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Chen J, Sun L, Chen Y, Shi J, Zhang Y, Zhu L, Ding B, Ding C, Zhu H, Zhu L, Yu H. Imaging features and preoperative diagnostic insights of esophageal schwannomas as a rare type. Clin Imaging 2025; 122:110471. [PMID: 40250318 DOI: 10.1016/j.clinimag.2025.110471] [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: 12/28/2024] [Revised: 03/27/2025] [Accepted: 04/03/2025] [Indexed: 04/20/2025]
Abstract
PURPOSE We aimed to analyze and summarize the key features of esophageal schwannomas to provide new insights into preoperative diagnosis and enhance clinical recognition. METHODS Twenty-one consecutive patients with pathologically confirmed esophageal schwannoma who underwent surgical resection between January 2013 and January 2023 were enrolled. Imaging results from barium swallow, CT, MRI, 18F-FDG PET-CT, esophagoscopy, and endoscopic ultrasound were compiled and analyzed. RESULTS Our cohort comprised 10 males and 11 females, with mean age of 55.86 ± 9.09 years. The mean tumor size was 5.69 ± 1.32 cm, with tumors commonly located in the upper to middle esophagus. 83.3 % (10/12) presented smooth filling defects with intact canal walls in barium meal. Most tumors (71.4 %, 15/21) were oval-shaped, exhibiting intracavitary growth with well-defined borders. Mild enhancement was observed on CT with pre-contrast attenuation of 36.0 ± 53.87 HU and post-contrast enhancement of 52.75 ± 7.45 HU. Most lesions showed plateau dynamic enhancement on MRI (85.7 %, 6/7). Air crescent signs (95.2 %, 20/21) and fascicular signs (87.5 %, 7/8) were observed in most cases. Neither calcifications nor target signs were observed, and cystic changes were infrequent. All lesions showed high uptake on PET-CT (SUVmax: 11.19 ± 3.41). Endoscopic lesions typically exhibit smooth surfaces, soft textures, and colors ranging from normal to slightly lighter hues (94.7 %, 18/19). Endoscopic ultrasound indicated minimal blood flow within lesions (53.8 %, 7/13), and elastography displayed a blue-green pattern (100 %, 5/5). CONCLUSION Esophageal schwannomas exhibit distinct imaging characteristics. MRI provides additional diagnostic information for more accurate evaluation, while high metabolic activity on PET-CT may mimic malignancy.
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Affiliation(s)
- Jing Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Linlin Sun
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yinan Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jueqian Shi
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yu Zhang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Bowen Ding
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Chengyu Ding
- Bayer Healthcare, No. 399, West Haiyang Road, Shanghai 200126, China
| | - Huiyuan Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Li Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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Wang Y, Xin Z, Wu W, Hu Z, Jia Z, Zhang C, Ma Y, Zhang X. Case Report: Coexistence of an esophageal schwannoma disguised as a leiomyoma with a gastrointestinal stromal tumor of the gastric fundus. Front Oncol 2025; 15:1573436. [PMID: 40308497 PMCID: PMC12040618 DOI: 10.3389/fonc.2025.1573436] [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] [Received: 02/09/2025] [Accepted: 04/01/2025] [Indexed: 05/02/2025] Open
Abstract
To our knowledge, this is the first reported case of coexisting esophageal schwannoma and gastric fundus gastrointestinal stromal tumor (GIST). This case report describes the diagnostic and treatment process of a patient with esophageal schwannoma who also had a concurrent gastric fundus GIST and was presented to Hebei General Hospital (Hebei, China) in October 2024. The association between the pathogenesis of the two types of submucosal gastrointestinal tumors is unclear, with limited existing evidence in the literature. The esophageal schwannoma was misdiagnosed as a leiomyoma preoperatively, which prompted us to seek new diagnostic modalities to differentiate gastrointestinal submucosal lesions (leiomyomas, GISTs, and schwannomas). Surgical resection is considered the optimal treatment for esophageal schwannoma. The patient underwent a right single-port thoracoscopic esophageal tumor resection and recovered well, subsequently being discharged smoothly from the hospital.
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Affiliation(s)
- Yuedong Wang
- Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhifei Xin
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wenbo Wu
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhonghui Hu
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhenghao Jia
- Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chengyao Zhang
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
- North China University of Science and Technology, Tangshan, Hebei, China
| | - Yi Ma
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
- North China University of Science and Technology, Tangshan, Hebei, China
| | - Xiaopeng Zhang
- Department of Thoracic Surgery Hebei General Hospital, Shijiazhuang, Hebei, China
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Cao X, Li J. Snare-assisted submucosal tunneling for resection of esophageal schwannomas: Case Report. Front Med (Lausanne) 2025; 12:1580999. [PMID: 40270493 PMCID: PMC12014619 DOI: 10.3389/fmed.2025.1580999] [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] [Received: 02/21/2025] [Accepted: 03/26/2025] [Indexed: 04/25/2025] Open
Abstract
Esophageal schwannoma is a rare type of esophageal tumor that presents significant challenges in resection, particularly when large and irregularly shaped. This case report highlights the successful removal of a large esophageal schwannoma using a novel technique that combines submucosal tunneling endoscopic resection (STER) with modified snare-assisted external traction. A 68-year-old male with dysphagia was diagnosed with a 35 mm × 20 mm × 15 mm esophageal schwannoma. Due to the tumor's size and consistency, traditional resection methods proved difficult. The snare-assisted traction technique, applied within the submucosal tunnel, provided optimal tension and improved visualization, enabling en bloc resection. The patient recovered well postoperatively, and follow-up endoscopy confirmed complete healing. This novel traction technique is safe and effective for the resection of large esophageal submucosal tumors (SMTs), offering enhanced procedural efficiency and better outcomes in complex cases. However, the clinical utility of this technique requires confirmation through prospective studies with adequate sample sizes and long-term outcome assessments.
