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K A M, Nelluri N, Narra AR, Kota SR, Abuji K. Common Benign Nerve Sheath Tumor at an Uncommon Location - Gastric Schwannoma. Cureus 2024; 16:e62569. [PMID: 39027743 PMCID: PMC11255416 DOI: 10.7759/cureus.62569] [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: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Gastric schwannomas are rare types of gastrointestinal mesenchymal tumours that are slow-growing and mostly benign. They are usually asymptomatic. In some cases, nonspecific gastric symptoms, palpable mass, and bleeding can be seen. A definitive diagnosis requires pathological and immunohistochemical examination, and surgical resection offers an excellent prognosis with uncommon recurrence. We present a case of a 62-year-old woman who underwent exploratory laparotomy and wedge resection with preoperative diagnosis as gastrointestinal stromal tumor and postoperatively diagnosed as schwannoma on histopathology.
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Affiliation(s)
- Manjesh K A
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College, Hyderabad, IND
| | - Nagarjun Nelluri
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College, Hyderabad, IND
| | - Ankith R Narra
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College, Hyderabad, IND
| | - Sreedhar R Kota
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College, Hyderabad, IND
| | - Kishore Abuji
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College, Hyderabad, IND
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Zhang C, Wang C, Mao G, Cheng G, Ji H, He L, Yang Y, Hu H, Wang J. Radiomics analysis of contrast-enhanced computerized tomography for differentiation of gastric schwannomas from gastric gastrointestinal stromal tumors. J Cancer Res Clin Oncol 2024; 150:87. [PMID: 38336926 PMCID: PMC10858083 DOI: 10.1007/s00432-023-05545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess the performance of radiomics-based analysis of contrast-enhanced computerized tomography (CE-CT) images for distinguishing GS from gastric GIST. METHODS Forty-nine patients with GS and two hundred fifty-three with GIST were enrolled in this retrospective study. CT features were evaluated by two associate chief radiologists. Radiomics features were extracted from portal venous phase images using Pyradiomics software. A non-radiomics dataset (combination of clinical characteristics and radiologist-determined CT features) and a radiomics dataset were used to build stepwise logistic regression and least absolute shrinkage and selection operator (LASSO) logistic regression models, respectively. Model performance was evaluated according to sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve, and Delong's test was applied to compare the area under the curve (AUC) between different models. RESULTS A total of 1223 radiomics features were extracted from portal venous phase images. After reducing dimensions by calculating Pearson correlation coefficients (PCCs), 20 radiomics features, 20 clinical characteristics + CT features were used to build the models, respectively. The AUC values for the models using radiomics features and those using clinical features were more than 0.900 for both the training and validation groups. There were no significant differences in predictive performance between the radiomic and clinical data models according to Delong's test. CONCLUSION A radiomics-based model applied to CE-CT images showed comparable predictive performance to senior physicians in the differentiation of GS from GIST.
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Affiliation(s)
- Cui Zhang
- Department of Radiology, TongDe Hospital of ZheJiang Province, No. 234, Gucui Road, Hangzhou, 310013, Zhejiang, China
| | - Chongwei Wang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guoqun Mao
- Department of Radiology, TongDe Hospital of ZheJiang Province, No. 234, Gucui Road, Hangzhou, 310013, Zhejiang, China
| | | | - Hongli Ji
- Jianpei Technology, Hangzhou, Zhejiang, China
| | - Linyang He
- Jianpei Technology, Hangzhou, Zhejiang, China
| | - Yang Yang
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Wang
- Department of Radiology, TongDe Hospital of ZheJiang Province, No. 234, Gucui Road, Hangzhou, 310013, Zhejiang, China.
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Li J, Chen JH, Huang WF, Liu M, Hong SK, Zhang JY. Gastric schwannoma: A retrospective analysis of clinical characteristics, treatments, and outcomes. Asian J Surg 2024; 47:407-412. [PMID: 37741754 DOI: 10.1016/j.asjsur.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical characteristics, treatment options, and prognosis of patients with gastric schwannoma (GS). METHODS Patients who were pathologically diagnosed with GS between April 2011 and October 2022 were enrolled. The data of clinical characteristics, pathological features, treatment options, and clinical outcomes were collected and compared between GS patients who underwent endoscopic resection (ER) and surgical resection (SR). RESULTS Of the 32 cases, 23 underwent SR and nine underwent ER. The median tumor size was significantly smaller in ER group than in SR group (12.0 vs. 40.0 mm, P < 0.001), while patients in SR group were older than those in ER group (54.5 ± 10.6 vs. 45.3 ± 10.9 years, P = 0.036). Moreover, tumors in ER group were more likely to exhibit an intraluminal pattern (100% vs. 26.1%, P < 0.001). Patients in ER group had significantly lower hospitalization cost (25859.2 ± 8623.9 vs. 44953.0 ± 13083.8 RMB, P = 0.011) than those in SR group. No differences were found between the two groups in terms of R0 resection rate, operative time, estimated blood loss, adverse events, and recurrence rate. All patients were followed up for 4-96 months (mean: 35 months; median: 23 months), during which no evidence of recurrence or metastasis was observed. CONCLUSIONS Both ER and SR are safe and effective treatment modalities for the management of GS, with ER being associated with lower medical costs compared to SR. The majority of GS are benign and do not recur, with little possibility of malignant transformation.
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Affiliation(s)
- Ji Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Hai Chen
- Endoscopy Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Ming Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shao-Kun Hong
- Department of General Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Jiang X, Zhao M, Wu J, Ding Y, Wang J. Laparoscopic resection for gastric schwannoma larger than 30 mm with long-term outcomes. BMC Surg 2023; 23:284. [PMID: 37726737 PMCID: PMC10510170 DOI: 10.1186/s12893-023-02190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND AIMS Laparoscopic resection has been reported as effective and safe for gastric schwannoma (GS) in the form of case reports. However, study on laparoscopic surgery in patients with GS larger than 30 mm has been rarely reported. To this end, the present study aimed to evaluate the safety and efficacy of laparoscopic resection for the treatment of GS larger than 30 mm and its long-term outcomes. METHODS This is a retrospective case series study of patients with GS larger than 30 mm who underwent laparoscopic resection at our hospital between January 2014 and December 2020. Clinical pathology, surgical and follow-up data were collected and analyzed. RESULTS A total of 10 patients with a mean age of 51.6 years were included. Seven tumors were located in gastric body, 2 in antrum and 1 in fundus. Laparoscopic gastric wedge resection was performed in 7 patients, while laparoscopic gastric local resection was performed in 3 patients. All patients achieved complete resection. The mean operation time was 112.6 ± 34.3 min, and the mean postoperative hospital stay was 13.8 ± 5.1 days. Postoperative gastroplegia occurred in 2 patients and was treated with conservative therapy. No recurrence, metastasis or residue was found during the follow-up of mean 45.1 months. CONCLUSIONS Laparoscopic resection is a safe and effective method for treating GS larger than 30 mm with favorable long-term follow-up outcomes. Laparoscopic resection may be considered as the first-line treatment for GS larger than 30 mm.
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Affiliation(s)
- Xuetong Jiang
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Mingzuo Zhao
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Jianqiang Wu
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Yang Ding
- Department of Pathology, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Jian Wang
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China.
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Zhang S, Yang Z, Chen X, Su S, Huang R, Huang L, Shen Y, Zhong S, Zhong Z, Yang J, Long W, Zhuang R, Fang J, Dai Z, Chen X. Development of a CT image analysis-based scoring system to differentiate gastric schwannomas from gastrointestinal stromal tumors. Front Oncol 2023; 13:1057979. [PMID: 37448513 PMCID: PMC10338089 DOI: 10.3389/fonc.2023.1057979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose To develop a point-based scoring system (PSS) based on contrast-enhanced computed tomography (CT) qualitative and quantitative features to differentiate gastric schwannomas (GSs) from gastrointestinal stromal tumors (GISTs). Methods This retrospective study included 51 consecutive GS patients and 147 GIST patients. Clinical and CT features of the tumors were collected and compared. Univariate and multivariate logistic regression analyses using the stepwise forward method were used to determine the risk factors for GSs and create a PSS. Area under the receiver operating characteristic curve (AUC) analysis was performed to evaluate the diagnostic efficiency of PSS. Results The CT attenuation value of tumors in venous phase images, tumor-to-spleen ratio in venous phase images, tumor location, growth pattern, and tumor surface ulceration were identified as predictors for GSs and were assigned scores based on the PSS. Within the PSS, GS prediction probability ranged from 0.60% to 100% and increased as the total risk scores increased. The AUC of PSS in differentiating GSs from GISTs was 0.915 (95% CI: 0.874-0.957) with a total cutoff score of 3.0, accuracy of 0.848, sensitivity of 0.843, and specificity of 0.850. Conclusions The PSS of both qualitative and quantitative CT features can provide an easy tool for radiologists to successfully differentiate GS from GIST prior to surgery.
