed for case reports and case series of colonic and rectal schwannoma. Ninety-five patients with colonic or rectal schwannoma from 70 articles were included. Median age was 61.5 years (59% female). Presentation was asymptomatic (28%), rectorrhagia (23.2%), or abdominal pain (15.8%). Schwannoma occurred in the left and sigmoid colon in 36.8%, in the cecum and right colon in 30.5%, and in the rectum in 21.1%. Median tumor size was 3 cm and 56.2% of patients who underwent preoperative colonoscopy had a typical smooth submucosal mass. At pathology, 97.9, 13.7, and 5.3% of schwannomas stained positive for S100, vimentin, and GFAP, respectively. The median mitotic index was 1/50. Conclusions Colorectal schwannoma is a very rare subtype of gastrointestinal schwannoma which occurs in the elderly, almost equally in men and women. Schwannoma should be included in the differential diagnosis of a submucosal lesion along with gastrointestinal stromal tumor, neuro-endocrine tumors, and leiomyoma-leiomyosarcoma. Definitive diagnosis is based on immunohistochemistry of the operative specimen. Rarely malignant, surgery is the mainstay of treatment.
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Affiliation(s)
- Ali Bohlok
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Melody El Khoury
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Bormans
- Institutional Library, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Gomez Galdon
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Issam El Nakadi
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Donckier
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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15
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Leonard A, McCarthy LP, Pastor DM. When a polyp is not a polyp: incidental finding of a sigmoid schwannoma at first colonoscopic screening. BMJ Case Rep 2018; 2018:bcr-2017-220886. [PMID: 29455175 DOI: 10.1136/bcr-2017-220886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Schwannomas, peripheral nerve sheath tumours arising from Schwann cells, are often associated with inherited disorders such as neurofibromatosis. Gastrointestinal schwannomas, while rare, have been reported in those without personal or family history of neurofibromatosis. Diagnoses of these lesions, however, typically follow evaluations prompted by symptomatic presentations associated with abdominal pain, rectal bleeding, change in bowel habits or positive results on faecal occult blood tests performed for colorectal cancer screening. Further, management of these predominantly benign lesions commonly incorporates surgical resection. We present the case of a sigmoid schwannoma found in an asymptomatic individual on first screening colonoscopy and treated with complete endoscopic polypectomy with anticipated surveillance colonoscopy.
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Affiliation(s)
| | - Lezah P McCarthy
- Department of Pathology, Albany Stratton VA Medical Center, Albany, New York, USA
| | - Danielle M Pastor
- Department of Surgery, Albany Stratton VA Medical Center, Albany, New York, USA
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16
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Bae H, Van Vrancken M, Kang TW, Park HY, Chu J, Park HK, Ha SY, Choi D, Kim KM. Peritumoral lymphoid cuff correlates well with lymph node enlargement in gastrointestinal schwannomas. Oncotarget 2018; 9:12591-12598. [PMID: 29560092 PMCID: PMC5849156 DOI: 10.18632/oncotarget.24476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background/Aims To determine the incidence of regional lymphadenopathy in gastrointestinal (GI) schwannoma and to evaluate the relationship between peritumoral lymphoid cuff and lymphadenopathy. Methods We queried 118 GI tract schwannomas and reviewed radiologic findings, intraoperative findings, and electronic medical records of all cases for enlarged regional lymph nodes. Results Location of tumors included 85 gastric (72%), 11 colonic (9.3%), 7 esophageal (5.9%), 3 pancreatic (2.5%), 1 hepatic (0.8%), and 11 mesenteric (9.3%). The size of the tumors ranged from 0.2 to 11 cm (mean 3.8 cm). Histologically, 70.3% showed a peritumoral lymphoid cuff ranging in thickness from 0.3 to 6 mm (mean 1.6 mm). The peritumoral lymphoid cuff was significantly more frequent in gastric schwannomas (78.8%) followed by colonic (72.7%), esophageal (57.1%) and rare in other locations (p = 0.001). Of the 106 cases for which clinical or radiologic data was available for, 76 cases (71.7%) showed regional lymphadenopathy. The presence of peritumoral lymphoid cuff showed significant correlation with regional lymphadenopathy (p < 0.001) and the size of enlarged lymph nodes (p = 0.002). Conclusions A peritumoral lymphoid cuff is frequently seen in GI tract schwannomas and correlates well with regional lymphadenopathy. However, in a significant subset (29.7%), a lymphoid cuff was not present warranting continued need for caution in the preoperative radiologic and postoperative pathologic diagnoses.
