Published online Apr 27, 2022. doi: 10.4240/wjgs.v14.i4.362
Peer-review started: December 8, 2021
First decision: January 8, 2022
Revised: February 24, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: April 27, 2022
Processing time: 136 Days and 19.5 Hours
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.
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.
Combined laparoscopic and endoscopic surgery is a minimally invasive and effective treatment option for large GSs.
Core Tip: Gastric schwannomas (GSs) do not have specific clinical and endoscopic characteristics. Therefore, preoperative diagnosis may be difficult, and they can be misdiagnosed as gastrointestinal stromal tumors. In addition, while laparoscopic resection is possible, it is difficult to determine the location of intraluminal tumors. In contrast, endoscopic resection is only suitable for small submucosal tumors. Here, we present a case of a GS excised using laparoscopic-gastroscopic cooperative surgery. Additionally, we performed a literature review on computed tomography findings and surgical interventions used in the management of gastrointestinal stromal tumors and GSs.