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Vulasala SS, Robinson J, Sharma A, Wehry S, Mohamedahmed O, Gopireddy D. Unveiling the Rare: A Case Report of Rectal Schwannoma in a Neurofibromatosis Type 1 Patient. Cureus 2025; 17:e82808. [PMID: 40416267 PMCID: PMC12102582 DOI: 10.7759/cureus.82808] [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: 03/10/2025] [Accepted: 04/21/2025] [Indexed: 05/27/2025] Open
Abstract
Neurofibromatosis type 1 (NF-1) is an autosomal dominant neurocutaneous disorder characterized by skin abnormalities, such as café-au-lait macules and skinfold freckling, as well as peripheral nerve sheath tumors such as neurofibromas, schwannomas, and various other tumors. A 28-year-old man with a history of NF-1 presented to our facility with rectal bleeding. A rectal mass was subsequently discovered on colonoscopy and subsequent imaging. This mass was biopsied with histopathology consistent with a low-grade schwannoma. Schwannomas, while less common in NF-1 than NF-2, do sometimes occur in NF-1 patients, most commonly along the cranial, spinal, or peripheral nerves. These tumors also rarely occur in the gastrointestinal tract and even more rarely within the rectum specifically. Schwannoma must be considered in the differential for any rectal mass discovered in a patient with NF-1, so that the patient can be appropriately managed and treated.
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Affiliation(s)
- Sai Swarupa Vulasala
- Diagnostic Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jacob Robinson
- Diagnostic Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | | | - Sean Wehry
- Diagnostic Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Omer Mohamedahmed
- Pathology and Laboratory Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Dheeraj Gopireddy
- Diagnostic Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Amita K, Rajani T. Atypical Epithelioid Schwannoma in a Young Female- A Dilemma Set by Morphology; Resolved by Immunohistochemistry-A Rare Case Report. Indian J Dermatol 2025; 70:97-101. [PMID: 40162348 PMCID: PMC11952709 DOI: 10.4103/ijd.ijd_584_23] [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: 06/01/2023] [Accepted: 08/01/2024] [Indexed: 04/02/2025] Open
Abstract
Epithelioid morphology spawns myriad of benign and malignant tumors into differential diagnoses, which include epithelioid sarcoma, malignant melanoma, epithelioid malignant peripheral nerves sheath tumor, epithelioid hemangioendothelioma, myoepithelioma, etc. Epithelioid schwannoma (ES), especially the atypical variant has not received much attention in literature. Conclusive diagnosis, important for accurate management is, however, challenging. We describe a case of atypical ES in a 24-year-old female. On clinical and radiological examination, a provisional diagnosis of vascular malformation was made. Atypical epithelioid ESs are rare, but it is important to be aware of this variant to avoid misdiagnosis with other malignant epithelioid tumors. Apart from clinical and morphological features, immunohistochemistry aids in arriving at a decisive diagnosis. Perineurium-like capsule, circumscription, oblong shape of the lesion, and hyalinized blood vessels are pointers toward shwannomatous differentiation of this tumor.
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Affiliation(s)
- K Amita
- From the Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya, Karnataka, India
| | - T Rajani
- From the Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya, Karnataka, India
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3
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Sun Q, Zhu Q, Lu X, Zhu G, Lang W, Zhang J, Qu J. Mesocolic schwannoma mimicking gastrointestinal stromal tumor: A case report and review of literature. Medicine (Baltimore) 2024; 103:e40434. [PMID: 39533578 PMCID: PMC11557058 DOI: 10.1097/md.0000000000040434] [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: 07/06/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
RATIONALE Schwannomas are common peripheral nerve tumors originating from Schwann cells, primarily occurring in the head and neck, limbs, and trunk. Schwannomas occurring in the mesocolon are rare and often have no specific manifestations. Abdominal schwannomas need to be differentiated from common abdominal tumors such as gastrointestinal stromal tumors. PATIENT CONCERNS We report a case of a mesocolic schwannoma in a 59-year-old female presenting with gastrointestinal symptoms of acid reflux. At an outside hospital, gastroscopy, colonoscopy, and abdominal computed tomography scans revealed a soft tissue mass adjacent to the greater curvature of the stomach, leading to a suspicion of a gastric mesenchymal tumor. DIAGNOSES Mesocolic schwannoma. INTERVENTIONS Laparoscopy was performed at our hospital. Intraoperatively, the tumor was found to be closely related to the transverse colon and was initially diagnosed as a mass originating from the transverse colon. Consequently, a resection of the mass along with the adherent portion of the transverse colon was performed. Postoperative pathology and immunohistochemistry confirmed that the tumor was a schwannoma of the mesentery and did not originate from the transverse colon. OUTCOMES AND LESSONS Schwannomas can be distinguished from gastrointestinal stromal tumors by immunohistochemical staining, and surgical treatment is effective for benign schwannomas.
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Affiliation(s)
- Qihang Sun
- General Surgery Department, Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
| | - Qingshun Zhu
- Gastrointestinal Surgery Medical Center, Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
| | - Xuren Lu
- General Surgery Department, Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
| | - Guangxu Zhu
- Gastrointestinal Surgery Medical Center, Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
| | - Wei Lang
- Gastrointestinal Surgery Medical Center, Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
| | - Jie Zhang
- Hypertension and Nephrology Department, Jinan Traditional Chinese Medicine Hospital, Jinan, Shandong, China
| | - Jianjun Qu
- Gastrointestinal Surgery Medical Center, Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
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Hobbs M, Denis R, Felix M, Zeichen M. Schwannoma in the Rectum: A Case Report. Cureus 2024; 16:e61571. [PMID: 38962623 PMCID: PMC11221193 DOI: 10.7759/cureus.61571] [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: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
A woman in her 60s with a past medical history of recurrent Helicobacter pylori (H. pylori) presented for surgical consultation after a colonoscopy revealed a mass in the rectum. Preoperative biopsy revealed mucosal excrescence with no dysplasia or malignant changes. The final pathology showed a solid, submucosal rectal mass that was positive for SOX10 and S100 on immunohistochemistry, supporting our diagnosis of Schwannoma. This case emphasizes the importance of considering schwannomas in the differential diagnosis of patients presenting with a rectal mass no matter how rare it may be.