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Affiliation(s)
- Ximei Cao
- Department of Gastroenterology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People's Hospital, Jiujiang, China
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiangtao Li
- Department of Gastroenterology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People's Hospital, Jiujiang, China
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Miyazaki R, Tamura M, Yamamoto M, Kitagawa H, Seo S. Simultaneous Bilateral Video-Assisted Thoracoscopic Surgery in the Prone Position for Resection of a Large Middle Mediastinal Tumor: A Case Report. Cureus 2025; 17:e79029. [PMID: 40099078 PMCID: PMC11911899 DOI: 10.7759/cureus.79029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2024] [Indexed: 03/19/2025] Open
Abstract
Schwannoma is the most common type of neurogenic tumor in the thorax and is typically benign. This article describes the case of a 64-year-old asymptomatic woman with abnormal findings on a chest X-ray examination. Preoperative enhanced computed tomography showed the presence of a middle mediastinal tumor measuring 7.4 cm protruding into both thoracic cavities. The mass was adjacent to the posterior aspect of the trachea. The esophagus was compressed to the right, indicating the potential appearance of symptoms in the future. Consequently, we performed simultaneous bilateral video-assisted thoracoscopic surgery in the prone position, achieving complete resection. Postoperative pathological examination revealed a benign schwannoma. Here, we report a case of a middle mediastinal tumor resected by a rarely utilized video-assisted thoracoscopic surgery (VATS) method.
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Affiliation(s)
- Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi, JPN
| | - Masaya Tamura
- Department of Thoracic Surgery, Kochi Medical School, Kochi, JPN
| | - Marino Yamamoto
- Department of Thoracic Surgery, Kochi Medical School, Kochi, JPN
| | | | - Satoru Seo
- Department of Surgery, Kochi Medical School, Kochi, JPN
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Zhang J, Ji X, Dong A. FDG PET/CT in a Case of Esophageal Schwannoma. Clin Nucl Med 2024; 49:1154-1155. [PMID: 39385389 DOI: 10.1097/rlu.0000000000005474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
ABSTRACT Esophageal schwannoma is very rare. We describe FDG PET/CT findings in a case of benign esophageal schwannoma. Endoscopic ultrasound showed the tumor was located in the muscular layer of the esophagus. FDG PET/CT showed intense FDG uptake with SUV max of 10 of the tumor mimicking malignancy. This case indicates that schwannoma should be included in the differential diagnosis of esophageal FDG-avid lesions.
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Affiliation(s)
- Jun Zhang
- From the Departments of Cardiothoracic Surgery
| | - Xia Ji
- Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Menzie J, Eldredge T, Low L. Robotic-Assisted Minimally Invasive Resection of Multiple Oesophageal Schwannomas: A Case Report. Cureus 2024; 16:e74589. [PMID: 39735038 PMCID: PMC11674935 DOI: 10.7759/cureus.74589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2024] [Indexed: 12/31/2024] Open
Abstract
Schwannomas are rare, benign tumours arising from Schwann cells, with oesophageal cases representing a small fraction. Their variety of symptoms and nonspecific imaging features often make preoperative diagnosis challenging, frequently requiring immunohistochemical staining for confirmation. We describe the case of a 62-year-old woman with progressive dysphagia, found to have a subepithelial mass at the gastroesophageal junction (GOJ). Imaging and endoscopic ultrasound-guided biopsy confirmed an oesophageal schwannoma. The patient underwent robotic-assisted thoracoscopic excision, which allowed for precise tumour removal while avoiding a more extensive oesophagectomy. Intraoperatively, two distinct lobular tumours were identified and successfully excised without compromising the oesophageal mucosa. Postoperatively, the patient recovered well with resolution of symptoms and no evidence of residual tumour on follow-up imaging. This case highlights the potential of robotic-assisted approaches for treating oesophageal schwannomas, which can offer advantages in complex resections by improving surgical precision and reducing morbidity. Despite promising outcomes, robotic-assisted enucleation of oesophageal schwannomas remains rare, with few cases documented. This case supports robotic resection of oesophageal schwannomas as a feasible option in specialized settings, but further studies are needed to establish its role and develop recommendations.
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Affiliation(s)
- Jack Menzie
- Department of General Surgery, Monash Health, Melbourne, AUS
| | - Thomas Eldredge
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Monash Health, Melbourne, AUS
| | - Liang Low
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Monash Health, Melbourne, AUS
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Qureshi S, Khan S, Abbasi WA, Sohail M. Minimally invasive resection of a giant esophageal schwannoma. Pak J Med Sci 2024; 40:2447-2450. [PMID: 39554676 PMCID: PMC11568729 DOI: 10.12669/pjms.40.10.8824] [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] [Received: 09/28/2023] [Revised: 08/15/2024] [Accepted: 08/29/2024] [Indexed: 11/19/2024] Open
Abstract
Benign tumors of the esophagus are uncommon, and primary esophageal schwannoma of the esophagus is even rarer, accounting for 2% of cases. Less than 30 cases have been reported in the literature. Here we report a case of a young man with a symptomatic giant esophageal schwannoma, which was completely removed by laparoscopic three-staged esophagectomy. This is the first case of such a large lesion being removed by a minimally invasive approach. Our patient was a 22-year-old male, presented with dysphagia and dyspnea for five years. An endoscopy and CT scan suggested a giant leiomyoma. Postoperative biopsy revealed a primary esophageal schwannoma. We present our case of benign esophageal tumor measuring about 10.5 cm in greatest dimension. This is the first schwannoma resection performed with the Mckeown technique among the limited case reports in the literature. Esophageal schwannoma must be kept as a possible diagnosis in patients presenting with benign esophageal tumors. Esophagectomy is the mainstay of treatment for giant esophageal schwannomas. Minimally invasive esophagectomy can be safely performed for giant benign esophageal tumors.