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Affiliation(s)
- Sheng Zhang
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
| | - Zhiqi Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital, Meizhou, China
| | - Xiaofeng Chen
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital, Meizhou, China
| | - Shuyan Su
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ruibin Huang
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Liebin Huang
- Department of Radiology, Jiangmen Central Hospital, Guangdong, China
| | - Yanyan Shen
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, China
| | - Sihua Zhong
- Research Center Institute, United Imaging Healthcare, Shanghai, China
| | - Zijie Zhong
- Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Jiada Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Guangdong, China
| | - Ruyao Zhuang
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhuozhi Dai
- Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiangguang Chen
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
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Fugărețu C, Mișarca C, Petcu L, Șoană R, Cîrnațiu A, Surlin MV, Patrascu S, Ramboiu S. Schwannoma: A Rare Case of Submucosal Gastric Tumor. Diagnostics (Basel) 2023; 13:2073. [PMID: 37370968 PMCID: PMC10297452 DOI: 10.3390/diagnostics13122073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Schwannoma is a tumor that originates from the Schwann cells that surround a neuron's axon. This tumor is very rare in the gastrointestinal tract and develops submucosally from intestinal nerve plexuses. The most common location for gastrointestinal schwannomas is the stomach, where they account for only 0.2% of gastric tumors. We present the case of a 56-year-old asymptomatic patient who was diagnosed, following a routine ultrasound examination, with an abdominal tumor. An abdominal MRI confirmed the gastric origin of the tumor. Although a subsequent upper-digestive endoscopic ultrasound was performed, a definitive diagnosis could not be established. Thus, a laparoscopic wedge resection of the stomach was performed. The immunohistochemical examination of the tumor established the diagnosis of benign schwannoma. Despite the availability of advanced endoscopy and imaging techniques, the diagnosis of gastric schwannoma is very rarely preoperative. The immunohistochemical identification of S-100 on the surgical specimen confirmed the diagnosis.
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Affiliation(s)
- Cosmina Fugărețu
- 1st General Surgery Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
- Faculty of General Medicine Brașov, Transilvania University, 500036 Brașov, Romania
| | - Cătalin Mișarca
- 1st General Surgery Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
- Faculty of General Medicine Brașov, Transilvania University, 500036 Brașov, Romania
| | - Lucian Petcu
- 1st General Surgery Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
| | - Raluca Șoană
- Pathological Anatomy Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
| | - Andrada Cîrnațiu
- 1st General Surgery Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
| | - Marin Valeriu Surlin
- 1st General Surgery Department, Emergency Hospital of Craiova, 200642 Craiova, Romania
- Faculty of General Medicine Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stefan Patrascu
- 1st General Surgery Department, Emergency Hospital of Craiova, 200642 Craiova, Romania
- Faculty of General Medicine Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sandu Ramboiu
- 1st General Surgery Department, Emergency Hospital of Craiova, 200642 Craiova, Romania
- Faculty of General Medicine Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Zhong Z, Xu Y, Liu J, Zhang C, Xiao Z, Xia Y, Wang Y, Wang J, Xu Q, Lu Y. Clinicopathological study of gastric schwannoma and review of related literature. BMC Surg 2022; 22:159. [PMID: 35538511 PMCID: PMC9088084 DOI: 10.1186/s12893-022-01613-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Zhihan Zhong
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yuhao Xu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Junwei Liu
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China, 310014
| | - Chengwu Zhang
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China, 310014
| | - Zunqiang Xiao
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China, 310014
| | - Yan Xia
- Cancer Center, Department of Pathology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Yu Wang
- Medical Record Department, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jianfeng Wang
- Department of Cardiology, Chunan Chinese Traditional Medicine, Hangzhou, Zhejiang, China
| | - Qiuran Xu
- Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
| | - Yi Lu
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China, 310014.
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He CH, Lin SH, Chen Z, Li WM, Weng CY, Guo Y, Li GD. Laparoscopic-assisted endoscopic full-thickness resection of a large gastric schwannoma: A case report. World J Gastrointest Surg 2022; 14:362-369. [PMID: 35664360 PMCID: PMC9131838 DOI: 10.4240/wjgs.v14.i4.362] [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: 12/08/2021] [Revised: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schwannomas, also known as neurinomas, are benign tumors derived from Schwann cells. Gastrointestinal schwannomas are rare and are most frequently reported in the stomach. They are usually asymptomatic and are difficult to diagnose preoperatively; however, endoscopy and imaging modalities can provide beneficial preliminary diagnostic data. There are various surgical options for management. Here, we present a case of a large gastric schwannoma (GS) managed by combined laparoscopic and endoscopic surgery.
CASE SUMMARY A 28-year-old woman presented with a 2-mo history of epigastric discomfort and a feeling of abdominal fullness. On upper gastrointestinal endoscopy and endoscopic ultrasonography, a hypoechogenic submucosal mass was detected in the gastric antrum: It emerged from the muscularis propria and projected intraluminally. Computed tomography showed a nodular lesion (4 cm × 3.5 cm), which exhibited uniform enhancement, on the gastric antrum wall. Based on these findings, a preliminary diagnosis of gastrointestinal stromal tumor was established, with schwannoma as a differential. Considering the large tumor size, we planned to perform endoscopic resection and to convert to laparoscopic treatment, if necessary. Eventually, the patient underwent combined laparoscopic and gastroscopic surgery. Immunohistochemically, the resected specimen showed positivity for S-100 and negativity for desmin, DOG-1, α-smooth muscle actin, CD34, CD117, and p53. The Ki-67 index was 3%, and a final diagnosis of GS was established.
CONCLUSION Combined laparoscopic and endoscopic surgery is a minimally invasive and effective treatment option for large GSs.
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Affiliation(s)
- Cheng-Hai He
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
| | - Shi-Hua Lin
- Department of Internal Medicine, Zhejiang Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Zhen Chen
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
| | - Wei-Min Li
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
| | - Chun-Yan Weng
- Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Yun Guo
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
| | - Guo-Dong Li
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
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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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10
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Lu ZY, Zhao DY. Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture: A case report. World J Gastroenterol 2021; 27:3940-3947. [PMID: 34321856 PMCID: PMC8291012 DOI: 10.3748/wjg.v27.i25.3940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schwannomas, also known as neurinomas, are tumors that derive from Schwann cells. Gastrointestinal schwannomas are extremely rare, but the stomach is the most common site. Gastric schwannomas are usually asymptomatic. Endoscopy and imaging modalities might offer useful preliminary diagnostic information. However, to diagnose schwannoma, the immunohistochemical positivity for S-100 protein is essential, whereas CD117, CD34, SMA, desmin, and DOG-1 are negative.
CASE SUMMARY A 45-year-old female was found to have a gastric mass during a medical examination, which was diagnosed as a gastric schwannoma. We performed endoscopic full-thickness resection and endoscopic purse-string suture. Pathology and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 protein. Furthermore, to exclude the misdiagnosis of gastrointestinal stromal tumor, we performed a mutational detection of the c-Kit and PDGFRA genes. Postoperative follow-up revealed that the patient recovered well.
CONCLUSION Immunohistochemical staining is essential for the diagnosis of schwannoma. Endoscopic full-thickness resection is an effective treatment method for gastric schwannoma.
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Affiliation(s)
- Zhi-Yu Lu
- Departments of Gastroenterology, Institute of Digestive, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
| | - Dun-Yong Zhao
- Departments of Gastroenterology, Institute of Digestive, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
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Lauricella S, Valeri S, Mascianà G, Gallo IF, Mazzotta E, Pagnoni C, Costanza S, Falcone L, Benvenuto D, Caricato M, Capolupo GT. What About Gastric Schwannoma? A Review Article. J Gastrointest Cancer 2021; 52:57-67. [PMID: 32964322 DOI: 10.1007/s12029-020-00456-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Gastric schwannomas (GSs) are rare mesenchymal neoplasms of the gastrointestinal tract. Diagnosis is often achieved postoperatively, based on pathology reports of retrieved specimens. The aim of the present study is to follow up all patients with gastric schwannoma (Gs) undergoing endoscopic, partial, or more extended surgery and to evaluate the appearance of local or distant recurrence. METHODS A PubMed, Cochrane, and Embase systematic review of the literature has been performed. Original papers, review articles, and case reports published between 1988 and 2019 were considered eligible. All the studies who met the inclusion criteria were analyzed. Statistical analysis of data has been performed using GraphPad Prism 7 software. RESULTS Three hundred twenty-eight articles were found, and a total of 102 were included and analyzed in depth. Fifty-three papers reported the follow-up information, ranging from 1 to 417 months across different studies. Among them, 31 patients underwent endoscopic removal of the gastric lesions; 140 patients underwent local surgery, including wedge resection or partial gastrectomy; and 148 patients underwent subtotal or total gastrectomy. The median follow-up was of 27-38-33 months, respectively. No recurrence or distant metastasis was detected in the endoscopy group. Among local surgery group, liver metastasis was reported in one case; in extended surgery group, one patient died for multiple liver metastases. CONCLUSIONS Local or more extended surgery involved a larger cohort of patients and reported satisfactory long-term results compared with endoscopy group. Surgery in absence of a definite preoperative diagnosis is considered the gold standard treatment for resectable Gs.