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Affiliation(s)
- Mikayla Hobbs
- General Surgery, St. George's University School of Medicine, St. George, GRD
| | - Ryan Denis
- General Surgery, St. George's University School of Medicine, St. George, GRD
| | - Martin Felix
- General Surgery, St. George's University School of Medicine, St. George, GRD
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Prasad AS, Shanbhogue KP, Ramani NS, Balasubramanya R, Surabhi VR. Non-gastrointestinal stromal tumor, mesenchymal neoplasms of the gastrointestinal tract: a review of tumor genetics, pathology, and cross-sectional imaging findings. Abdom Radiol (NY) 2024; 49:1716-1733. [PMID: 38691132 DOI: 10.1007/s00261-024-04329-1] [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: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
There is a diverse group of non-gastrointestinal stromal tumor (GIST), mesenchymal neoplasms of the gastrointestinal (GI) tract that demonstrate characteristic pathology and histogenesis as well as variable imaging findings and biological behavior. Recent advancements in tumor genetics have unveiled specific abnormalities associated with certain tumors, influencing their molecular pathogenesis, biology, response to treatment, and prognosis. Notably, giant fibrovascular polyps of the esophagus, identified through MDM2 gene amplifications, are now classified as liposarcomas. Some tumors exhibit distinctive patterns of disease distribution. Glomus tumors and plexiform fibromyxomas exhibit a pronounced affinity for the gastric antrum. In contrast, smooth muscle tumors within the GI tract are predominantly found in the esophagus and colorectum, surpassing the incidence of GISTs in these locations. Surgical resection suffices for symptomatic benign tumors; multimodality treatment may be necessary for frank sarcomas. This article aims to elucidate the cross-sectional imaging findings associated with a wide spectrum of these tumors, providing insights that align with their histopathological features.
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Affiliation(s)
| | | | - Nisha S Ramani
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, USA
| | | | - Venkateswar R Surabhi
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
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Altaf F, Javed N, Ghazanfar H, Dev A. Schwann Cell Hamartoma Presenting as a Colonic Polyp: A Rare Case Report With a Literature Review. Cureus 2024; 16:e57674. [PMID: 38707060 PMCID: PMC11070221 DOI: 10.7759/cureus.57674] [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: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Mucosal Schwann cell hamartomas (MSCHs) are non-common noncancerous growths derived from Schwann cells in the peripheral nervous system, often found unexpectedly during routine colonoscopy examinations. These growths primarily occur in the colon, although they can also appear in the esophagus and are not linked to familial cancer syndromes. Diagnosis relies on specific histological characteristics and staining patterns. It is essential to distinguish MSCHs accurately since their appearance can closely resemble that of malignant tumors. Characteristically, these hamartomas test positive for S-100 protein but do not exhibit markers typical of other gastrointestinal growths, such as gastrointestinal stromal tumors (negative for KIT), leiomyomas (negative for smooth muscle actin), neurofibromas (negative for CD34), and perineuromas (negative for epithelial membrane antigen or claudin-1). This report discusses the case of a 48-year-old woman who was diagnosed with MSCH during a screening colonoscopy.
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Affiliation(s)
- Faryal Altaf
- Internal Medicine, BronxCare Health System, New York, USA
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Anil Dev
- Gastroenterology, BronxCare Health System, New York, USA
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Gazivoda V, Wang D, Siddique M, Zeng J, Robert ME, Pantel H, Mongiu A. Rare cases of colonic schwannomas. J Surg Case Rep 2023; 2023:rjac438. [PMID: 38163055 PMCID: PMC10757069 DOI: 10.1093/jscr/rjac438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/03/2022] [Indexed: 01/03/2024] Open
Abstract
Schwannomas of the gastrointestinal tract are rare spindle cell tumors that account for 2-6% of mesenchymal tumors. An elderly male was found to have a left colon mass on CT scan and colonoscopy with pathology of fibrotic tissue. A laparoscopic-assisted left hemi-colectomy with primary anastomosis was performed. Pathology demonstrated spindle cell neoplasm arranged in short fascicles that were strongly and diffusely positive for S100. An elderly female was found to have a submucosal lesion on surveillance colonoscopy in the proximal transverse colon. Biopsy with jumbo forceps revealed spindle cell neoplasm positive for S100. Patient underwent an uncomplicated limited non-oncologic segmental transverse colectomy. We report only the ninth case of left and sixth in the transverse colon described in the literature. As is true for other mesenchymal tumors, mucosal biopsy is usually inconclusive and deep biopsy or submucosal resection is required, making pre-operative surgical decision difficult.
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Affiliation(s)
| | - Donghai Wang
- Yale University School of Medicine, New Haven, CT, United States
| | | | | | - Marie E Robert
- Yale University School of Medicine, New Haven, CT, United States
| | - Haddon Pantel
- Yale University School of Medicine, New Haven, CT, United States
| | - Anne Mongiu
- Yale University School of Medicine, New Haven, CT, United States
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Selntigia A, Neri B, Russo C, Martire FG, Soreca G, Biasutto D, Matteo FMD, Exacoustos C. A Rare Sigmoid-Colon Schwannoma in a Premenopausal Woman: A Case Report. Acta Med Litu 2023; 30:188-193. [PMID: 38516511 PMCID: PMC10952420 DOI: 10.15388/amed.2023.30.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 03/23/2024] Open
Abstract
Background Schwannomas of the gastrointestinal tract are a rare type of spindle cell tumor of peripheral nerve. Commonly, schwannomas are discovered incidentally, as they are usually asymptomatic. Case 46-year-old female patient, suffering from secondary amenorrhea and nonspecific intermittent pelvic pain associated with constipation. During gynecological visit an ultrasonographic systematic transvaginal examination was performed. At the sigmoid-rectal level an intraluminal solid mass was described and an urgent colonoscopy was prescribed. Endoscopic submucosal dissection was performed with en-bloc resection. On immunohistochemical analysis, S100 was strongly positive in tumor cells. Finally, a benign schwannoma of the sigmoid colon was diagnosed. Conclusion Our case highlights the importance of an adequate transvaginal pelvic examination with the evaluation of all pelvic organs. It could be challenging to make diagnosis in an early stage on asymptomatic patients.