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Affiliation(s)
- Sajida Qureshi
- Sajida Qureshi, FCPS, FRCS Meritorious Professor of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi-74200, Pakistan
| | - Sumayah Khan
- Sumayah Khan, FCPS Fellow Upper GI Surgery, Dow Medical College, Dow University of Health Sciences, Karachi-74200, Pakistan
| | - Waqas Ahmad Abbasi
- Waqas Ahmad Abbasi, BS Biosciences, MS Biosciences Research Associate, Dow Medical College, Dow University of Health Sciences, Karachi-74200, Pakistan
| | - Muneeba Sohail
- Muneeba Sohail, MBBS Dow Medical College, Dow University of Health Sciences, Karachi-74200, Pakistan
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Nakagawa M, Mori N, Saisyo K, Yoshida T, Isobe T, Sakai H, Hisaka T, Ishibashi N, Fujita F. Hybrid surgical approach for a large schwannoma from the cervical esophagus to the upper thoracic esophagus: a case report. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2024; 3:45. [PMID: 39516926 PMCID: PMC11533642 DOI: 10.1186/s44215-024-00171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Esophageal schwannoma is an extremely rare esophageal submucosal tumor. We report a case of a hybrid surgery for a large esophageal schwannoma that had extended from the cervical to the upper thoracic esophagus by using thoracoscopic and cervical approaches. CASE PRESENTATION A 58-year-old male was referred to our hospital for further examination and treatment of dysphagia and weight loss over the past 6 months. Upper gastrointestinal endoscopy revealed a 5.7-cm submucosal tumor from the cervical esophagus to the upper thoracic esophagus. The submucosal tumor was diagnosed as esophageal schwannoma by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Contrast-enhanced CT showed that the tumor had not invaded surrounding organs. Since the tumor extended from the cervical esophagus to the upper thoracic esophagus, we decided that it should be resected by not only the cervical but also the thoracoscopic approach. In operation, the patient was first placed in the prone position, and a thoracoscopic dissection of the upper thoracic esophagus containing the tumor was performed from the surrounding area. After changing the patient's position from prone to supine, a cervical skin incision was performed, and we underwent the tumor enucleation. After enucleation, the esophageal wall was thinned, so the right sternocleidomastoid muscle was used to reinforce the esophageal wall. The tumor size of the specimen was 60 × 52 × 42 mm. The postoperative course was uneventful, and the patient was discharged on the 22nd day after surgery. CONCLUSIONS Enucleation of a large esophageal schwannoma from the cervical to the upper thoracic esophagus could be safely performed using both thoracoscopic and cervical approaches. The sternocleidomastoid muscle flap is useful in the occasion considering stenosis by muscular layer suture.
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Affiliation(s)
- Masashi Nakagawa
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Kohei Saisyo
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Takehumi Yoshida
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67 Asahi Machi, Kurume City, Fukuoka, 830-0011, Japan
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Yin X, Yang H, Zhang B, Yin Y. A rare simultaneous coexistence of pancreatic gastrointestinal stromal tumor and esophageal schwannoma: a case report and review of literature. Front Oncol 2024; 14:1428910. [PMID: 39376980 PMCID: PMC11456398 DOI: 10.3389/fonc.2024.1428910] [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] [Received: 05/07/2024] [Accepted: 08/29/2024] [Indexed: 10/09/2024] Open
Abstract
The concurrent presence of gastrointestinal stromal tumor and schwannoma is extremely rare, and its pathological characteristics remain unclear. This case report reported the diagnostic and treatment process of a patient with a pancreatic GIST coexisting with esophageal schwannoma, who was admitted to West China Hospital (Sichuan, China) in April 2015. The patient did not undergo surgical resection of the tumor but instead received an 8-year regimen of imatinib therapy, during which no tumor progression was observed. However, the patient developed pleural effusion as a result of the localized enlargement of the esophageal schwannoma, which exerted pressure on the right inferior pulmonary vein. This case report provides valuable clinical insights into this distinctive disease presentation.