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Affiliation(s)
- Sara Lauricella
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Sergio Valeri
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University, Rome, Italy
| | - Gianluca Mascianà
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ida Francesca Gallo
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University, Rome, Italy
| | - Erica Mazzotta
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Chiara Pagnoni
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Saponaro Costanza
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Falcone
- Department of Pathology, Campus Bio-Medico University, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
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12
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Suzuki K, Saito K, Yamada T, Arizono E, Kumita H, Kasahara K, Katsumata K, Tasaki K, Matsubayashi J, Nagao T. Perilesional Lymph Node Swelling Might Be a Radiologic Clue for Appendiceal Schwannoma: A Case Report. Curr Med Imaging 2021; 17:1266-1270. [PMID: 34102981 DOI: 10.2174/1573405617666210608152957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastrointestinal schwannoma is not a common type of tumor, and lesions originating from the appendix are extremely rare. Herein, we report a patient with appendiceal schwannoma characterized by lymph node swelling. CASE REPORT A 67-year-old male patient who had diabetes complained of weight loss. A computed tomography scan revealed a mass in the right side of the pelvic cavity. Moreover, a contrast-enhanced computed tomography scan showed perilesional lymph node swelling measuring up to 28 mm. A low-intensity mass was observed on T1-weighted imaging, heterogeneous high-intensity mass on T2-weighted imaging, and restricted diffusion on diffusion-weighted imaging. There were no abnormal findings on colonoscopy. Based on a preoperative examination, a differential diagnosis of either appendiceal schwannoma, carcinoid, or gastrointestinal stromal tumor was considered. During surgery, a large appendiceal mass and multiple swollen perilesional lymph nodes were observed. Therefore, ileocecal resection and D3 lymph node dissection were performed. Pathological and immunohistochemical analyses confirmed the diagnosis of appendiceal schwannoma. There were numerous swollen lymph nodes in the mesenteric region. The lymph nodes revealed reactive lymphoid hyperplasia, with enlarged follicles of various sizes and shapes with an irregular distribution. Almost all lymphocytes, except those at the germinal centers, were small. CONCLUSION Gastrointestinal schwannoma is characterized by lymph node swelling. Appendiceal schwannoma may have characteristics, including peritumoral lymph node swelling, similar to other types of gastrointestinal schwannoma such as that in the stomach. Thus, this characteristic can be a diagnostic clue for appendiceal schwannoma.
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Affiliation(s)
- Kunihito Suzuki
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Elly Arizono
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Hidehiro Kumita
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kenta Kasahara
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koichiro Tasaki
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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13
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Differentiation of gastric schwannomas from gastrointestinal stromal tumors by CT using machine learning. Abdom Radiol (NY) 2021; 46:1773-1782. [PMID: 33083871 DOI: 10.1007/s00261-020-02797-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify schwannomas from gastrointestinal stromal tumors (GISTs) by CT features using Logistic Regression (LR), Decision Trees (DT), Random Forest (RF), and Gradient Boosting Decision Tree (GBDT). METHODS This study enrolled 49 patients with schwannomas and 139 with GISTs proven by pathology. CT features with P < 0.1 derived from univariate analysis were inputted to four models. Five machine learning (ML) versions, multivariate analysis, and radiologists' subjective diagnostic performance were compared to evaluate diagnosis performance of all the traditional and advanced methods. RESULTS The CT features with P < 0.1 were as follows: (1) CT attenuation value of unenhancement phase (CTU), (2) portal venous enhancement (CTV), (3) degree of enhancement in the portal venous phase (DEPP), (4) CT attenuation value of portal venous phase minus arterial phase (CTV-CTA), (5) enhanced potentiality (EP), (6) location, (7) contour, (8) growth pattern, (9) necrosis, (10) surface ulceration, (11) enlarged lymph node (LN). LR (M1), RF, DT, and GBDT models contained all of the above 11 variables, while LR (M2) was developed using six most predictive variables derived from (M1). LR (M2) model with AUC of 0.967 in test dataset was thought to be optimal model in differentiating the two tumors. Location in gastric body, exophytic and mixed growth pattern, lack of necrosis and surface ulceration, enlarged lymph nodes, and larger EP were the most important CT features suggestive of schwannomas. CONCLUSION LR (M2) provided the optimal diagnostic potency among other ML versions, multivariate analysis, and radiologists' performance on differentiation of schwannomas from GISTs.
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14
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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: 18] [Impact Index Per Article: 4.5] [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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15
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Yanagawa S, Kagemoto K, Tanji H, Kodama S, Takeshima Y, Sumimoto K. A Rare Case of Gastric Schwannoma: A Case Report and Literature Review. Case Rep Oncol 2020; 13:330-335. [PMID: 32308600 PMCID: PMC7154269 DOI: 10.1159/000506450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
In general, schwannoma is a benign and slow-glowing neoplasm that rarely occurs in the gastrointestinal tract as a submucosal tumor (SMT), with the most common site being the stomach. As gastric schwannoma (GS) is a rare tumor, there is limited data in the literature about its clinical features. The diagnosis of schwannoma can only be made by pathological examination with positive staining for S-100 protein. It is necessary to obtain an accurate diagnosis to introduce optimal treatment options preoperatively. However, a precise diagnosis of GS is difficult, even with modern imaging techniques. On the other hand, a complete resection with a negative surgical margin (R0) of GS is considered the best treatment, with an excellent prognosis. We present a case of a 66-year-old female patient who underwent laparoscopic-assisted wedge gastrectomy for gastric SMT, pathologically diagnosed as GS, with positive staining for S-100 protein and negative for c-kit and CD34. At 12-month follow-up after surgery, there was no recurrence or metastasis of GS. Our treatment is appropriate and effective in case of GS exceeding 50 mm.
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Affiliation(s)
| | - Kenichi Kagemoto
- Department of Internal Medicine, Yoshida General Hospital, Akitakata City, Japan
| | - Hidehiro Tanji
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | - Shinya Kodama
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Sumimoto
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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16
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Gastric Gastrointestinal Stromal Tumors (GIST): a Case Series and Current State of the Art in the Workup and Treatment of This Rare Disease. J Gastrointest Cancer 2020; 50:548-555. [PMID: 29192406 DOI: 10.1007/s12029-017-0034-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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Chen Z, Yang J, Sun J, Wang P. Gastric gastrointestinal stromal tumours (2-5 cm): Correlation of CT features with malignancy and differential diagnosis. Eur J Radiol 2019; 123:108783. [PMID: 31841880 DOI: 10.1016/j.ejrad.2019.108783] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/20/2019] [Accepted: 11/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to investigate the computed tomography (CT) features of 2-5 cm gastric gastrointestinal stromal tumors (GISTs), schwannomas and leimyomas which have close relationship with malignancy evaluation and differential diagnosis. METHOD Seventy-six patients with pathologically confirmed gastric submucosal tumors (SMTs) between 2-5 cm were included in this study, including 60 GISTs, 10 schwannomas and 6 leiomyomas. CT imaging features were reviewed and quantitative parameters including CT values during nonenhanced phase (CTV-N), portal phase (CTV-P) and delayed phase (CTV-D) were recorded. The association of CT features with mitotic counts of GISTs and the significantly different CT features between GISTs and benign SMTs were analyzed. RESULTS The lobulated contour was significantly more common in GISTs with high mitoses (P < 0.05). The value of CTV-D/CTV-P was significantly lower in GISTs with high mitoses (P < 0.05) and it was an independent predictor for high-mitosis GISTs (P = 0.049, odds ratio [OR] = 186.445) with an area under the curve (AUC) of 0.722. CT features including heterogeneous enhancement and presence of necrosis or cystic degeneration were significantly suggestive of GISTs instead of benign SMTs (P < 0.05). The value of CTV-D/CTV-P was significantly higher in schwannomas than that in GISTs (P < 0.05) with an AUC of 0.853. The value of CTV-P/CTV-N was significantly lower in leiomyomas than that in GISTs (P < 0.05) with an AUC of 0.883. CONCLUSIONS Some qualitative and quantitative parameters on contrast-enhanced CT can be helpful in preoperative diagnosis and risk stratification of 2-5 cm gastric GISTs.
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Affiliation(s)
- Zeyang Chen
- Department of General Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China
| | - Jiali Sun
- Department of Radiology, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China
| | - Pengyuan Wang
- Department of General Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China.