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Affiliation(s)
- Aikaterini Selntigia
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Benedetto Neri
- Department of Systems Medicine, Gastroenterological Unit, University “Tor Vergata” of Rome, Italy
| | - Consuelo Russo
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Francesco Giuseppe Martire
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Giorgia Soreca
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
| | - Dario Biasutto
- Operative Endoscopy Department, Campus Bio-Medico, University Hospital, Rome, Italy
| | | | - Caterina Exacoustos
- Department of Surgical Sciences, Obstetric/Gynecological Clinic, University of Rome “Tor Vergata”, Italy
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Nasri S, Hedi Mraidha M, Abdelkrim MB, Youssef S, Hamila F, Amine Elghali M. Colonic schwannoma: A case of unusual presentation and outcome. Rare Tumors 2022; 14:20363613221110837. [PMID: 35774844 PMCID: PMC9237920 DOI: 10.1177/20363613221110837] [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: 03/05/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Schwannomas are mesenchymal tumors arising from neural sheath cells and whose diagnosis is based on immunohistochemistery. The digestive and especially colonic location of this tumor is rare. Commonly described in elderly patient, their malignancy is unusual. Case report: We report the case of a 23-year-old girl, with learning disability, operated in emergency for acute peritonitis. Peroperatively, we discovered a peritonitis secondary to a bulky perforated cecal tumor. We performed a right colectomy and an ileostomy. The posterior margin of the resection was macroscopically involved. The diagnosis of colonic schwannoma was confirmed with immunopathological examination of the surgical specimen. Surgical exploration 4 months later and morphological investigations during 2 years showed stability of the tumoral residue in the right iliac fossa. However, we noticed, on CT scanning control 2 years postoperatively, the appearance of a mesenteric recurrence. Exploratory laparotomy confirmed the unresectability of this mesenteric mass and showed the presence of multiple parietal nodules whose biopsies revealed their neurofibromatous nature. The 4 year follow-up of the patient didn’t reveal any complication rather than need to right nephrostomy due to ureter compression by the primary tumoral residue. Discussion: Colonic schwannoma is a rare disease, commonly described in uncomplicated stages. The learning disability of our patient had favorized the absence of declared symptoms and promoted the evolution of the cecal swhannoma until its perforation. This complication was not described before. Local recurrence has been also rarely reported in the literature. Association with neurofibroma may be hereditary in a context of neurofibromatosis or sporadic. Conclusion: Colonic schwannoma may have polymorphic presentation mimicking malignant tumor in such cases. Not treated in time, it can lead to severe complications, such as tumoral perforation. Surgical resection remains the mainstay treatment. The slow evolutionary genius of schwannoma, even when incompletely resected by necessity, confirms its good prognosis.
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Affiliation(s)
- Salsabil Nasri
- Department of Visceral Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Hedi Mraidha
- Department of Visceral Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mehdi Ben Abdelkrim
- Department of Visceral Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sabri Youssef
- Department of Visceral Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Fehmi Hamila
- Department of Visceral Surgery, Farhat Hached University Hospital, Sousse, Tunisia
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Singh A, Aggarwal M, Chadalavada P, Siddiqui MT, Garg R, Lai K, Chahal P. Natural history of gastrointestinal schwannomas. Endosc Int Open 2022; 10:E801-E808. [PMID: 35692918 PMCID: PMC9187404 DOI: 10.1055/a-1784-0806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background and study aims Data are lacking on the natural history of gastrointestinal tract schwannomas. We aimed to study the natural history of all gastrointestinal schwannomas including location, diagnosis, management, and long-term outcomes. Patients and methods Patients with a pathological diagnosis of gastrointestinal schwannoma between January 2000 and March 2020 were identified. Data on baseline demographics, presentations, associated malignancies, malignant transformation, treatment, and recurrence were collected. Results Our cohort consisted of 44 patients with a mean age of 58.6 years, with 63.6 % women and 84.1 % White. The stomach (38.6 %) was the most common location followed by the colorectum (31.8 %). Only 22.7 % of patients were symptomatic and 22.0 % had a personal history of other malignancies. Tissue diagnosis was obtained via endoscopy in 47.7 % and from surgical pathology in 52.3 %. On histology, 65.9 % of the tumors were solid, 11.4 % had mixed features, and 2.3 % had necrosis. SP100 was tested in all but one patient and was positive in all. Mean Ki-67 in 12 patients with tumors measuring ≥ 2 cm was 3.0 % indicating a low proliferation rate. Of the patients, 77.3 % had surgery and 18.2 % underwent endoscopic resection. At a mean follow-up of 5.0 ± 4.31 years, there was no malignant transformation, recurrence or mortality associated with gastrointestinal schwannomas. Conclusions Gastrointestinal schwannomas are diagnosed in the fifth to sixth decade with predominance in women and Whites. They are benign, mostly asymptomatic, and diagnosed incidentally. Asymptomatic gastrointestinal schwannomas including lesions ≥ 2 cm in size do not appear to need further monitoring or intervention. Patients with them should be counseled to remain up to date with routine screening guidelines pertaining to the colon, breast, and lung cancer due to the high incidence of concomitant malignancy.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
| | - Manik Aggarwal
- Department of Medicine; Cleveland Clinic, Cleveland, Ohio, United States
| | | | | | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
| | - Keith Lai
- Department of Pathology; Cleveland Clinic, Cleveland, Ohio, United States
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
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López Grove R, Gentile E, Savluk L, Santino JP, Ulla M. Correlation between pneumo-computed tomography and pathology findings for subepithelial gastric lesions. RADIOLOGIA 2022; 64:237-244. [PMID: 35676055 DOI: 10.1016/j.rxeng.2022.02.001] [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: 07/02/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This article aims to show the usefulness of the pneumo-computed tomography gastric distention technique in the detection and morphological characterization of subepithelial gastric lesions. We correlate the pneumo-computed tomography and pathology findings in lesions studied at our institution and review the relevant literature. CONCLUSION Pneumo-computed tomography, combined with multiplanar reconstructions, three-dimensional reconstructions, and virtual endoscopy, is useful for delineating the morphological details of subepithelial gastric lesions, thanks to the additional gastric distention. This technique better delimits and characterizes the upper and lower margins of the lesions. Pneumo-computed tomography can be considered a useful noninvasive imaging techniques for characterizing these lesions.