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Affiliation(s)
- Xiaonan Yin
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongxin Yang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Bo Zhang
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Yin
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Fiore R, Gombert E, La Rosa S, Dunet V, Sykiotis GP, Gorostidi F. Esophageal schwannoma mimicking non-functional parathyroid adenoma on 99mTc-sestamibi imaging: a case report. Front Endocrinol (Lausanne) 2024; 15:1258233. [PMID: 38841301 PMCID: PMC11150598 DOI: 10.3389/fendo.2024.1258233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Technetium-99m sestamibi single-photon emission computed tomography/computed tomography (99mTc-sestamibi SPECT/CT) is a mainstay of the pre-operative localization of parathyroid lesions. We report here the case of a 30 year-old woman with a fortuitously discovered 2 cm cervical mass for which a parathyroid origin was originally suspected due to its retro-thyroidal localization and a personal history of nephrolithiasis. Normal serum calcium and parathyroid hormone (PTH) levels excluded primary hyperparathyroidism, raising suspicion of a non-functional parathyroid adenoma, and SPECT/CT imaging showed that the mass was 99mTc-sestamibi-avid. Fine-needle aspiration (FNA) was performed; cytology was non-diagnostic but the needle washout was negative for thyroglobulin, calcitonin and PTH, arguing against a thyroidal or parathyroidal origin of the mass. Core needle biopsy revealed a schwannoma, ostensibly originating from the recurrent laryngeal nerve; upon surgical resection, it was finally found to arise from the esophageal submucosa. This case illustrates the fact that endocrinologists, radiologists, nuclear medicine, head and neck, and other specialists investigating patients with cervical masses should be aware that schwannomas need to be considered in the differential diagnosis of focal 99mTc-sestamibi uptake in the neck region.
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Affiliation(s)
- Roberto Fiore
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Edwige Gombert
- Service of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stefano La Rosa
- Institute of Pathology, Department of Laboratory Medicine and Pathology, University of Lausanne, Lausanne, Switzerland
- Service of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Vincent Dunet
- Service of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerasimos P. Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François Gorostidi
- Service of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Jiao J, Fan X, Luo L, Zhao W, Zheng Z, Chen X, Wang T, Wang B, Liu W. Efficacy of endoscopic ultrasound and endoscopic resection for esophageal schwannoma. Scand J Gastroenterol 2023; 58:963-969. [PMID: 36880341 DOI: 10.1080/00365521.2023.2185867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Esophageal schwannoma (ES) is a rare submucosal tumor, and its complete and safe resection is a topic that deserves special attention. AIM This study aimed to investigate the clinical value of endoscopic ultrasound (EUS) in the diagnosis of ES and the clinical efficacy of endoscopic resection for ES. METHODS The clinical data, endoscopic characteristics, endoscopic treatment, postoperative complications, immunohistochemical results, and follow-up records of patients with ES admitted to the Tianjin Medical University General Hospital from January 2012 to January 2022 were retrospectively analyzed. RESULTS Under white-light endoscopy, 81.8% (9/11) of lesions were submucosal elevations, covering the normal esophageal epithelium. Two of the lesions with redness and erosive surface. Eight lesions (72.7%) appear on EUS originating from the muscularis propria were homogeneous or inhomogeneous hypoechoic signals. Two lesions were inhomogeneous hyperechoic originating from the submucosa or muscularis propria, respectively. One lesion was homogeneous hypoechoic originating from the submucosa. All lesions had no blood flow signals, cystic changes, or calcification, and were completely removed by submucosal tunnel endoscopic resection (STER) or endoscopic submucosal dissection (ESD). All patients did not experience serious adverse events as well as recurrence, metastasis, or cicatricial esophageal stenosis during the follow-up period. CONCLUSION ES is a rare submucosal lesion, which endoscopic characteristics are difficult to distinguish from other esophageal submucosal tumors. Endoscopic resection can provide a minimally invasive and alternative treatment for ES.
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Affiliation(s)
- Jiao Jiao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Lili Luo
- Department of geriatric, General Hospital, Tianjin Medical University, Tianjin, China
| | - Wei Zhao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Zhongqing Zheng
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Tao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Wentian Liu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
- Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
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12
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Mu YZ, Zhang Q, Zhao J, Liu Y, Kong LW, Ding ZX. Total removal of a large esophageal schwannoma by submucosal tunneling endoscopic resection: A case report and review of literature. World J Clin Cases 2023; 11:2510-2520. [PMID: 37123315 PMCID: PMC10130983 DOI: 10.12998/wjcc.v11.i11.2510] [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: 12/23/2022] [Revised: 01/14/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Primary schwannoma is a rare submucosal tumor of the esophagus, which is most often benign, and surgery is the only effective treatment. So far, only a few cases have been reported. Herein, we reported a single case diagnosed with primary esophageal schwannoma that was totally removed by submucosal tunneling endoscopic resection (STER).
CASE SUMMARY A 62-year-old man presented to the hospital with a history of resection of a malignant gastric tumor and mild dysphagia. Endoscopic examination revealed a large submucosal elevated lesion in the esophagus 25-30 cm from the incisors. Endoscopic ultrasonography detected a 45 mm × 35 mm × 31 mm hypoechoic lesion; chest computed tomography showed a mass of approximately 55 mm × 35 mm × 29 mm. A preliminary examination showed features suggestive of a stromal tumor. Pathological findings indicated esophageal schwannoma. Next, STER alone was performed to completely resect the mass, and the patient recovered well post-surgery. Afterward, the patient was discharged and showed no tumor recurrence at 33 mo of follow-up.
CONCLUSION Endoscopic resection is still an effective treatment for large esophageal schwannomas (> 30 mm) under meticulous morphological evaluation.