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18
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Yoo J, Kim SH, Han JK. Multiparametric MRI and 18F-FDG PET features for differentiating gastrointestinal stromal tumors from benign gastric subepithelial lesions. Eur Radiol 2019; 30:1634-1643. [PMID: 31781931 DOI: 10.1007/s00330-019-06534-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate whether multiparametric magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET) can be helpful in differentiating gastrointestinal stromal tumors (GISTs) from non-GISTs and high-risk GISTs from low-risk GISTs. METHODS This retrospective study included 56 patients with pathologically confirmed GISTs (n = 39), leiomyoma (n = 8), schwannoma (n = 5), heterotopic pancreas (n = 3), and glomus tumor (n = 1) who underwent MRI and/or PET examinations. Two radiologists reviewed MRI regarding location, shape, contour, growth pattern, margin, signal intensity (SI) on T1- (T1WI) and T2-weighted images (T2WI), degree and pattern of enhancement, hemorrhage, and necrosis. Mean apparent diffusion coefficient (ADC) and maximum standardized uptake value (SUVmax) were measured. Imaging features were compared among non-GISTs, low-risk GISTs, and high-risk GISTs using uni- and multivariate statistical analyses. RESULTS Size, longitudinal location, shape, contour, growth pattern, SI on T1- and T2WI, enhancement pattern, hemorrhage, necrosis, ADC, and SUVmax were significantly different among non-GISTs, low-risk GISTs, and high-risk GISTs (p < 0.05). On multivariate analysis, SI on T2WI (hazard ratio [HR], 66.0; p = 0.002) was the only independent variable for differentiating GISTs from non-GISTs whereas enhancement pattern (HR, 56.0; p = 0.041), ADC (HR, 0.997; p = 0.01), and SUVmax (HR, 2.08; p = 0.027) were significant features for differentiating between high-risk and low-risk GISTs. CONCLUSIONS Several qualitative and quantitative MRI and PET features including ADC and SUVmax values are significantly different among non-GISTs, low-risk GISTs, and high-risk GISTs. Multiparametric information obtained from MRI with or without PET can be useful for differentiation of gastric subepithelial tumors as well as for determining patients' management and prognosis. KEY POINTS • Several qualitative MRI features are helpful in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs as well as high-risk GISTs from low-risk GISTs. • Apparent diffusion coefficient value on diffusion-weighted imaging can be useful in distinguishing GISTs from non-GISTs as well as high-risk GISTs from low-risk GISTs. • PET has the potential to distinguish between high-risk and low-risk GISTs.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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19
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Huh CW, Jung DH, Kim JS, Shin YR, Choi SH, Kim BW. CT Versus Endoscopic Ultrasound for Differentiating Small (2-5 cm) Gastrointestinal Stromal Tumors From Leiomyomas. AJR Am J Roentgenol 2019; 213:586-591. [PMID: 31063418 DOI: 10.2214/ajr.18.20877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. Abdominal CT or endoscopic ultrasound is recommended for the evaluation of gastric subepithelial tumors. However, few studies have compared the diagnostic performance of these two methods. We compared the diagnostic performance of CT versus endoscopic ultrasound for gastric subepithelial tumors smaller than 5 cm. We also identified significant CT findings associated with the diagnosis of gastrointestinal stromal tumors. MATERIALS AND METHODS. Seventy-one patients with pathologically proven gastric subepithelial tumors were enrolled. We examined the diagnostic performance of CT compared with endoscopic ultrasound. We analyzed CT findings, including the location, long diameter (LD), short diameter (SD), LD-SD ratio, contour, margin, growth pattern, degree and pattern of enhancement, attenuation value, intralesional necrosis, calcification, hemorrhage, surface dimpling, and perilesional lymph node. RESULTS. Endoscopic ultrasound had a sensitivity of 77.6%, specificity of 61.5%, PPV of 90.0%, NPV of 38.1%, and accuracy of 74.6%. CT had a sensitivity of 84.5%, specificity of 53.8%, PPV of 89.1%, NPV of 43.8%, and accuracy of 78.9%. Multivariate analysis revealed that the presence of intralesional necrosis (odds ratio [OR], 10.88; p = 0.037) and an LD-SD ratio less than 1.5 (OR, 32.37; p = 0.002) were independent CT findings for the diagnosis of gastrointestinal stromal tumors. CONCLUSION. CT is as effective as endoscopic ultrasound for the diagnosis of gastric subepithelial tumors smaller than 5 cm. Tumors with intralesional necrosis and an LD-SD ratio less than 1.5 may require further pathologic diagnosis.
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Affiliation(s)
- Cheal Wung Huh
- Department of Internal Medicine, Division of Gastroenterology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 665, Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Seoul, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joon Sung Kim
- Department of Internal Medicine, Division of Gastroenterology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 665, Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Seoul, Korea
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Ho Choi
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, Division of Gastroenterology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 665, Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Seoul, Korea
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20
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Liu M, Liu L, Jin E. Gastric sub-epithelial tumors: identification of gastrointestinal stromal tumors using CT with a practical scoring method. Gastric Cancer 2019; 22:769-777. [PMID: 30535637 DOI: 10.1007/s10120-018-00908-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine CT features that can identify gastrointestinal stromal tumors (GISTs) among gastric sub-epithelial tumors (SETs) and to explore a practical scoring method. METHODS Sixty-four patients with gastric SETs (51 GISTs and 13 non-GISTs) from hospital I were included for primary analyses, and 92 (67 GISTs and 25 non-GISTs) from hospital II constituted a validation cohort. Pre-operative CT images were reviewed for imaging features: lesion location, growth pattern, lesion margin, enhancement pattern, dynamic pattern, attenuation at each phasic images and presence of necrosis, superficial ulcer, calcification, and peri-lesion enlarged lymph node (LN). Clinical and CT features were compared between the two groups (GISTs versus non-GISTs) and a GIST-risk scoring method was developed; then, its performance for identifying GISTs was tested in the validation cohort. RESULTS Seven clinical and CT features were significantly suggestive of GISTs rather than non-GISTs: older age (> 49 years), non-cardial location, irregular margin, lower attenuation on unenhanced images (≤ 43 HU), heterogeneous enhancement, necrosis, and absence of enlarged LN (p < 0.05). At validation step, the established scoring method with cut-off score dichotomized into ≥ 4 versus < 4 for identifying GISTs revealed an AUC of 0.97 with an accuracy of 92%, a sensitivity of 100% and a negative predictive value (NPV) of 100%. CONCLUSIONS Gastric GISTs have special CT and clinical features that differ from non-GISTs. With a simple and practical scoring method based on the significant features, GISTs can be accurately differentiated from non-GISTs.
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Affiliation(s)
- Ming Liu
- Department of Radiotherapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Liheng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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21
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Wang W, Cao K, Han Y, Zhu X, Ding J, Peng W. Computed tomographic characteristics of gastric schwannoma. J Int Med Res 2019; 47:1975-1986. [PMID: 30871392 PMCID: PMC6567782 DOI: 10.1177/0300060519833539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to characterize the computed tomographic (CT) features of gastric schwannoma (GS). Methods We retrospectively reviewed CT images of 19 cases of histologically proven GS between January 2010 and December 2015. Tumor location, size, contour, margin, growth pattern, and degree and pattern of enhancement, perigastric lymph nodes, ulceration, necrosis, and calcification were evaluated. Results GS was located in the gastric body (73.7%), gastric antrum (15.8%), and gastric fundus (10.5%), with a mean maximum diameter of 4.5 ± 1.8 cm. All tumors presented as oval, well-defined solid masses, with exophytic (36.8%), endoluminal (15.8%), or mixed (47.4%) growth patterns. Ulcers (57.9%) and perigastric lymph nodes (47.4%) were observed. Moderate enhancement (87.5%) was observed in the portal phase. Eighteen (94.7%) cases showed homogeneous enhancement. Conclusions GS typically presents as a mass in the stomach with an exophytic or mixed growth pattern, moderate homogeneous enhancement, and is prone to be accompanied by perigastric lymph node inflammatory reactive swelling. Larger GSs are more likely to be associated with ulcers.