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Affiliation(s)
- Hyunsik Bae
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Tae Wook Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Young Park
- Department of Pathology, Inje University Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Jinah Chu
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Kyu Park
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yun Ha
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongil Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
RATIONALE Schwannomas of gastrointestinal tracts are rare and difficult to detect preoperatively because of negative results of endoscopic and imaging examinations. Here, we reported a case of rectal schwannoma, which was diagnosed by immunohistochemical staining after laparoscopic protectomy. PATIENT CONCERNS A 61-year-old woman complained of a 1-month history of difficulty in defecation and irregularly abdominal discomfort during her physical checkup in our hospital. DIAGNOSES Immunohistochemical staining results after laparoscopic protectomy revealed a strong positive reaction for S-100 protein. Therefore, rectal schwannoma was confirmed. INTERVENTIONS Treatment with laparoscopic protectomy was given. OUTCOMES Symptoms resolved completely after 12 days of the surgery, and was regular followed-up in outpatient clinic. LESSONS Schwannomas are difficult to identify preoperatively, and immunohistochemical staining for S-100 protein is an effective method to diagnose it.
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Affiliation(s)
| | | | - Junan Li
- Department of Endoscopy, The Second Hospital of Jilin University, Changchun, Jilin
| | - Ye Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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18
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Uhr A, Singh AP, Munoz J, Aka A, Sion M, Jiang W, Goldstein SD, Rosato EL. Colonic Schwannoma: A Case Study and Literature Review of a Rare Entity and Diagnostic Dilemma. Am Surg 2016. [DOI: 10.1177/000313481608201224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
An asymptomatic 73-year-old woman was found to have a submucosal mass in the descending colon on routine colonoscopy. A CT scan revealed a 31 X 28 X 31 mm lesion in the same location. Previous biopsy proved to be nondiagnostic, and the patient underwent a laparoscopic descending colon resection. Histologic evaluation of the tumor revealed a low grade spindle cell neoplasm with strong, diffuse positivity for S-100 protein by immunohistochemistry, leading to the diagnosis of schwannoma. A review of the literature revealed intestinal schwannoma to be a rare disease entity, with only about 50 cases previously reported.
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Affiliation(s)
- Alex Uhr
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Awinder P. Singh
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jose Munoz
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Allison Aka
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Melanie Sion
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Wei Jiang
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Ernest L. Rosato
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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19
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Daley MJ, Trust MD, Peterson EJ, Luftman K, Miller AH, Ali S, Clark A, Aydelotte JD, Coopwood TB, Brown CV. Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. Am Surg 2016. [DOI: 10.1177/000313481608200224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity.
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Affiliation(s)
| | - Marc D. Trust
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | | | - Kevin Luftman
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Andrew H. Miller
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Sadia Ali
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Adam Clark
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | | | | | - Carlos V.R. Brown
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
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20
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Çakır T, Aslaner A, Yaz M, Gündüz UR. Schwannoma of the sigmoid colon. BMJ Case Rep 2015; 2015:bcr-2014-208934. [PMID: 25976197 DOI: 10.1136/bcr-2014-208934] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Colonic schwannomas are very rare gastrointestinal tumours originating from Schwann cells, which form the neural sheath. Primary schwannomas of the lower gastrointestinal tract are very rare and usually benign in nature. However, if they are not surgically removed, malign degeneration can occur. We report a case of a 79-year-old woman who presented to our clinic with rectal bleeding and constipation. She underwent a lower gastrointestinal tract endoscopy. A mass subtotally obstructing the lumen of the sigmoid colon was seen and biopsies were taken. Histopathological examination indicated a suspicion of gastrointestinal tumour and the patient underwent sigmoid colon resection after preoperative evaluation by laboratory analysis, abdominal ultrasonography and CT. Her postoperative course was uneventful and she was discharged on the fifth day for outpatient control. The histopathology report revealed schwannoma of the sigmoid colon. This was a case of schwannoma of the sigmoid colon that was successfully treated with total resection.