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Affiliation(s)
- Yu-Zhu Mu
- Department of Radiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Qi Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Jing Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Yan Liu
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Ling-Wei Kong
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Zhong-Xiang Ding
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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13
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Wang H, Li Y, Wu M, Cui H. Benign esophageal schwannoma: A case report. Asian J Surg 2023; 46:1437-1438. [PMID: 36163096 DOI: 10.1016/j.asjsur.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Huien Wang
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yifan Li
- Graduate School, Hebei North University, Zhangjiakou, Hebei, China; Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Meiqi Wu
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China; Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Hongshang Cui
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China; Hebei General Hospital, Shijiazhuang, Hebei, China
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14
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Mahathanaruk N, Praneetvatakul P. Esophageal Schwannoma Presenting as Neck Mass and Misdiagnosed as Thyroid Nodule: A Case Report. OTO Open 2023; 7:e32. [PMID: 36998562 PMCID: PMC10046706 DOI: 10.1002/oto2.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 02/21/2023] Open
Affiliation(s)
- Nilnetre Mahathanaruk
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine Ramathibodi Hospital Bangkok Thailand
| | - Phurich Praneetvatakul
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine Ramathibodi Hospital Bangkok Thailand
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15
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Jiao J, Fan X, Luo L, Zheng Z, Wang B, Liu W. Endoscopic resection in the treatment of intramural esophageal bronchogenic cysts: A retrospective analysis of 17 cases. Dig Liver Dis 2022; 54:1691-1697. [PMID: 36096990 DOI: 10.1016/j.dld.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/07/2022] [Accepted: 08/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Intramural esophageal bronchogenic cysts (EBCs) are rare congenital malformations. Differences in reports on the clinical features of intramural EBCs and some controversies about the treatment strategy for intramural EBCs exist. OBJECTIVES To investigate the clinical characteristics of intramural EBCs and evaluate the safety and efficacy of endoscopic resection. METHODS The clinical and endoscopic features, endoscopic resection treatment, postoperative adverse events, and follow-up results of 17 patients with intramural EBCs were retrospectively studied. RESULTS Intramural EBCs exhibited male predominance with a male/female ratio of 58.8% (10/7) and were predominantly found in the distal esophagus. Approximately 94.1% of patients presented with gastrointestinal symptoms. All lesions were protruding masses covered by intact mucosal epithelium. The morphologies of intramural EBCs were diverse under white light endoscopy. On endoscopic ultrasonography, intramural EBCs presented as homogeneous or inhomogeneous hypoechoic or anechoic lesions. Eleven lesions originated from the muscularis propria, which underwent submucosal tunnel endoscopic resection (STER), and six lesions were from the submucosa, which underwent endoscopic submucosal dissection (ESD). Approximately 88.2% of patients underwent complete endoscopic resection. No serious pneumothorax, bleeding, pleural effusion, esophagotracheal fistula, or other adverse events occurred in all patients after endoscopic resection, and no cyst recurrence, metastasis, or esophageal scar stenosis was observed during the follow-up period. CONCLUSIONS Intramural EBCs can be treated by digestive endoscopic surgery. STER and ESD are safe, effective, and minimally invasive resection methods.
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Affiliation(s)
- Jiao Jiao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China; Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China; Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Lili Luo
- Department of geriatric, General Hospital, Tianjin Medical University, Tianjin, China
| | - Zhongqing Zheng
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China; Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China; Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Wentian Liu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China; Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China.
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16
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Fan X, Jiao J, Luo L, Zhu L, Zheng Z, Chen X, Wang T, Liu W, Wang B. Role of endoscopic ultrasound and endoscopic resection in the diagnosis and treatment of esophageal granular cell tumors. Scand J Gastroenterol 2022; 57:1264-1271. [PMID: 35576559 DOI: 10.1080/00365521.2022.2067784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Diagnosis and complete resection of esophageal granular cell tumors (GCTs) is an area of concern. However, articles on endoscopic ultrasound (EUS) and endoscopic resection of esophageal granular cell tumors are few. To evaluate the role of endoscopic ultrasound and endoscopic resection in the diagnosis and treatment of esophageal granular cell tumors. METHODS A retrospective analysis of 15 patients with esophageal granular cell tumors who underwent endoscopic ultrasound examination and endoscopic resection in our hospital was conducted. The clinical data, endoscopic ultrasound images, endoscopic treatment, pathological characteristics, postoperative complications and follow-up status of all patients were evaluated. Ten board-certified endoscopists independently evaluated the white light endoscopic images of the 15 patients (Test 1) and the endoscopic ultrasound images together with white light endoscopic images of the same patient set (Test 2). RESULT Female patients accounted for 53.4% of the participants. The average age at the time of diagnosis was 49.13 ± 9.31 years old. Ten lesions (66.67%) showed hypoechoic signal, four lesions (26.67%) showed hyperechoic signal and one lesion showed medium signal. The diagnostic accuracy was significantly higher with Test 2(65.3% vs. 92.0%, p < .001). Complete endoscopic resection was performed in all the patients. No complications occurred in any of the patients. No esophageal stenosis, recurrence, or metastases was found in all patients during the follow-up period. CONCLUSION The endoscopic ultrasound images of esophageal granular cell tumors have certain characteristics that help diagnose esophageal granular cell tumors. Endoscopic resection of esophageal granular cell tumors is an effective, safe and feasible treatment method.