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Affiliation(s)
- Wei Wang
- 1 Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Kaiming Cao
- 3 Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Yang Han
- 4 Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xiaoli Zhu
- 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China.,5 Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China
| | - Jianhui Ding
- 1 Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Weijun Peng
- 1 Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
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22
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Mekras A, Krenn V, Perrakis A, Croner RS, Kalles V, Atamer C, Grützmann R, Vassos N. Gastrointestinal schwannomas: a rare but important differential diagnosis of mesenchymal tumors of gastrointestinal tract. BMC Surg 2018; 18:47. [PMID: 30045739 PMCID: PMC6060462 DOI: 10.1186/s12893-018-0379-2] [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: 07/21/2017] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Schwannomas 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. METHODS Seven 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. RESULTS The 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. CONCLUSIONS Schwannomas 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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Affiliation(s)
- Alexandros Mekras
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Vasileios Kalles
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Cem Atamer
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
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Rohit M, Bhatt A, Cruise M, Wearsch PA, Goldblum JR, Sturgis CD. Endoscopic ultrasound FNA: An illustrated review of spindle cell neoplasms of the upper gastrointestinal tract including a novel case of gastric plexiform fibromyxoma. Diagn Cytopathol 2018; 46:730-738. [PMID: 30043412 DOI: 10.1002/dc.24040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
Abstract
Plexiform fibromyxoma (PF) is a recently-described and rare mesenchymal neoplasm of the gastric wall. A few small case series reports of this spindle cell entity exist in the surgical pathology literature, but to our knowledge no prior endoscopic ultrasound guided fine needle aspiration cytology examples have been reported. In clinical practice, mural gastrointestinal (GI) lesions are often initially evaluated by endoscopic ultrasound guided (EUS) fine needle aspiration (FNA). In addition, newer EUS fine needle biopsy techniques also allow for reliable retrieval of core tissue samples with intact cellular architecture, making EUS histopathologic analyses possible. We report a combined EUS FNA and core biopsy case of PF and correlate the findings with imaging results. The cytomorphology of PF is described and illustrated, and important entities in the differential diagnosis of upper GI spindle cell lesions (including GI stromal tumor, leiomyoma, schwannoma, carcinoid tumor, desmoid-type fibromatosis, and inflammatory fibroid polyp) are reviewed. Illustrated examples of relevant cytomorphologic, cell block histomorphologic and immunohistochemical characteristics are emphasized.
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Affiliation(s)
- Maitreyi Rohit
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
| | - Amit Bhatt
- Department of Gastrointestinal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael Cruise
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Pamela A Wearsch
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
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Gastric Schwannoma: A Case Report and Review of the Literature for Gastric Submucosal Masses Distinction. Case Rep Med 2018; 2018:1230285. [PMID: 29849652 PMCID: PMC5914132 DOI: 10.1155/2018/1230285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/03/2018] [Accepted: 03/07/2018] [Indexed: 12/16/2022] Open
Abstract
Schwannomas origin from Schwann cells sheath and generally are benign, slow-growing, and asymptomatic neoplasms which frequently appear in the head and neck. Although gastrointestinal schwannoma is really rare, the most affected organ in GI system is the stomach. Gastric schwannoma forms 0.2% of all gastric tumors. This neoplasm is always detected as a submucosal mass, the same as other gastrointestinal stromal tumors. Although these tumors have almost the same presentations, they are completely different at therapeutic options and prognoses. Hence, it is important to distinguish them apart and make an accurate diagnosis to optimize treatment outcomes. Herein, we report a case of 28-year-old woman with frequent vomiting and abdominal pain caused by 5 × 6 cm schwannoma in the antrum of the stomach. This is a rare case of gastric outlet obstruction due to a massive schwannoma. In addition, all other probable submucosal masses will be discussed at different aspects.
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25
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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
Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the "gold standard." We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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27
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Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors. Case Rep Gastrointest Med 2017; 2017:9615359. [PMID: 28573055 PMCID: PMC5440794 DOI: 10.1155/2017/9615359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022] Open
Abstract
Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians, and the precise differential diagnosis between GS and other gastric submucosal tumors remains difficult preoperatively. The present study reports a case of GS misdiagnosed as gastrointestinal stromal tumor and reviews the clinical, imaging, and pathological features, treatment, and follow-up of 221 patients with GS previously reported in the English literature. Although GS is rare, the case reported in the current study highlights the importance of including GS in differential diagnoses of gastric submucosal tumors. Furthermore, the findings of the review suggest that although many cases are asymptomatic, the most common symptoms are abdominal pain or discomfort, not gastrointestinal bleeding, and malignant GSs present with clinical symptoms more commonly. Although large-sample multicenter studies on the efficacy, safety, and oncological outcomes of minimally invasive techniques are required, the findings presented herein may be helpful for clinicians when diagnosing or treating GS.
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He MY, Zhang R, Peng Z, Li Y, Xu L, Jiang M, Li ZP, Feng ST. Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography. Oncol Lett 2017; 13:3746-3752. [PMID: 28521476 DOI: 10.3892/ol.2017.5955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 01/31/2017] [Indexed: 02/07/2023] Open
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.
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Affiliation(s)
- Ming-Yan He
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Rong Zhang
- Department of Radiology, The Tumor Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, WA 6009, Australia
| | - Mengjie Jiang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
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Ra JC, Lee ES, Lee JB, Kim JG, Kim BJ, Park HJ, Park SB, Choi BI. Diagnostic performance of stomach CT compared with endoscopic ultrasonography in diagnosing gastric subepithelial tumors. Abdom Radiol (NY) 2017; 42:442-450. [PMID: 27654991 DOI: 10.1007/s00261-016-0906-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the diagnostic ability of multi-detector computed tomography (MDCT) compared to endoscopic ultrasonography (EUS) as a standard reference, and investigate the factors influencing the detection of small gastric subepithelial tumors (SETs) (<5 cm) on MDCT with stomach protocol. METHODS We retrospectively investigated 70 patients who were suspected with gastric SETs on esophagogastroduodenoscopy (EGD), and underwent both EUS and computed tomographic (CT) scanning. EUS was performed by two gastroenterologists, and location, size, echotexture, echogenicity, and layer of origin were described when gastric SETs were detected on EUS. MDCTs were reviewed based on consensus of two radiologists blinded to the EUS result. Size, location, enhancement pattern, and contour of the lesion detected on CT were described. We calculated the diagnostic ability of CT compared to EUS with respect to detection of gastric SETs, and investigated the factors influencing detection of SETs on CT. We also used receiver operating characteristic (ROC) curve to obtain optimal cut-off size for predicting CT visibility of small SETs. RESULTS Of the 70 patients, who underwent both CT and EUS due to suspicious presence of SET on EGD, EUS detected 56 probable cases of SET and 14 cases of external compression. CT led to detection of 39 cases of SET out of the 56 cases. Sensitivity and specificity of CT was 69.6% and 100.0%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of CT were 100.0% and 45.2%, respectively. There was a significant difference in mean size of CT-detected lesions compared to CT-invisible lesions (14.36 mm vs. 8.52 mm, p < 0.001), but no significant differences in terms of layer of origin and location between these two groups (p > 0.5) were observed. The ROC analysis revealed that the optimal cut-off value, also referred to prediction of CT visibility, was 10 mm. Out of 70 cases, 26 cases (37.14%) were identified as external compression or insignificant lesions such as lipoma, hemangioma, lymphangioma, or gastritis cystica on CT, and do not require regular follow-up. CONCLUSIONS Stomach CT shows good feasibility with respect to depiction of small SETs, especially in cases where size is larger than 10 mm. Henceforth, it is proposed that stomach CT would be a complimentary or problem-solving tool for SET in evaluating the presence of external compression and characterization of tumors.
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Affiliation(s)
- Joon Chul Ra
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea.
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Jae Gyu Kim
- Department of Gastroenterology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Beom Jin Kim
- Department of Gastroenterology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
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30
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Park HC, Son DJ, Oh HH, Oak CY, Kim MY, Chung CY, Myung DS, Kim JS, Cho SB, Lee WS, Joo YE. Endoscopic ultrasonographic characteristics of gastric schwannoma distinguished from gastrointestinal stromal tumor. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 65:21-6. [PMID: 25603850 DOI: 10.4166/kjg.2015.65.1.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. METHODS A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. RESULTS GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada's classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. CONCLUSIONS The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.
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Affiliation(s)
- Hyung-Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Jun Son
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung-Hoon Oh
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chan-Young Oak
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi-Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Cho-Yun Chung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dae-Seong Myung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Sun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Wan-Sik Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Eun Joo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Richman DM, Tirumani SH, Hornick JL, Fuchs CS, Howard S, Krajewski K, Ramaiya N, Rosenthal M. Beyond gastric adenocarcinoma: Multimodality assessment of common and uncommon gastric neoplasms. Abdom Radiol (NY) 2017; 42:124-140. [PMID: 27645897 DOI: 10.1007/s00261-016-0901-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite advances in molecular biology, imaging, and treatment, gastric neoplasms remain a significant cause of morbidity and mortality; gastric adenocarcinoma is the fifth most common malignancy and third most common cause of death worldwide (Brenner et al., Methods Mol Biol 472:467-477, 2009; Howson et al. Epidemiol Rev 8:1-27, 1986; Roder, Gastric Cancer 5(Suppl 1):5-11, 2002; Ferlay et al., GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. International Agency for Research on Cancer, 2013). Because of both the frequency at which malignant gastric tumors occur as well as the worldwide impact, gastric neoplasms remain important lesions to identify and characterize on all imaging modalities. Despite the varied histologies and behaviors of these neoplasms, many have similar imaging features. Nonetheless, the treatment, management, and prognosis of gastric neoplasms vary by pathology, so it is essential for the radiologist to make every effort to differentiate between these lesions and raise the less common entities as differential diagnostic considerations when appropriate.