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Affiliation(s)
- Tuğrul Çakır
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Arif Aslaner
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Müjgan Yaz
- Department of Pathology, Antalya Training and Research Hospital, Antalya, Turkey
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21
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A case of benign schwannoma of the ascending colon treated with laparoscopic-assisted wedge resection. Int Surg 2015; 98:315-8. [PMID: 24229016 DOI: 10.9738/intsurg-d-13-00015.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Isolated colonic schwannomas are rare gastrointestinal mesenchymal tumors. Only a small number of cases have been reported. Occurrence of these tumors is more common in the stomach than in the large intestine. These spindle cell lesions are distinct from leiomyoma, leiomyosarcoma, and gastrointestinal stromal tumors because the tumor cells have a distinct immunophenotype, with strong diffuse positivity for S-100 and vimentin, as well as corroborative negative staining of CD117 and smooth muscle markers. We present a case of colonic schwannoma in a 70-year-old woman who had no specific symptoms. The patient was diagnosed with a submucosal tumor in the ascending colon on colonoscopy and abdominal computed tomography. Laparoscopic-assisted wedge resection of colon was performed. The very rare pathologic diagnosis of ascending schwannoma was made postoperatively. This case is interesting because schwannomas of the colon and rectum are extremely rare and are treated by laparoscopic-assisted wedge resection.
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22
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Tashiro Y, Matsumoto F, Iwama K, Shimazu A, Matsumori S, Nohara S, Miura H, Takei M, Namekata K, Takase M, Okada M, Tsumura H. Laparoscopic resection of schwannoma of the ascending colon. Case Rep Gastroenterol 2015; 9:15-9. [PMID: 25759634 PMCID: PMC4327572 DOI: 10.1159/000373882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Schwannomas of the colon are rare and difficult to diagnose preoperatively. We report a case of schwannoma of the ascending colon that was resected laparoscopically. A 64-year-old woman was referred to our hospital by her local clinic for further evaluation and management of a submucosal tumor of the ascending colon. A definitive preoperative diagnosis could not be reached despite examinations. Gastrointestinal stromal tumor, leiomyoma and lymphoma were the differential diagnoses. We performed a laparoscopic right hemicolectomy with D2 lymph node dissection. Histological findings with hematoxylin-eosin staining revealed spindle-like tumor cells, and immunohistochemical analysis showed that the tumor was positive for S-100 but negative for c-kit, CD34, smooth muscle actin and desmin, with a Ki-67 index of <5%. Thus, the diagnosis in this case was benign schwannoma of the ascending colon.