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Affiliation(s)
- R López Grove
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - E Gentile
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - L Savluk
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J P Santino
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Ulla
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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López Grove R, Gentile E, Savluk L, Santino J, Ulla M. Correlación anatomopatológica con neumo-tomografía computarizada de lesiones gástricas subepiteliales. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Guevara-Martínez J, Toribio-Vázquez C, Noire FPL, Cantero R. Transanal Minimally Invasive Surgery for Local Excision of a Rectal Schwannoma. Dis Colon Rectum 2022; 65:e1-e3. [PMID: 34882634 DOI: 10.1097/dcr.0000000000002041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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14
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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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PET/CT and contrast-enhanced CT imaging findings in benign solitary schwannomas. Eur J Radiol 2021; 141:109820. [PMID: 34139574 DOI: 10.1016/j.ejrad.2021.109820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Imaging features of positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT and pathological changes in benign solitary schwannoma were retrospectively analyzed, and the factors associated with high uptake of fluorodeoxyglucose (FDG) were examined. METHODS The PET/CT, contrast-enhanced CT, and pathological results of 58 cases of benign solitary schwannomas confirmed by surgery or biopsy were retrospectively analyzed. The association of each variable with the maximum standardized uptake value (SUVmax) was evaluated. RESULTS The SUVmax of the 58 benign schwannoma cases was 4.1 ± 2.1 (1.5-11.1). When the locations of schwannomas were divided into gastrointestinal system/heart/abdominal and pelvic cavities/thoracic wall (type-1 locations) and other sites (type-2 locations), the schwannoma location was significantly correlated with the SUVmax (r = 0.538, p = 0.000). The SUVmax values were 5.8 ± 2.4 and 3.3 ± 1.5, respectively (p = 0.000). Peritumoral lymphoid cuffs were observed in 7 cases, 4 of which were tumors of gastrointestinal origin, accounting for 80 % of the gastrointestinal schwannomas (4/5). The presence of peritumoral lymphoid cuffs was significantly correlated with the SUVmax (r = 0.456, p = 0.000). The location of the schwannoma was significantly correlated with the presence of peritumoral lymphoid cuffs (r = 0.640, p = 0.000). We found that a peritumoral lymphoid cuff is strongly correlated with the presence of regional lymphadenopathy. Among the 7 cases showing peritumoral lymphoid cuffs, 5 cases had the presence of peritumoral enlarged lymph nodes. The degree of enhancement was significantly correlated with the SUVmax (r = 0.556, p = 0.000). CONCLUSIONS Benign schwannomas originating from the gastrointestinal system/heart/abdominal location and showing the presence of peritumoral lymphoid cuffs or moderate and significant enhancement on contrast-enhanced CT were significantly associated with high FDG uptake. An accurate understanding of the factors associated with high FDG uptake can help reduce the misdiagnosis rate.
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16
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Sbaraglia M, Businello G, Bellan E, Fassan M, Dei Tos AP. Mesenchymal tumours of the gastrointestinal tract. Pathologica 2021; 113:230-251. [PMID: 34294940 PMCID: PMC8299319 DOI: 10.32074/1591-951x-309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023] Open
Abstract
Mesenchymal tumours represent a heterogenous group of neoplasms encopassing benign, intermediate malignancy, and malignant entities. Sarcomas account for approximately 1% of human malignancies. In consideration of their rarity as well as of intrinsic complexity, diagnostic accuracy represents a major challenge. Traditionally, mesenchymal tumours are regarded as lesions the occurrence of which is mostly limited to somatic soft tissues. However, the occurrence of soft tissue tumours at visceral sites represent a well recognized event, and the GI-tract ranks among the most frequently involved visceral location. There exist entities such as gastrointestinal stromal tumours (GIST) and malignant gastointestinal neuroectodermal tumors that exhibit exquisite tropism for the GI-tract. This review will focus also on other relevant clinico-pathologic entities in which occurrence at visceral location is not at all negligible.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Gianluca Businello
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Elena Bellan
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Matteo Fassan
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
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17
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Abstract
BACKGROUND Gastric schwannoma is a rarely seen gastric tumor accounting for only 0.2% of all gastric tumors. It is difficult to distinguish a gastric schwannoma from other gastric tumors preoperatively.Case presentation: A 30-year-old man with no significant medical history or physical examination findings presented with a 1-month history of right upper abdominal discomfort. The preoperative diagnosis was a gastrointestinal stromal tumor, but the postoperative pathologic and immunohistochemical examinations confirmed a gastric schwannoma. The patient underwent laparoscopic wedge resection of the stomach without additional postoperative treatment, and his postoperative recovery was uneventful. No recurrence or metastasis was found at the 2-year follow-up examination. CONCLUSION Although gastric schwannomas are usually not malignant, they are difficult to distinguish from other malignant stromal tumors preoperatively. Surgical resection should be recommended when a schwannoma is malignant or considered to be at risk of becoming malignant.
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Affiliation(s)
- Changsheng Pu
- Department of General Surgery, Peking University International Hospital, Beijing, China
| | - Keming Zhang
- Department of General Surgery, Peking University International Hospital, Beijing, China
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18
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Jackson CH, Hunt BC, Harris GJ. Fate and Management of Incompletely Excised Solitary Fibrous Tumor of the Orbit: A Case Series and Literature Review. Ophthalmic Plast Reconstr Surg 2021; 37:108-117. [PMID: 32496393 DOI: 10.1097/iop.0000000000001691] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE There is an imperfect correlation between the histology and behavior of solitary fibrous tumor (SFT). In addition, recurrence is common, and dedifferentiation may occur over time. Preferred primary treatment is intact excision, but friable pseudocapsules and tenacious attachments can thwart this goal in the crowded, visually sensitive orbit. This study addresses the fate and appropriate management of incompletely excised orbital SFT. METHODS Among a single surgeon's 7-case experience with orbital SFT, 3 cases involved incomplete primary excision, either before (2 cases) or after (1 case) referral. We reviewed the clinicopathologic data in these 3 cases, with follow-up intervals of 18, 21, and 52 years after initial presentation. We reviewed the English-language literature on SFT, with special attention to evolving nomenclature, orbital involvement, recurrence, malignant transformation, and management options. RESULTS Benign versus malignant designations of SFT vary with histological and behavioral criteria. Approximately 150 orbital cases have been reported. Published rates of primary malignancy and recurrence across all histologic categories are 6% to 12% and 30% to 37%, respectively. We identified 43 well-documented recurrences (range, 6 months-33 years; median, 3 years) and 10 cases of histological dedifferentiation (range, 14 months-33 years). Because of SFT's rarity and needed follow-up intervals, the value of adjuvant therapy is not yet proven. In follow up of 18, 21, and 52 years after initial presentation, our 3 cases with incomplete excision showed either no recurrence (Case 1) or no morphological dedifferentiation (Cases 2, 3). CONCLUSION A treatment algorithm is predicated on the completeness of surgical excision and histological features. However, we recommend case-by-case multidisciplinary decisions in a tumor-board setting.