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32
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Beduya D, Parasher G. Evaluation and Management of Mucosal and Submucosal Lesions in the Foregut. UPPER ENDOSCOPY FOR GI FELLOWS 2017:139-150. [DOI: 10.1007/978-3-319-49041-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Romdhane H, Cheikh M, Mzoughi Z, Slama SB, Ennaifer R, Belhadj N. Gastric Schwannoma: A Case Report. Clin Pract 2016; 6:849. [PMID: 28028429 PMCID: PMC5159778 DOI: 10.4081/cp.2016.849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/29/2016] [Accepted: 09/22/2016] [Indexed: 12/13/2022] Open
Abstract
Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis via endoscopy is a challenging issue due to the difficulty of differentiation from other submucosal tumors. A 54-year-old woman presented with epigastric pain persisting for the last 10 months. Upper endoscopy revealed an elevated submucosal mass of the gastric antrum. The overlying mucosa was normal. Biopsy specimens yielded only unspecific signs of mild inactive chronic inflammation. Endoscopic ultrasound examination noted a hypoechoic homogeneous mass lesion located in the gastric antrum. The mass appeared to arise from the muscularis propria, and there was no perigastric lymphadenopathy. A contrast-enhanced computed tomography scan identified a homogeneous round mass and arising from the antrum of the stomach. Submucosal tumor was suspected and surgical intervention was recommended. The patient underwent an elective laparoscopic partial gastrectomy. The histopathologic features and immunohistochemical-staining pattern were consistent with a benign gastric schwannoma. Our patient shows no recurrence with a follow-up of one year. The definitive diagnosis of gastric schwannomas requires immunohistochemical studies. Complete margin negative surgical resection, as in this case, is the curative treatment of choice. The clinical course is generally benign.
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Affiliation(s)
- Hayfa Romdhane
- Department of Gastroenterology, Mongi Slim University Hospital and University of Tunis El Manar , Tunis, Tunisia
| | - Myriam Cheikh
- Department of Gastroenterology, Mongi Slim University Hospital and University of Tunis El Manar , Tunis, Tunisia
| | - Zeineb Mzoughi
- Department of Visceral Surgery, Mongi Slim Hospital , Sidi Daoued, La Marsa, Tunisia
| | - Sana Ben Slama
- Department of Pathology, Mongi Slim Hospital , Sidi Daoued, La Marsa, Tunisia
| | - Rym Ennaifer
- Department of Gastroenterology, Mongi Slim University Hospital and University of Tunis El Manar , Tunis, Tunisia
| | - Najet Belhadj
- Department of Gastroenterology, Mongi Slim University Hospital and University of Tunis El Manar , Tunis, Tunisia
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Yoon JM, Kim GH, Park DY, Shin NR, Ahn S, Park CH, Lee JS, Lee KJ, Lee BE, Song GA. Endosonographic Features of Gastric Schwannoma: A Single Center Experience. Clin Endosc 2016; 49:548-554. [PMID: 26975861 PMCID: PMC5152784 DOI: 10.5946/ce.2015.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/01/2015] [Accepted: 12/05/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Gastric schwannomas are rare benign mesenchymal tumors that are difficult to differentiate from other mesenchymal tumors with malignant potential, such as gastrointestinal stromal tumors. This study aimed to evaluate the characteristic findings of gastric schwannomas via endoscopic ultrasonography (EUS). METHODS We retrospectively reviewed the EUS findings of 27 gastric schwannoma cases that underwent surgical excision at Pusan National University Hospital during 2007 to 2014. RESULTS Gastric schwannomas were mainly located in the middle third of the stomach with a mean tumor size of 32 mm. All lesions exhibited hypoechoic echogenicity, and 24 lesions (88.9%) exhibited heterogeneous echogenicity. Seventeen lesions (63.0%) exhibited decreased echogenicity compared to the normal proper muscle layer. Distinct borders were observed in 24 lesions (88.9%), lobulated margins were observed in six lesions (22.2%), and marginal haloes were observed in 24 lesions (88.9%). Hyperechogenic spots were observed in 21 lesions (77.8%), calcifications were observed in one lesion (3.7%), and cystic changes were observed in two lesions (7.4%). CONCLUSIONS During EUS, gastric schwannomas appear as heterogeneously hypoechoic lesions with decreased echogenicity compared to the normal proper muscle layer. These features may be helpful for differentiating gastric schwannomas from other mesenchymal tumors.
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Affiliation(s)
- Jong Min Yoon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Na Ri Shin
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Sangjeong Ahn
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Chul Hong Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin Sung Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Key Jo Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Vargas Flores E, Bevia Pérez F, Ramirez Mendoza P, Velázquez García JA, Ortega Román OA. Laparoscopic resection of a gastric schwannoma: A case report. Int J Surg Case Rep 2016; 28:335-339. [PMID: 27788385 PMCID: PMC5080746 DOI: 10.1016/j.ijscr.2016.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 12/16/2022] Open
Abstract
Schwannomas, generally present as a slow and asymptomatic growing mass and they rarelly appear in the gastrointestinal tract. When they do, they commonly do in the stomach. Gastric schwannomas are benign tumors with an excellent prognosis. Immunohystochemical study on the surgical specimen should aid the final diagnosis of a gastric schwannoma. Introduction Mesenchymal tumors of the gastrointestinal tract are a group spindle cell tumors which include gastrointestinal stromal tumors, leiomyomas, leiomyosarcomas and schwannomas (Nishida and Hirota, 2000). Schwannomas generally present as a slow and asymptomatic growing mass in the gastrointestinal tract typically arising in the gastric submucosa accounting for up to 0.2% of gastric tumors (Melvin and Wilkinson, 1993; Sarlomo-Rikala M, Miettinen, 1995). Treatment with negative surgical margin resection (as approached in this case) is considered the standard treatment. Presentation of case A 60-year-old woman was referred to our general surgery service for dyspepsia. During her evaluation a gastric mass was incidentally found on upper GI endoscopy which showed a submucosal exophytic neoplasm at the gastric antrum. The patient was discharged following an uneventful recovery from a successful surgical laparoscopic tumor resection. Discussion Schwannomas are benign neurogenic tumors that originate from Schwann cells. They commonly occur in the head and neck but are rare in the GI tract (Menno et al., 2010). The differential diagnosis between gastric schwannomas and GISTs can be difficult in the preoperative assessment. With the advent of immunohistochemical staining techniques it is now possible to make a differential diagnosis based on their distinctive immunophenotypes. Gastric schwannomas are consistently positive for S-100 protein and negative for c-kit; conversely, 95% of GISTs are positive for c-kit and negative for S-100 protein in up to 98 to 99% of the cases. Conclusion Gastric schwannomas should be included in the differential diagnosis of any gastric submucosal mass. Negative margin resection as seen with this patient is the standard surgical treatment as there is low malignant transformation potential.
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Affiliation(s)
- Edgar Vargas Flores
- Department of General Surgery, Hospital de especialidades, Centro Médico Nacional La Raza, Seris y Zaachila sin número. Colonia La raza, Delegación Azcapotzalco, 02990, D.F., Mexico.
| | - Francisco Bevia Pérez
- Department of General Surgery, Hospital de especialidades, Centro Médico Nacional La Raza, Seris y Zaachila sin número. Colonia La raza, Delegación Azcapotzalco, 02990, D.F., Mexico.
| | - Pablo Ramirez Mendoza
- Department of Pathology, Hospital de especialidades, Centro Médico Nacional La Raza, Seris y Zaachila sin número, Colonia La raza, Delegación Azcapotzalco, 02990, D.F., Mexico.
| | - José Arturo Velázquez García
- Department of General Surgery, Hospital de especialidades, Centro Médico Nacional La Raza, Seris y Zaachila sin número. Colonia La raza, Delegación Azcapotzalco, 02990, D.F., Mexico.
| | - Oscar Alejandro Ortega Román
- Department of General Surgery, Hospital de especialidades, Centro Médico Nacional La Raza, Seris y Zaachila sin número. Colonia La raza, Delegación Azcapotzalco, 02990, D.F., Mexico.
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Ji JS, Lu CY, Mao WB, Wang ZF, Xu M. Gastric schwannoma: CT findings and clinicopathologic correlation. ACTA ACUST UNITED AC 2016; 40:1164-9. [PMID: 25316564 DOI: 10.1007/s00261-014-0260-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the computed tomography (CT) imaging characteristics of gastric schwannoma. METHODS Eight cases of gastric schwannomas confirmed by surgery and pathology were retrospectively analyzed by CT. We reviewed the CT findings of gastric schwannomas for the following characteristics: tumor location, size, contour, margin, growth pattern, enhancement pattern, the presence or absence of necrosis, and perigastric lymph nodes. RESULTS The tumors were located in the lesser curvature of gastric body (n = 5) and greater curvature of the gastric antrum (n = 3) with a median size of 4.8 cm (range 1.7-11.4 cm). Gastric schwannomas appeared as submucosal tumors with CT features of ovoid (7/8 patients), well-defined (8/8) and exophytic (4/8) or mixed (3/8) growth patterns. On dynamic CT examination, the tumors displayed homogeneous enhancement in seven cases and heterogeneous enhancement in one case. Solid parts of eight tumors demonstrated mild enhancement during the arterial phase and strengthened progressive enhancement during the venous and delayed phases. Two cases had perigastric lymph nodes. CONCLUSIONS Gastric schwannomas typically manifested as ovoid, well-defined, exophytic, or mixed growth pattern masses on CT. Homogeneous progressive enhancement on dynamic CT is a characteristic finding of gastric schwannoma.