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Affiliation(s)
- Xiaofei Fan
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Jiao Jiao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Lili Luo
- Department of Geriatric, General Hospital, Tianjin Medical University, Tianjin, China
| | - Lanping Zhu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Zhongqing Zheng
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Tao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Wentian Liu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
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17
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Yuan Y, Gao J, Xiong G, Guo L. Diagnostic accuracy of multiparametric ultrasound for peripheral nerve schwannoma. Acta Radiol 2022; 64:1608-1614. [PMID: 36071627 DOI: 10.1177/02841851221125109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ultrasound (US) diagnostic techniques have the advantages of low cost, convenient operation, and high availability. PURPOSE To explore the diagnostic accuracy of multiparametric US in evaluating signs of peripheral schwannoma. MATERIAL AND METHODS This retrospective case-control study included patients with soft-tissue masses on the limbs (divided into the schwannoma and non-schwannoma groups) between January 2017 and November 2020. US features were compared between the two groups, and receiver operating characteristics analysis was used to evaluate the diagnostic efficacy of these features. RESULTS A total of 165 patients were included in this study; of them, 63 (38.2%) were diagnosed with schwannoma. Regular morphology (95.2% vs. 39.2%), cystic degeneration (71.4% vs. 27.5%), target sign on elastography (82.5% vs. 0), and polar blood supply sign (87.3% vs. 14.7%) were more common in schwannomas than in non-schwannoma lesions (all P < 0.001). Combining the four signs for diagnosis of schwannomas, the sensitivity, specificity, and accuracy were 95.24%, 96.08%, and 95.76%, respectively, with an area under the curve (AUC) of 0.987 (95% confidence interval = 0.955-0.998). Entering and exiting nerve sign was observed in 87.3% of schwannomas and in 3.0% of non-schwannoma lesions (P < 0.001), while split-fat sign was similar between the two groups (9.5% vs. 2.0%; P = 0.068). CONCLUSION Polar blood supply sign and target sign on elastography are specific US signs in peripheral schwannomas. The combination of two-dimensional imaging, color flow imaging, and elastography can achieve an excellent diagnostic accuracy in schwannomas.
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Affiliation(s)
- Yu Yuan
- Department of Ultrasound, 74768Tianjin Hospital, Tianjin, PR China
| | - Jinmei Gao
- Department of Ultrasound, 74768Tianjin Hospital, Tianjin, PR China
| | - Guangyi Xiong
- Department of Pathology, 74768Tianjin Hospital, Tianjin, PR China
| | - Lin Guo
- Department of Radiology, 74768Tianjin Hospital, Tianjin, PR China
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18
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Yin L, Sun Y, Cao Q, Yang T, Li W, Zhu Y, Liu T, Li B. Two giant connected retroperitoneal schwannomas: a rare case report. J Int Med Res 2022; 50:3000605221119423. [PMID: 36036264 PMCID: PMC9434686 DOI: 10.1177/03000605221119423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Schwannoma is a type of tumor originating from Schwann cells of peripheral
nerves. In this study, we report a rare case of two giant connected
retroperitoneal schwannomas. The patient presented to our department with a
1-day history of abdominal pain and without other symptoms. There were no
abnormalities in the patient’s tumor markers. Abdominal plain computed
tomography (CT) revealed two (combined) retroperitoneal masses appearing as soft
tissue-density shadows with uneven internal density, cystic low-density shadows,
and patchy calcification shadows. The larger mass measured approximately
12.0 cm × 12.3 cm in size. The tumors were completely excised by a reasonable
surgical approach while the surrounding organs closely related to the tumor were
preserved. Postoperative pathology confirmed that the tumors were benign
schwannomas. In the 18-month follow-up, the patient had no recurrences and was
asymptomatic. We summarize the diagnosis and treatment of two rare combined
giant retroperitoneal schwannomas in a single patient. Laparotomy for the
management of retroperitoneal giant schwannomas may be safe and effective.
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Affiliation(s)
- Liquan Yin
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yao Sun
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Qian Cao
- Department of Education, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Tao Yang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Wei Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Yuecheng Zhu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Tongjun Liu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Bo Li
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
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19
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Wang TY, Wang BL, Wang FR, Jing MY, Zhang LD, Zhang DK. Thoracoscopic resection of a large lower esophageal schwannoma: A case report and review of the literature. World J Clin Cases 2021; 9:11061-11070. [PMID: 35047619 PMCID: PMC8678873 DOI: 10.12998/wjcc.v9.i35.11061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/28/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal schwannomas originating from Schwann cells are extremely rare esophageal tumors. They commonly occur in the upper and middle esophagus but less frequently in the lower esophagus. Herein, we report a rare case of a large lower esophageal schwannoma misdiagnosed as a leiomyoma. We also present a brief literature review on lower esophageal schwannomas.
CASE SUMMARY A 62-year-old man presented with severe dysphagia lasting 6 mo. A barium esophagogram showed that the lower esophagus was compressed within approximately 5.5 cm. Endoscopy revealed the presence of a large submucosal protuberant lesion in the esophagus at a distance of 32-38 cm from the incisors. Endoscopic ultrasound findings demonstrated a 4.5 cm × 5.0 cm hypoechoic lesion. Chest computed tomography revealed a mass of size approximately 53 mm × 39 mm × 50 mm. Initial tests revealed features indicative of leiomyoma. After multidisciplinary discussions, the patient underwent a video-assisted thoracoscopic partial esophagectomy. Further investigation involving immunohistochemical examination confirming palisading spindle cells as positive for S100 and Sox10 led to the final diagnosis of a lower esophageal schwannoma. There was no tumor recurrence or metastasis during follow-up.
CONCLUSION The final diagnosis of esophageal schwannoma requires histopathological and immunohistochemical examination. The early appropriate surgery favors a remarkable prognosis.