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Affiliation(s)
- Chad H Jackson
- Orbital and Oculofacial Plastic Surgery, Department of Ophthalmology
| | - Bryan C Hunt
- Head and Neck Surgical Pathology, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Gerald J Harris
- Orbital and Oculofacial Plastic Surgery, Department of Ophthalmology
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19
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Andhalgaonkar T, Sinha R. Mesenchymal Tumors and Lymphoproliferative Diseases of the Stomach and Duodenum. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1722794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractNeoplasms of the stomach are classified into two large categories on the basis of the cell of origin: epithelial and nonepithelia. The vast majority of both benign and malignant tumors of the stomach are of epithelial origin, with mesenchymal and neuroendocrine tumors being much less common. The epithelial tumors arise from the mucosa while the nonepithelial tumors arise from the submucosa, muscularis propria, or serosa. The nonepithelial or intramural tumors of stomach include gastrointestinal stromal tumors, leiomyomas, schwannoma, granular cell tumors, glomus tumor, leiomyosarcoma, Kaposi sarcoma, lymphoma, and others. In this review, radiological appearance of mesenchymal tumors and lymphoproliferative tumors are described.
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Affiliation(s)
- Tanmay Andhalgaonkar
- Department of Clinical Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| | - Rakesh Sinha
- Department of Clinical Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
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20
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Madero Velázquez L, Uceda F, Buendía L. Duodenal schwannoma, an infrequent entity. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:548-549. [PMID: 33244978 DOI: 10.17235/reed.2020.7371/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Schwannomas are benign tumors derived from the Schwann cells of the neural sheath. Their incidence in the digestive tract is very low and generally occurs in the stomach, colon and rectum. Duodenal schwannoma is even rarer.
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Affiliation(s)
| | - Francisco Uceda
- Aparato Digestivo, Hospital General Universitario de Elche, España
| | - Lidia Buendía
- Aparato Digestivo, Hospital General Universitario de Elche, España
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21
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Rubio Sierra MP, Alrakawi A, Alduaij A, AlNuaimi D, Balci NC. Periampullary duodenal schwannoma mimicking ampullary neoplasm. Radiol Case Rep 2020; 15:2085-2089. [PMID: 32944106 PMCID: PMC7481489 DOI: 10.1016/j.radcr.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 12/03/2022] Open
Abstract
Schwannomas are neurogenic tumors that arise from Schwann cells in the neural sheath. Gastrointestinal schwannomas occur most often in the stomach, followed by the colon and the rectum. Duodenal schwannomas are rare amongst mesenchymal tumors of the gastrointestinal tract and only a few cases have been reported up to the current date with an incidence of approximately 2%-6%. Duodenal Schwannomas do not have characteristic imaging features thereby cannot be easily differentiated from other submucosal and adjacent extraluminal neoplasms. We present a case of a 76-year old male patient that presented to our hospital with abdominal pain and was diagnosed after an upper gastrointestinal endoscopy with an ampullary duodenal neoplasm that proved to be a periampullary duodenal Schwannoma on histopathology. Duodenal Schwannomas although rare should be considered in the differential diagnosis of ampullary neoplasms.
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Affiliation(s)
| | - Aydamir Alrakawi
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Maryah Island Abu Dhabi United Arab Emirates
| | - Ahmad Alduaij
- National Reference Laboratories, Cleveland Clinic Abu Dhabi, Maryah Island Abu Dhabi United Arab Emirates
| | - Dana AlNuaimi
- Imaging Institute, Cleveland Clinic Abu Dhabi, Maryah Island Abu Dhabi United Arab Emirates
| | - Numan Cem Balci
- Imaging Institute, Cleveland Clinic Abu Dhabi, Maryah Island Abu Dhabi United Arab Emirates
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22
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Alkatan HM, Alsalamah AK, Almizel A, Alshomar KM, Maktabi AM, ElKhamary SM, Eberhart CG, Iuliano A, Lanni V, Strianese D. Orbital solitary fibrous tumors: a multi-centered histopathological and immunohistochemical analysis with radiological description. Ann Saudi Med 2020; 40:227-233. [PMID: 32493043 PMCID: PMC7270616 DOI: 10.5144/0256-4947.2020.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Solitary fibrous tumors (SFT), formerly called hemangiopericytoma, are rare tumors derived from mesenchymal cells originally described in the pleura, but these tumors may affect extraserosal tissues including the lacrimal gland and orbit. OBJECTIVE Conduct a multi-centered clinical, radiological and histopathological analysis of 17 orbital SFT cases. DESIGN A retrospective case series. SETTING Three eye centers in two countries. PATIENTS AND METHODS The data collected from the charts of 17 adult patients presenting with tissue diagnosis of orbital hemangiopericytoma or SFT from January 2003 to December 2018 included demographics, clinical imaging and histopathological information including immunohistochemical (IHC) characteristics. MAIN OUTCOME MEASURES The demographic characteristics, clinical presentation, and histopathological patterns or variants of SFT were analyzed. SAMPLE SIZE 17 adult patients. RESULTS Mean age was 45 years (range 23-80 years). Male to female ratio was 3:1. The right eye was affected in 12 (70.5%) patients. Commonest presentation was proptosis in 13/17 (76% of patients). Other symptoms were impaired motility (29%) and ptosis (11%). Lesions mostly affected the medial orbit (35%), then orbital apex in 11%. The histopathological classic pattern-less variant was the commonest. One case with aggressive behavior, multiple recurrences and atypical features was encountered. Immunohistochemical (IHC) markers used included CD34 expression in all cases, Bcl-2 expression in 10/11, CD99 in 9/9 and Vimentin in 4/4. STAT6 was used in 2 cases. CONCLUSIONS SFTs are rare tumors affecting the orbit in both genders equally in their mid-forties, but showed male predominance in our analysis with a predominant classic histopathological pattern. Tissue diagnosis is essential and requires IHC studies for confirmation. LIMITATIONS Sample size is relatively small owing to the rarity of this tumor in the orbit. CONFLICT OF INTEREST None.