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Affiliation(s)
- Jian-song Ji
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, 289 Kuocang Road, Lishui, Zhejiang, 32300, China,
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Tao K, Chang W, Zhao E, Deng R, Gao J, Cai K, Wang G, Zhang P. Clinicopathologic Features of Gastric Schwannoma: 8-Year Experience at a Single Institution in China. Medicine (Baltimore) 2015; 94:e1970. [PMID: 26559271 PMCID: PMC4912265 DOI: 10.1097/md.0000000000001970] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/04/2015] [Accepted: 10/13/2015] [Indexed: 12/16/2022] Open
Abstract
To explore the clinicopathologic characteristics, diagnosis, treatment, and prognosis of gastric schwannoma in the imatinib era.The clinicopathologic characteristics and postoperative outcomes of patients diagnosed with gastric schwannoma at our institution between January 2007 and February 2015 were retrospectively collected and analyzed.The main patient complaint was epigastric pain or discomfort. Tumor sizes ranged from 15 to 80 mm (mean, 57.1 mm). In 17 patients, the tumors were located in the body of the stomach. A total of 20 patients were preoperatively misdiagnosed with a gastrointestinal stromal tumor. The rate of correct preoperative diagnosis was only 3.3%. All patients underwent surgical resection and showed strong S-100 protein positivity. Laparoscopic surgery for gastric schwannoma was associated with less blood loss and a shorter postoperative hospital stay than open surgery (P < 0.01). Total 28 patients were disease free without recurrence or metastasis at a median follow-up time of 50 months.Gastric schwannoma is often preoperatively misdiagnosed as gastric gastrointestinal stromal tumor. Laparoscopic resection of gastric schwannoma is considered safe and effective, and it may be the preferred surgery for most small- and moderate-sized tumors. The long-term outcome is excellent, as this type of neoplasm is uniformly benign.
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Affiliation(s)
- Kaixiong Tao
- From the Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kang HC, Menias CO, Gaballah AH, Shroff S, Taggart MW, Garg N, Elsayes KM. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics 2014; 33:1673-90. [PMID: 24108557 DOI: 10.1148/rg.336135507] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intramural gastric masses arise in the wall of the stomach (generally within the submucosa or muscularis propria), often with intact overlying mucosa. These tumors are typically mesenchymal in origin and have overlapping radiologic appearances. A combination of features such as location, attenuation, enhancement, and growth pattern may suggest one diagnosis over another. Gastrointestinal stromal tumors (GISTs) account for the majority of intramural tumors and can vary widely in appearance, from small intraluminal lesions to exophytic masses that protrude into the peritoneal cavity, commonly with areas of hemorrhage or necrosis. A well-circumscribed mass measuring -70 to -120 HU is a lipoma. Leiomyomas usually manifest as low-attenuation masses at the gastric cardia. Homogeneous attenuation is a noteworthy characteristic of schwannomas, particularly for larger lesions that might otherwise be mistaken for GISTs. A hypervascular mass in the antrum is a common manifestation of glomus tumors. Hemangiomas are also hypervascular but often manifest in childhood. Inflammatory fibroid polyps usually arise as a polypoid mass in the antrum. Inflammatory myofibroblastic tumors are infiltrative neoplasms with a propensity for local recurrence. Plexiform fibromyxomas are rare, usually antral tumors. Carcinoid tumors are epithelial in origin, but often submucosal in location, and therefore should be distinguished from other intramural lesions. Multiple carcinoid tumors are associated with hypergastrinemia, either in the setting of chronic atrophic gastritis or Zollinger-Ellison syndrome. Sporadic solitary carcinoid tumors not associated with hypergastrinemia have a higher rate of metastasis. Histopathologic analysis, including immunohistochemistry, is usually required for diagnosis of intramural masses.
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Affiliation(s)
- Hyunseon C Kang
- Departments of Diagnostic Radiology and Pathology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030; Department of Radiology, Mayo Clinic, Tucson, Ariz
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Choi YR, Kim SH, Kim SA, Shin CI, Kim HJ, Kim SH, Han JK, Choi BI. Differentiation of large (≥ 5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: radiologists' performance using CT. Eur J Radiol 2013; 83:250-60. [PMID: 24325848 DOI: 10.1016/j.ejrad.2013.10.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/19/2013] [Accepted: 10/30/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE To identify significant CT findings for the differentiation of large (≥ 5 cm) gastric gastrointestinal stromal tumors (GIST) from benign subepithelial tumors and to assess whether radiologists' performance in differentiation is improved with knowledge of significant CT criteria. MATERIALS AND METHODS One-hundred twenty patients with pathologically proven large (≥ 5 cm) GISTs (n=99), schwannomas (n=16), and leiomyomas (n=5) who underwent CT were enrolled. Two radiologists (A and B) retrospectively reviewed their CT images in consensus for the location, size, degree and pattern of enhancement, contour, growth pattern and the presence of calcification, necrosis, surface ulceration, or enlarged lymph nodes. CT findings considered significant for differentiation were determined using uni- and multivariate statistical analyses. Thereafter, two successive review sessions for the differentiation of GIST from non-GIST were independently performed by two other reviewers (C and D) with different expertise of 2 and 9 years using a 5-point confidence scale. At the first session, reviewers interpreted CT images without knowledge of significant CT findings. At the second session, the results of statistical analyses were provided to the reviewers. To assess improvement in radiologists' performance, a pairwise comparison of receiver operating curves (ROC) was performed. RESULTS Heterogeneous enhancement, presence of necrosis, absence of lymph nodes, and mean size of ≥ 6 cm were found to be significant for differentiating GIST from schwannoma (P<0.05). Non-cardial location, heterogeneous enhancement, and presence of necrosis were differential CT features of GIST from leiomyoma (P<0.05). Multivariate analyses indicated that absence of enlarged LNs was the only statistically significant variable for GIST differentiating from schwannoma. The area under the curve of both reviewers obtained using ROC significantly increased from 0.682 and 0.613 to 0.903 and 0.904, respectively, with information of the significant CT findings differentiating GISTs from non-GISTs (P<0.001). CONCLUSION Non-cardial location, heterogeneous enhancement, presence of necrosis, larger lesion size, and absence of lymphadenopathy are highly suggestive CT findings for large GISTs in differentiation from schwannomas or leiomyomas. Regardless of radiologists' expertise, diagnostic performance in differentiation can be significantly improved with knowledge of these CT findings.
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Affiliation(s)
- Ye Ra Choi
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea.
| | - Sun-Ah Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Hyung Jin Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Seong Ho Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
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Fujiwara S, Nakajima K, Nishida T, Takahashi T, Kurokawa Y, Yamasaki M, Miyata H, Takiguchi S, Mori M, Doki Y. Gastric schwannomas revisited: has precise preoperative diagnosis become feasible? Gastric Cancer 2013; 16:318-23. [PMID: 22907486 DOI: 10.1007/s10120-012-0186-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/31/2012] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Shinichi Fujiwara
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
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Okten RS, Kacar S, Kucukay F, Sasmaz N, Cumhur T. Gastric subepithelial masses: evaluation of multidetector CT (multiplanar reconstruction and virtual gastroscopy) versus endoscopic ultrasonography. ACTA ACUST UNITED AC 2013; 37:519-30. [PMID: 21822967 DOI: 10.1007/s00261-011-9791-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the role of multidetector computed tomography (MDCT) with multiplanar reconstruction (MPR) and virtual gastroscopy (VG) for detection and differentiation of gastric subepithelial masses (SEMs) by comparison with endoscopic ultrasonography (EUS). METHODS Forty-one patients with a suspected SEM were evaluated using EUS and MDCT. MDCT findings were analyzed based on the consensus of two radiologists who were blinded to the EUS findings. The analysis of the CT features included the location, size, and contours of the tumor, the presence of central dimpling, as well as the growth pattern, enhancement pattern, and enhancement degree. The long diameter (LD) and the short diameter (SD) of each lesion were measured and the LD/SD ratios were calculated. EUS and MDCT results were compared with histopathology for the pathologically proven lesions. For the non-pathologically proven lesions, MDCT results were compared with EUS. RESULTS Among the 41 patients, 34 SEMs were detected using EUS. For the detection of SEMs with MDCT, a sensitivity of 85.3%, a specificity of 85.7%, a positive predictive value of 96.7%, and a negative predictive value of 54.5% were calculated. The overall accuracy of MDCT for detecting and classifying the SEMs was 85.3 and 78.8%, respectively. CONCLUSIONS MDCT with MPR and VG is a valuable method for the evaluation of SEMs. Specific MDCT criteria for various SEMs may be helpful in making an accurate diagnosis.