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Affiliation(s)
- Tian-Yi Wang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Bian-Li Wang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Fu-Rong Wang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Meng-Yuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Lu-Dan Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - De-Kui Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
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20
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Gupta P, Rana S, Dey P. Cytomorphological and immunocytochemical diagnosis of an oesophageal mass in a 62-year-old female with dysphagia. Cytopathology 2021; 33:281-284. [PMID: 34525230 DOI: 10.1111/cyt.13059] [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: 08/05/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Abstract
Oesophageal schwannoma is an extremely rare benign neoplasm. Cytological diagnosis of oesophageal schwannoma has been sporadically reported in the literature. Herein, we present a case of oesophageal schwannoma in an older woman that could be accurately diagnosed based on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology accompanied by cell block immunocytochemistry.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Khan U, Simone C, Safieddine N, Gazala S. Video-assisted thoracoscopic resection of a giant esophageal schwannoma: A case report. Int J Surg Case Rep 2021; 85:106202. [PMID: 34388894 PMCID: PMC8350491 DOI: 10.1016/j.ijscr.2021.106202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intrathoracic schwannomas are rare and difficult to diagnose. However, they are the most common type of neurogenic tumor in the chest. Most patients are incidentally diagnosed or develop symptoms from mass effect, such as chest pain, dysphagia or dyspnea. Larger tumors have been resected using open approaches, while smaller ones are often excised with minimally invasive approaches. CASE PRESENTATION A 60-year-old woman with a prior Roux-en-Y gastric bypass and a history of dysphagia, decreased appetite, and weight loss was referred for evaluation. CT chest revealed an 8 cm soft tissue mass centered in the distal esophagus. Gastroscopy showed the tumor to be 8 cm as well, with 2 cm of normal esophagus prior to the gastric pouch. A right-sided video-assisted thoracoscopic (VATS) approach for enucleation was successfully completed with primary esophageal repair for an 8.0 × 5.5 × 6.5 cm schwannoma. CLINICAL DISCUSSION Surgical resection for schwannomas is often indicated due to symptoms from mass effect (Moro et al., 2017). There are reports of VATS and robotic-assisted thoracic surgery approaches for small tumors. These techniques are appealing due to shorter length of stays and less post-operative pain. None have been described for lesions larger than 6 cm. CONCLUSION Minimally invasive approaches such as VATS for large schwannomas are technically feasible and safe to perform without the need for a thoracotomy.
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Affiliation(s)
- Usman Khan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Carmine Simone
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada
| | - Najib Safieddine
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada
| | - Sayf Gazala
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada,Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada,Corresponding author at: University of Toronto, Division of Thoracic Surgery, Michael Garron Hospital, Toronto, Canada; Chest Centre, Michael Garron Hospital, 825 Coxwell Avenue, East York, ON M4C 3E7, Canada.
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22
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Shi Y, Chai N, Zhong L, Li L, Zou J, Xiang J, Wang X, Linghu E. Experience with Esophageal Granular Cell Tumors: Clinical and Endoscopic Analysis of 22 Cases. Dig Dis Sci 2021; 66:1233-1239. [PMID: 32474763 DOI: 10.1007/s10620-020-06337-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Esophageal granular cell tumors (GCTs) are rare tumors. Differences in reports on the clinical features of GCTs in the esophagus and some controversies about the diagnostic strategy for esophageal GCTs exist. OBJECTIVES We aimed to investigate the clinical features and diagnosis of esophageal GCTs. Additionally, we sought to determine the prevalence of gastroesophageal reflux disease and reflux esophagitis in patients with esophageal GCTs. METHODS We retrospectively studied the clinical features, endoscopic features, and management of 22 patients with esophageal GCTs. RESULTS Esophageal GCTs were more common in men than in women with a ratio of 1.2:1 and were predominantly found in the distal esophagus. Ten patients with esophageal GCTs had regurgitation and/or heartburn symptoms, and eight patients were confirmed to have reflux esophagitis by endoscopy. All esophageal GCTs were protuberant lesions covered by normal esophageal epithelium. The endoscopic morphology of esophageal GCTs was diverse. On endoscopic ultrasonography, these tumors appeared as homogeneous or inhomogeneous hypoechoic lesions with clear borders originating from the submucosal or mucosal layer. Eleven patients underwent endoscopic forceps biopsy at the first endoscopy, and only six patients were correctly diagnosed by pathology. Nevertheless, the 18 lesions treated with endoscopic resection were all correctly diagnosed without complications, and no patients developed recurrence during the follow-up period. CONCLUSIONS The occurrence of esophageal GCTs may be related to esophageal inflammation. As a method for obtaining an accurate pathological diagnosis and for treatment, endoscopic resection should be offered as the primary option for patients with esophageal GCTs.
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Affiliation(s)
- Yongsheng Shi
- Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Ningli Chai
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lisen Zhong
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Longsong Li
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiale Zou
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jingyuan Xiang
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiangyao Wang
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Enqiang Linghu
- Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
- Department of Gastroenterology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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23
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Li B, Wang X, Zou WL, Yu SX, Chen Y, Xu HW. Endoscopic resection of benign esophageal schwannoma: Three case reports and review of literature. World J Clin Cases 2020; 8:5690-5700. [PMID: 33344562 PMCID: PMC7716328 DOI: 10.12998/wjcc.v8.i22.5690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/15/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal schwannomas are uncommon esophageal submucosal benign tumors and are usually treated with surgery.
CASE SUMMARY Here, we report three cases of middle/lower thoracic esophageal schwannoma treated successfully with endoscopic resection. These lesions were misdiagnosed as leiomyoma on preoperative imaging. During the endoscopic resection of such tumors, there is a risk of esophageal perforation due to their deep location. If possible, submucosal tunneling endoscopic resection should be used.