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Affiliation(s)
- Hind Manaa Alkatan
- From the Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Abrar K Alsalamah
- From the Division of Vitreoretinal and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Khalid M Alshomar
- From the Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- From the Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sahar M ElKhamary
- From the Department of Radiology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Charles G Eberhart
- From the Department of Pathology, Ophthalmology and Oncology, John Hopkins University, School of Medicine, Baltimore, United States
| | - Adriana Iuliano
- From the Department of Neuroscience, School of Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Vittoria Lanni
- From the Department of Neuroscience, School of Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Diego Strianese
- From the Department of Neuroscience, School of Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.,From the Orbital Unit, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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23
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Hashimoto H, Koda H, Horiuchi H, Takayama M, Toyoda J, Momiyama M, Harihara Y, Morikawa T. Colonic Neurogenic Lesion: An Admixture of Mucosal Neurofibromatous Lesion and Submucosal Ganglioneuromatous Lesion With Transition. Int J Surg Pathol 2020; 28:563-568. [PMID: 32028811 DOI: 10.1177/1066896920904158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Benign neural tumors or tumor-like lesions are rarely detected in the gastrointestinal tract. In this article, we present the case of a neural lesion of the sigmoid colon, which was incidentally detected in a 68-year-old man treated with laparoscopic low anterior resection for an advanced carcinoma of the rectosigmoid junction. Within the resected specimen, a submucosal tumor-like protruding lesion was found in the sigmoid colon. Histologically, the growth was composed of mucosal neurofibromatous and submucosal ganglioneuromatous lesions, between which there was transition. Immunohistochemical analysis revealed a rupture of the perineurium in the area of transition, along with a proliferation of Schwann cells and supporting cells extending into the deep mucosa. This transition indicated that the mucosal and submucosal lesions comprised a single lesion, and that a diagnosis of neurofibroma or ganglioneuroma would be inadequate in this case. Because we could not classify it as an established single entity, we diagnosed the mass as an unclassifiable colonic neurogenic lesion. In summary, we report the case of an extremely rare occurrence of an unclassifiable colonic neurogenic lesion comprising an admixture of transitioning mucosal neurofibromatous and submucosal ganglioneuromatous lesions.
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Affiliation(s)
- Hirotsugu Hashimoto
- NTT Medical Center Tokyo, Tokyo, Japan.,Tokyo Healthcare University, Tokyo, Japan
| | | | - Hajime Horiuchi
- NTT Medical Center Tokyo, Tokyo, Japan.,Tokyo Healthcare University, Tokyo, Japan
| | | | | | | | | | - Teppei Morikawa
- NTT Medical Center Tokyo, Tokyo, Japan.,Tokyo Healthcare University, Tokyo, Japan
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24
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Park S, Ahn HK, Lee DH, Jung Y, Jeong JW, Nam S, Lee WS. Systematic mutation analysis in rare colorectal cancer presenting ovarian metastases. Sci Rep 2019; 9:16990. [PMID: 31740709 PMCID: PMC6861287 DOI: 10.1038/s41598-019-53182-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
Although colorectal cancer is one of the most lethal cancer types in the world, its metastasis to the ovary is rare, compared to metastasis to other organs. Consequently, the genomic basis for colon-to-ovary metastasis remains unstudied, due to limited available patients, and thus there have been no attempts to construct individual-specific networks. Due to its rarity, the small sample size makes common mutations difficult to find. To overcome this problem, we herein attempted to apply a biological connectivity map called a sample-specific network (SSN), to reveal common biological functions in three samples. Our three samples were compared to a clinical dataset contained in The Cancer Genome Atlas (TCGA) Colorectal Adenocarcinoma (COAD), showing different mutational spectra, compared to matched samples based on age, gender, microsatellite instability (MSI) status, and tumor, node, metastasis (TNM) stage. The SSNs for the three samples revealed significant correlations of the mutation statuses of several apoptosis genes, in contrast to the TCGA-matched samples. Further analysis of a targeted-gene panel sequencing dataset for colon-to-ovary metastasis of primary tumor samples also confirmed significant correlations of the mutational statuses among apoptosis genes. In summary, using SSN, we successfully identified a common function (apoptosis) among our three patients having colon-to-ovary metastasis, despite no common mutations in the three patients. Such computational analyses could facilitate productive study of rare cancers and other diseases.
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Affiliation(s)
- Sungjin Park
- College of Medicine, Gachon University, Incheon, Korea
- Gachon Institute of Genome Medicine and Science, Gachon University Gil Medical Center, Incheon, Korea
| | - Hee Kyung Ahn
- Department of Medical Oncology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dae Ho Lee
- College of Medicine, Gachon University, Incheon, Korea
- Gachon Advanced Institute of Health Sciences & Technology, Gachon University, Incheon, Korea
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - YunJae Jung
- Department of Microbiology, College of Medicine, Gachon University, Incheon, Korea
| | - Joo-Won Jeong
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seungyoon Nam
- College of Medicine, Gachon University, Incheon, Korea.
- Gachon Institute of Genome Medicine and Science, Gachon University Gil Medical Center, Incheon, Korea.
- Department of Medical Oncology, Gachon University Gil Medical Center, Incheon, Korea.
- Department of Life Sciences, Gachon University, Seongnam, Gyeonggi-do, Korea.
| | - Won-Suk Lee
- College of Medicine, Gachon University, Incheon, Korea.
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea.
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25
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Wang H, Yoshizumi T, Itoh S, Ikegami T, Harada N, Oda Y, Mori M. Retroperitoneal schwannoma preoperatively diagnosed as liver metastasis from colon cancer: A case report. Int J Surg Case Rep 2019; 64:31-34. [PMID: 31593915 PMCID: PMC6796696 DOI: 10.1016/j.ijscr.2019.09.031] [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: 06/24/2019] [Revised: 08/20/2019] [Accepted: 09/10/2019] [Indexed: 12/04/2022] Open
Abstract
Retroperitoneal schwannomas are very rare and difficult to make a definite diagnosis. This is the first report of surgery for colon cancer and retroperitoneal schwannoma performed simultaneously. Although liver lesions accompanied by advanced malignant tumor should be firstly considered as liver metastasis, other rare tumors are also occasionally seen. Background Retroperitoneal schwannomas are rare. Case presentation We here report a case of 64-year-old woman who was referred to her local hospital for abdominal pain and found to have a palpable tumor. Computed tomography (CT) and colonoscopy revealed a combination of liver and colon lesions and colon cancer with a large liver metastasis was suspected. After neoadjuvant chemotherapy had proved ineffective for her presumed liver metastasis, the patient was referred to our hospital where we performed a simultaneous right hemicolectomy and extended left hepatic lobectomy. The pathological diagnoses were a colonic adenocarcinoma and retroperitoneal schwannoma immediately adjacent to the liver. Conclusions Although liver metastasis should be the first provisional diagnosis in patients with advanced colon cancer, retroperitoneal schwannoma should also be suspected in the differential diagnosis of possible liver lesions.