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Affiliation(s)
- Yoshihiko Tashiro
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Fumio Matsumoto
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Keiko Iwama
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Ai Shimazu
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Sei Matsumori
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Shigeo Nohara
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Hiroyoshi Miura
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Masahiko Takei
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Koji Namekata
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Masaru Takase
- Department of Pathology, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Motoi Okada
- Department of Pathology, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Hidenori Tsumura
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
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23
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Bugiantella W, Rondelli F, Mariani L, Peppoloni L, Cristallini E, Mariani E. Schwannoma of the colon: A case report. Oncol Lett 2014; 8:2511-2512. [PMID: 25360169 PMCID: PMC4214396 DOI: 10.3892/ol.2014.2545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 05/29/2014] [Indexed: 12/26/2022] Open
Abstract
Schwannomas are rare tumors originating from the Schwann cells, which form the neural sheath. These tumors occur most frequently in the head, neck, arms and limbs. Primary schwannomas of the colon and rectum are extremely rare; they are usually benign, but in extremely rare cases (2%), they can present with malignant degeneration if not surgically removed. The current study presents the case of a 65-year-old male with blood in the feces who underwent a colonoscopy that revealed an oval-shaped mass covered by ulcerated mucosa. A standard biopsy examination indicated a gelatinous carcinoma, and the patient consequently underwent a laparoscopic resection of the left colon. Histological examination revealed a schwannoma. Immunohistochemistry showed the tumor to be positive for S100 and vimentin, but negative for cluster of differentiation (CD)117, cytokeratin (CK)7, CK20, chromogranin, actin and synaptophysin, with a Ki-67 proliferative index of 3%. Lymph nodes were not involved. Overall, pre-operative biopsy examinations may be difficult for schwannomas, and immunohistochemistry is necessary for the correct diagnosis of this condition. In contrast to gastrointestinal stromal tumors, schwannomas are negative for CD117 and positive for S100 protein and vimentin. A Ki-67 index of ≥5% is strictly correlated with greater tumor aggressiveness. Therefore, the gold standard treatment for schwannomas is oncological radical surgical resection.
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Affiliation(s)
- Walter Bugiantella
- General Surgery, 'San Giovanni Battista Hospital', USL Umbria 2, Foligno I-06034, Italy
| | - Fabio Rondelli
- General Surgery, 'San Giovanni Battista Hospital', USL Umbria 2, Foligno I-06034, Italy ; Department of Surgery, University of Perugia, Perugia I-06132, Italy
| | - Lorenzo Mariani
- General Surgery, 'San Giovanni Battista Hospital', USL Umbria 2, Foligno I-06034, Italy
| | - Lucina Peppoloni
- Pathological Anatomy, 'San Giovanni Battista Hospital', USL Umbria 2, Foligno I-06034, Italy
| | - Enrico Cristallini
- Pathological Anatomy, 'San Giovanni Battista Hospital', USL Umbria 2, Foligno I-06034, Italy
| | - Enrico Mariani
- General Surgery, 'San Giovanni Battista Hospital', USL Umbria 2, Foligno I-06034, Italy
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24
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Tokuhara K, Nakatani K, Oishi M, Iwamoto S, Inoue K, Kwon AH. Laparoscopic reduced port surgery for schwannoma of the sigmoid colon: a case report. Asian J Endosc Surg 2014; 7:260-3. [PMID: 25131324 DOI: 10.1111/ases.12102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/02/2014] [Indexed: 01/15/2023]
Abstract
A 74-year-old woman who developed schwannoma of the sigmoid colon was referred to our hospital for colonography to determine the cause of her stool occult blood. Colonoscopy revealed a submucosal tumor, which measured 3 cm in diameter, in the sigmoid colon. Endoscopic ultrasonography revealed a low echoic, homogeneous and demarcated submucosal tumor that continued into the fourth layer of the colonic wall. Gastrointestinal stromal, myogenic or neurogenic tumor was suspected, and thus, laparoscopic sigmoidectomy was carried out. We used two ports during the operation, a SILS Port in the umbilical region and a 12-mm port in the right lower abdominal wall, and performed sigmoidectomy with D2 lymph node dissection. Histological findings revealed spindle-like tumor cells with multiform nuclei. The tumor was diagnosed by immunostaining as benign schwannoma of the sigmoid colon. The conventional surgical treatment for schwannoma of the digestive tract is partial resection, but if preoperative diagnosis is unknown, radical resection with lymphadenectomy is acceptable for submucosal tumors in the digestive tract. In this case, laparoscopic reduced port surgery using only one or two ports may be more feasible and beneficial with regard to cosmesis and reduced postoperative pain than conventional laparoscopic colectomy.
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