CONCLUSION For larger schwannomas, endoscopy combined with thoracoscopy can be considered for en bloc resection. We performed a mini literature review in order to present the current status of diagnosis and treatment for esophageal schwannoma.
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Affiliation(s)
- Bin Li
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
| | - Xue Wang
- Department of Gastroenterology,Dezhou People’s Hospital, Dezhou 253014, Shangdong Province, China
| | - Wen-Lu Zou
- Cheeloo College of Medicine, Shandong University, Jinan 250012, Shangdong Province, China
| | - Shu-Xia Yu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
| | - Yong Chen
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
| | - Hong-Wei Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shangdong Province, China
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24
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Clinicopathological features of esophageal schwannomas in mainland China: systematic review of the literature. Int J Clin Oncol 2020; 26:284-295. [PMID: 33216242 DOI: 10.1007/s10147-020-01809-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Esophageal schwannoma (ES) are rare and mostly benign neurogenic tumors. The clinical misdiagnosis rate of it is high. In this study, the clinicopathologic features of ES in mainland China were studied to better understand the disease and improve the diagnosis and treatment rate. METHODS A systematic review was conducted in accordance with PRISMA guidelines. The keywords "esophageal schwannoma", "esophageal neurinoma" and "esophageal neurilemoma" were searched for databases such as Pubmed, EMbase, Wanfang Database and Chinese National Knowledge Infrastructure. The search time frame for database was until July 2019. Combined with our patient, the clinicopathological data and the diagnosis and treatment of ES were summarized. RESULTS ES occurs in the upper part of the mediastinum and in the thoracic esophagus in most patients in the neck, upper and middle segments. CT and PET/CT examinations can be used for diagnosis, but the differentiation value of both benign and malignant ES is similar. The histopathological findings of forceps biopsy specimens are often difficult to diagnose, and deep tissue biopsies may increase pathological accuracy. EUS-FNA is also recommended for ES diagnosis, but it may also be misdiagnosed. Pathological features include a fusiform arrangement in a palisade-like structure or a tumor cell arranged in a network to form a loose structure. ES characteristic immunohistochemistry results showed that S-100 protein has strong immunological activity. CONCLUSION The definitive diagnosis requires immunohistochemistry, especially immunological reaction with S-100 protein. The appropriate treatment plan should be selected according to the diameter of the lesion. The overall prognosis of ES is good, but attention should be paid to follow-up.
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Abstract
RATIONALE Schwannoma is a tumor of the peripheral nervous system that originated in the Schwann cells of the neural sheath. Esophageal schwannomas are rare esophageal submucosal tumors, comprising approximately 2% of esophageal tumors. Since the symptoms, signs, and images of esophageal schwannoma are not specific, its preoperative diagnosis remains challenging. PATIENT CONCERNS A 67-year-old woman visited our department with complaints of gradually developed dysphagia and dyspnea for 4 years. A chest computed tomography scan showed a well-demarcated, enhancing homogeneous tumor measuring 61 × 46 × 60 mm in the upper third of the esophagus. Upper gastrointestinal endoscopy revealed a smooth elevated lesion located 19 to 24 cm from the incisor teeth. An endoscopic ultrasound-guided fine-needle aspiration demonstrated the presence of benign spindle cells. DIAGNOSES Histopathologic examination revealed spindle-shaped cells in a fasciculated and disarrayed architecture. The immunohistochemical study showed positivity for S-100 protein antibody and absence of staining for CD117, CD34, smooth muscle actin, and Desmin. These findings confirmed the diagnosis of benign esophageal schwannoma. INTERVENTIONS The tumor was considered to be difficult to repair the esophagus by direct anastomosis after tumor resection. Therefore, subtotal esophagectomy and esophagogastrostomy in the right thorax were performed. OUTCOMES The patient has been doing well with no recurrence at 36 months after the operation. LESSONS The symptoms and surgical procedures for benign esophageal schwannoma depend on the size and location of the tumor, proper and timely treatment is essential. A definitive diagnosis is confirmed by histology, and complete excision should yield good results.
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Affiliation(s)
- Chun-Xiao Wu
- Department of Thoracic Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Xuhui District
| | - Qi-Quan Yu
- Department of Thoracic Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Xuhui District
| | - Wei-Zhen Shou
- Department of Thoracic Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Xuhui District
| | - Kun Zhang
- Department of Thoracic Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Xuhui District
| | - Ze-Quan Zhang
- Department of Thoracic Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Xuhui District
| | - Qi Bao
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Businello G, Dal Pozzo CA, Sbaraglia M, Mastracci L, Milione M, Saragoni L, Grillo F, Parente P, Remo A, Bellan E, Cappellesso R, Pennelli G, Michelotto M, Fassan M. Histopathological landscape of rare oesophageal neoplasms. World J Gastroenterol 2020; 26:3865-3888. [PMID: 32774063 PMCID: PMC7385561 DOI: 10.3748/wjg.v26.i27.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin, in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. However, several other histopathological variants can be distinguished, some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice. The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.
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Affiliation(s)
- Gianluca Businello
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Carlo Alberto Dal Pozzo
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Luca Mastracci
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Italy
| | - Andrea Remo
- Department of Pathology, Ospedale Mater Salutis di Legnago, Legnago 37045, Italy
| | - Elena Bellan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Mauro Michelotto
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
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