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Affiliation(s)
- Huanlin Wang
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Shu Z, Li C, Sun M, Li Z. Intestinal Schwannoma: A Clinicopathological, Immunohistochemical, and Prognostic Study of 9 Cases. Gastroenterol Res Pract 2019; 2019:3414678. [PMID: 31049058 PMCID: PMC6458941 DOI: 10.1155/2019/3414678] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intestinal schwannoma is a type of intestinal interstitial tumor with a very low incidence. At present, there are few studies on intestinal schwannoma. METHODS From January 2010 to January 2018, the patients diagnosed with intestinal schwannoma at the China-Japan Union Hospital of Jilin University were retrospectively reviewed. The patients' clinicopathological features and prognosis were analyzed. RESULTS This study enrolled 9 patients with intestinal schwannoma, including 3 males and 6 females. The main symptoms of the patients were abdominal pain and melena. Abdominal computed tomography showed intussusception, slightly high-density shadowing in the intestine, thickening of the intestinal wall, and an intestinal mass. Colonoscopy and endoscopic ultrasonography showed submucosal masses without ulcer formation. Two patients underwent endoscopic biopsy, and the pathological results revealed inflammation and necrosis. One patient had increased neuron-specific enolase (NSE) levels. Immunohistochemical analysis showed that the tumor cells were positive for S-100 and negative for CD117, DOG-1, desmin, and smooth muscle actin. An average of 17 lymph nodes were found around the intestines in 4 patients, all of which demonstrated reactive hyperplasia. No recurrence or metastasis occurred during postoperative follow-up. CONCLUSIONS Intestinal schwannoma is a rare tumor, and in our study its incidence was higher in women than in men. The main symptoms were abdominal pain and melena. Preoperative increases in NSE levels might contribute to a diagnosis. Complete surgical resection with free negative margins is the standard treatment for benign schwannoma. There was no recurrence or metastasis after complete surgical resection, suggesting that follow-up may not be required.
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Affiliation(s)
- Zhenbo Shu
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunsheng Li
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mingze Sun
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongmin Li
- Department of Gastrointestinal, Colorectal, and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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27
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Baig MMAS, Patel R, Kazem MA, Khan A. Schwannoma in the ascending colon, a rare finding on surveillance colonoscopy. J Surg Case Rep 2019; 2019:rjz046. [PMID: 30800278 PMCID: PMC6380074 DOI: 10.1093/jscr/rjz046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/31/2019] [Indexed: 11/15/2022] Open
Abstract
Schwannomas are peripheral nerve sheath tumours that can present as a rare tumour of GI tract, and even more uncommonly within the colon. We present a case of colonic schwannoma in an asymptomatic patient identified on surveillance colonoscopy. The tumour is of mesenchymal origin and is often challenging to diagnose prior to surgical resection. Endoscopy usually fails to provide adequate sample and diagnosis is usually confirmed on immunohistochemistry.
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Affiliation(s)
| | - Rikesh Patel
- Department of Colorectal Surgery, Aintree University Hospital, Liverpool L9 7AL, UK
| | - Mohamad Ali Kazem
- Consultant General and Colorectal Surgery, Leighton Hospital, Crewe CW1 4QJ, UK
| | - Arif Khan
- Consultant General and Colorectal Surgery, Leighton Hospital, Crewe CW1 4QJ, UK
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28
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Souza LCDA, Pinto TDA, Cavalcanti HODF, Rezende AR, Nicoletti ALA, Leão CM, Cunha VC. Esophageal schwannoma: Case report and epidemiological, clinical, surgical and immunopathological analysis. Int J Surg Case Rep 2019; 55:69-75. [PMID: 30710876 PMCID: PMC6357786 DOI: 10.1016/j.ijscr.2018.10.084] [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] [Received: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Schwannoma is a tumor of the peripheral nervous system originated in the Schwann cells of the neural sheath. PRESENTATION OF CASE A 43-years-old male complained of odynophagia, dysphagia and hemoptysis. The upper gastrointestinal endoscopy showed a smooth elevated lesion, 20 cm from the incisor teeth, occupying the entire lumen of the esophagus. The chest computed tomography (CT) scan showed a lesion of 7 cm and superior mediastinal, lower paraesophageal and cardiac enlarged lymph nodes. A posterolateral thoracotomy was performed with total esophagectomy without intraoperative complications. The anatomopathological analysis revealed fusocellular mesenchymal neoplasia of low malignancy potential. The immunohistochemical study showed positivity for S-100 protein and KI67 antibodies and absence of staining for CD117, CD34, ALK protein, SMA and Desmin. Thus, the morphological and immunohistochemical findings pointed to the diagnosis of esophageal Schwannoma. DISCUSSION Although rare and indolent, Schwannoma occurs in the peripheral nervous system, being uncommon in the esophagus. CONCLUSION The immunohistochemical study is essential for the diagnosis, which is based on the positivity for S-100 protein and absence of staining for CD34 and CD117.
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Affiliation(s)
- Luiz Carlos de Araújo Souza
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil.
| | - Thiago David Alves Pinto
- Physician Anatomopathologist of Diagnose laboratory and Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | | | - Alexandre Rezende Rezende
- Physician Anatomopathologist of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | - Ana Luiza Alves Nicoletti
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | - Cinthia Mares Leão
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
| | - Vinícius Carvalhêdo Cunha
- Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil
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Hashimoto H, Usui G, Sakai E, Ohata K, Morikawa T. Mucosal Schwann Cell Hamartoma of the Rectosigmoid Junction: A Rare Lesion Mimicking Mucosal Prolapse Syndrome and Other Neural Lesions. Int J Surg Pathol 2018; 27:515-517. [DOI: 10.1177/1066896918818897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we report the case of a 40-year-old woman with a sessile polyp of the rectosigmoid junction that underwent endoscopic resection. The resected specimen showed spindle cell proliferation with eosinophilic cytoplasm between mucosal crypts, mimicking mucosal prolapse syndrome. However, these were immunohistochemically positive for S-100, indicating neural cell origin. As neural polypoid lesion of the rectum, neurofibroma, perineurioma, schwannoma, and mucosal Schwann cell hamartoma were in the differential diagnosis. Histology and additional immunohistochemistry confirmed mucosal Schwann cell hamartoma. Mucosal Schwann cell hamartoma of the rectosigmoid junction or rectum can be a histological mimic of mucosal prolapse syndrome and other S-100 positive neural cell lesions; however, the lesion in the present case was correctly diagnosed with histology and immunohistochemistry.
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Affiliation(s)
| | | | | | - Ken Ohata
- NTT Medical Center Tokyo, Tokyo, Japan
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Kahng DH, Kim GH, Park SG, Lee SJ, Park DY. A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma. Clin Endosc 2018; 51:587-590. [PMID: 29764009 PMCID: PMC6283761 DOI: 10.5946/ce.2018.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023] Open
Abstract
Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare among mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas are usually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from other subepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas have not been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas from gastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health check-up endoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patient underwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesion was a benign schwannoma.