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Affiliation(s)
- Riza Sarper Okten
- Department of Radiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Sihhiye, Ankara, Turkey.
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Zhong DD, Wang CH, Xu JH, Chen MY, Cai JT. Endoscopic ultrasound features of gastric schwannomas with radiological correlation: A case series report. World J Gastroenterol 2012; 18:7397-7401. [PMID: 23326151 PMCID: PMC3544048 DOI: 10.3748/wjg.v18.i48.7397] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 09/13/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023] Open
Abstract
Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract. They are usually misdiagnosed as other submucosal tumors preoperatively. Experience of the imaging features of gastric schwannomas is extremely limited. In this report, we summarize the features of a series of endoscopic ultrasound (EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate. We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results. Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity, and a well-demarcated margin. The tumors originated from the fourth layer. Cystic changes and calcification were uncommon. Marginal hypoechoic haloes were observed in two patients. The results described here were different from those of previous studies. In the EUS evaluation, the internal echogenicity of gastric schwannomas was heterogeneous and low, but slightly higher than that of muscularis propria. These features might help us differentiate gastric schwannomas from other submucosal tumors. Further investigation is needed to differentiate these mesenchymal tumors.
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Rodriguez E, Tellschow S, Steinberg DM, Montgomery E. Cytologic findings of gastric schwannoma: a case report. Diagn Cytopathol 2012; 42:177-80. [PMID: 24436245 DOI: 10.1002/dc.22913] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/16/2012] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Erika Rodriguez
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Guthrie G, Mullen R, Moses A. Gastric Schwannoma or GIST: accuracy of preoperative diagnosis? Scott Med J 2012; 56:236. [PMID: 22089050 DOI: 10.1258/smj.2011.011175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mesenchymal cell tumours of the gastrointestinal tract are rare in western society. Gastrointestinal stromal tumour (GIST) is the most common of this group of tumours. Gastric schwannoma is rarer, accounting for only 0.2% of all gastric tumours and 4% of all benign gastric neoplasms. Indeed, schwannoma has only been recognized as a primary gastrointestinal tumour in the last 20 years through advances in pathological techniques. We report a rare case of gastric schwannoma, the endoscopic and radiological features of which were indistinguishable from a GIST. Due to the diagnostic uncertainty, surgical resection is the treatment of choice. Development of more reliable diagnostic methods, such as endoscopic core biopsy, may help the accuracy of preoperative diagnosis.
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Affiliation(s)
- G Guthrie
- Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, Scotland, UK.
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Gastric schwannoma: a rare but important differential diagnosis of a gastric submucosal mass. Case Rep Surg 2012; 2012:280982. [PMID: 22924149 PMCID: PMC3423772 DOI: 10.1155/2012/280982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 07/18/2012] [Indexed: 12/11/2022] Open
Abstract
Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60-70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10-30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.
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Choi JW, Choi D, Kim KM, Sohn TS, Lee JH, Kim HJ, Lee SJ. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT. Korean J Radiol 2012; 13:425-33. [PMID: 22778564 PMCID: PMC3384824 DOI: 10.3348/kjr.2012.13.4.425] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 12/14/2011] [Indexed: 12/12/2022] Open
Abstract
Objective To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. Materials and Methods We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. Results Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). Conclusion Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.
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Affiliation(s)
- Jin Wook Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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CT, MRI, and PET findings of gastric schwannoma. Jpn J Radiol 2012; 30:602-5. [PMID: 22660866 DOI: 10.1007/s11604-012-0093-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/22/2012] [Indexed: 12/20/2022]
Abstract
Gastric schwannoma is a rare tumor that accounts for only 0.2 % of all gastric tumors. We report a case of gastric schwannoma that underwent computed tomography (CT), magnetic resonance imaging (MRI), and [(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET), and its histological confirmation was acquired. Gastric schwannoma showed high intensity on T2-weighted and diffusion-weighted MRI and high maximum standardized uptake on [(18)F]-FDG-PET. Lymphadenopathy close to the tumor was also found. Although diffusion-weighted MRI, [(18)F]-FDG-PET, and the presence of lymphadenopathy could suggest malignant tumors, the detail interpretation of the other CT and MRI findings may give a clue for the diagnosis of gastric schwannoma.
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Voltaggio L, Murray R, Lasota J, Miettinen M. Gastric schwannoma: a clinicopathologic study of 51 cases and critical review of the literature. Hum Pathol 2012; 43:650-9. [PMID: 22137423 PMCID: PMC3305846 DOI: 10.1016/j.humpath.2011.07.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 07/02/2011] [Indexed: 12/11/2022]
Abstract
Schwannoma is a rare gastrointestinal mesenchymal tumor, as the vast majority of gastric mesenchymal tumors are gastrointestinal stromal tumors. In this study, we analyzed clinicopathologically 51 gastric schwannomas. These tumors predominantly occurred in older adults with a marked female predominance (40 women and 11 men; median and mean ages, 60 and 58 years). They variably presented with gastric discomfort, bleeding, or rarely gastric outlet obstruction; and many were incidental findings during other medical procedures. The tumors ranged from 1 to 10.5 cm (median, 4.5 cm). The typical histologic features included spindle cells usually with microtrabecular architecture and focal nuclear atypia, and peritumoral lymphoid cuff, whereas features of soft tissue schwannomas, such as encapsulation, nuclear palisading, vascular hyalinization, and dilatation, were absent or infrequent. Median mitotic count was 2/50 high-power fields, with the highest count being 13/50 high-power fields. No malignant variants were recognized, and long-term follow-up did not reveal recurrences or metastases. Immunohistochemically, all examined tumors were S100 protein positive and most were also GFAP positive, whereas CD34 and NF68 were encountered rarely and all tumors were negative for HMB45, KIT, DOG1/Ano 1, smooth muscle actin, desmin, and synaptophysin. None of the 9 tumors studied contained gastrointestinal stromal tumor-specific KIT or PDGFRA mutations. Fluorescence in situ hybridization studies revealed multiple signals with BCR probe (chromosome 22) and centromeric probes for chromosomes 2 and 18 suggesting polyploidy. These findings indicate that gastric schwannoma is a distinctive form of peripheral nerve sheath tumor that in many ways differs from soft tissue schwannoma. It should be distinguished from gastrointestinal stromal tumor and other mesenchymal tumors of the gastrointestinal tract, such as the S100 protein-positive gastrointestinal clear cell sarcoma and metastatic melanoma.
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Affiliation(s)
- Lysandra Voltaggio
- George Washington University Hospital, Department of Pathology, Washington, DC
| | - Rebecca Murray
- George Washington University Hospital, Department of Pathology, Washington, DC
| | - Jerzy Lasota
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland
- Joint Pathology Center, Silver Spring, Maryland
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Kulkarni N, Andrews SJ, Rao V, Rajagopal KV. Case report: Benign porta hepatic schwannoma. Indian J Radiol Imaging 2011; 19:213-5. [PMID: 19881089 PMCID: PMC2766878 DOI: 10.4103/0971-3026.54888] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Schwannoma is a myelin sheath tumor that can occur almost anywhere in the body. The most common locations are the central nervous system, extremities, neck, mediastinum and retroperitoneum. Benign schwannomas in the porta hepatis are extremely rare and radiologically are diagnosed as either enlarged lymph nodes or bowel masses, such as gastrointestinal stromal tumors. In this location they usually produce symptoms by compressing adjacent structures and often present with obstructive jaundice. The preoperative diagnosis can be extremely difficult.
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Affiliation(s)
- Naveen Kulkarni
- Department of Radiology, Kasturba Medical College, Manipal-576 104, Karnataka, India
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Raber MH, Ziedses des Plantes CMP, Vink R, Klaase JM. Gastric Schwannoma Presenting as an Incidentaloma on CT-Scan and MRI. Gastroenterology Res 2010; 3:276-280. [PMID: 27942308 PMCID: PMC5139856 DOI: 10.4021/gr245w] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2010] [Indexed: 12/12/2022] Open
Abstract
A 67 year old female was referred because of an incidentaloma on CT-scan and MRI which showed a 5.0 cm large mass in the wall of the distal stomach. After an initial work-up which suggested a gastrointestinal stromal tumor (GIST), a partial gastrectomy with a Billroth II gastrojejunostomy was performed. The histological diagnosis was a schwannoma. Gastric schwannomas are rare tumors which comprise 0.2% of all gastric tumors and 4% of all benign gastric neoplasms with a peak of incidence in the 4th and 5th decade of life. Gastric schwannomas are usually asymptomatic, but can present with ulceration and/or gastrointestinal bleeding. Clinical, endoscopical, surgical, radiological and histological features of this case are described and the relevant literature is reviewed.
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Affiliation(s)
- Menno H Raber
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Robert Vink
- Laboratorium Pathologie Oost Nederland, Enschede, the Netherlands
| | - Joost M Klaase
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
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