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Affiliation(s)
- Dong Hwahn Kahng
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Gyu Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Jeong Lee
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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31
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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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Bohlok A, El Khoury M, Bormans A, Galdon MG, Vouche M, El Nakadi I, Donckier V, Liberale G. Schwannoma of the colon and rectum: a systematic literature review. World J Surg Oncol 2018; 16:125. [PMID: 29970075 PMCID: PMC6029403 DOI: 10.1186/s12957-018-1427-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023] Open
Abstract
Background Schwannomas of the colon and rectum are rare among gastrointestinal schwannomas. They are usually discovered incidentally as a submucosal mass on routine colonoscopy and diagnosed on pathologic examination of the operative specimen. Little information exists on the diagnosis and management of this rare entity. The aim of this study is to report a case of cecal schwannoma and the results of a systematic review of colorectal schwannoma in the literature. Main body PubMed, Scopus, and Cochrane database searches were performed for case reports and case series of colonic and rectal schwannoma. Ninety-five patients with colonic or rectal schwannoma from 70 articles were included. Median age was 61.5 years (59% female). Presentation was asymptomatic (28%), rectorrhagia (23.2%), or abdominal pain (15.8%). Schwannoma occurred in the left and sigmoid colon in 36.8%, in the cecum and right colon in 30.5%, and in the rectum in 21.1%. Median tumor size was 3 cm and 56.2% of patients who underwent preoperative colonoscopy had a typical smooth submucosal mass. At pathology, 97.9, 13.7, and 5.3% of schwannomas stained positive for S100, vimentin, and GFAP, respectively. The median mitotic index was 1/50. Conclusions Colorectal schwannoma is a very rare subtype of gastrointestinal schwannoma which occurs in the elderly, almost equally in men and women. Schwannoma should be included in the differential diagnosis of a submucosal lesion along with gastrointestinal stromal tumor, neuro-endocrine tumors, and leiomyoma-leiomyosarcoma. Definitive diagnosis is based on immunohistochemistry of the operative specimen. Rarely malignant, surgery is the mainstay of treatment.
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Affiliation(s)
- Ali Bohlok
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Melody El Khoury
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Bormans
- Institutional Library, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Gomez Galdon
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Issam El Nakadi
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Donckier
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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Chayanupatkul M, Gould Suarez M, Sealock RJ. Colonic Schwannoma Diagnosed by Endoscopic Ultrasound With Fine-Needle Aspiration. Clin Gastroenterol Hepatol 2018; 16:A29-A30. [PMID: 28342954 DOI: 10.1016/j.cgh.2017.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Maneerat Chayanupatkul
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Milena Gould Suarez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Robert Jay Sealock
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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34
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Cheng E, Oliphant R, Fung C, Rickard M, Keshava A. Schwannoma of the appendix: A case report and review of the literature. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ernest Cheng
- Department of Colorectal Surgery; University of Sydney, Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Raymond Oliphant
- Department of Colorectal Surgery; University of Sydney, Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Caroline Fung
- Department of Anatomical Pathology; University of Sydney, Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Matthew Rickard
- Department of Colorectal Surgery; University of Sydney, Concord Repatriation General Hospital; Sydney New South Wales Australia
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
| | - Anil Keshava
- Department of Colorectal Surgery; University of Sydney, Concord Repatriation General Hospital; Sydney New South Wales Australia
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
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35
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van Wyk AC, van Zyl H, Rigby J. Colonic perineurioma (benign fibroblastic polyp): case report and review of the literature. Diagn Pathol 2018; 13:16. [PMID: 29463272 PMCID: PMC5819702 DOI: 10.1186/s13000-018-0694-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal perineuriomas are uncommon benign mucosal-based proliferations of mesenchymal cells that express perineurial markers, often associated with colonic crypts displaying a serrated/hyperplastic architecture. The vast majority of cases arise distal to the splenic flexure and have been described as sessile polyps. Using molecular analysis, BRAF mutations have been demonstrated in the serrated crypt epithelium. We report a new case of perineurioma presenting as a pedunculated polyp in the transverse colon, with prominent hemosiderin deposits in the uninvolved lamina propria that separated the perineurial proliferation from the surface epithelium, a previously unreported histological finding. By using immunohistochemistry, we demonstrated the presence of BRAF V600E mutated protein in the serrated crypt epithelium. In addition, a review of the literature on colorectal perineurioma is provided. CASE PRESENTATION A 5 mm pedunculated polyp was removed from the transverse colon of a 42 year old man who presented with epigastric pain, weight loss and rectal bleeding. A proliferation of uniform plump spindled cells expanded the lamina propria and separated serrated colonic crypts. The epithelial component closely resembled microvesicular hyperplastic polyp. Immunohistochemical stains for epithelial membrane antigen (EMA), glucose transporter 1 (GLUT1) and collagen IV were positive in the stromal proliferation. A mutation-specific monoclonal antibody directed against BRAF V600E showed positive cytoplasmic staining in the serrated crypt epithelium but not in the perineurial proliferation. Conspicuous hemosiderin deposition was seen in the inflamed lamina propria between the perineurial proliferation and the surface epithelium. CONCLUSION Although the majority of colorectal perineuriomas occur in the sigmoid colon and rectum and are described as sessile polyps, colorectal perineurioma can present as a pedunculated polyp proximal to the splenic flexure as described in this case. Conspicuous hemosiderin deposition can be seen in the superficial lamina propria. BRAF mutations are limited to the serrated crypt epithelium.
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Affiliation(s)
- Abraham Christoffel van Wyk
- Division of Anatomical Pathology, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
| | - Hennie van Zyl
- Department of Surgery, Karl Bremer Hospital, Cape Town, South Africa
| | - Jonathan Rigby
- Division of Anatomical Pathology, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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36
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McCarthy AJ, Karamchandani DM, Chetty R. Neural and neurogenic tumours of the gastroenteropancreaticobiliary tract. J Clin Pathol 2018; 71:565-578. [PMID: 29419412 DOI: 10.1136/jclinpath-2017-204895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/11/2022]
Abstract
Neural lesions occur uncommonly in the gastroenteropancreaticobiliary tract. However, due to the growing number of screening colonoscopy procedures, polypoid neural lesions of the colon are being recognised increasingly and range from benign tumours to high-grade malignant neoplasms. Morphological variability of neural tumours can be wide, although some entities share pathological features, and, as such, these lesions can be diagnostically challenging. We review the spectrum of pathology of neural tumours in the gastroenteropancreaticobiliary tract, with the goal of providing a practical approach for practising surgical pathologists.
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Affiliation(s)
- Aoife J McCarthy
- Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Dipti M Karamchandani
- Department of Pathology, Division of Anatomic Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Runjan Chetty
- Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
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37
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García-Molina F, Ruíz-Macia JA, Sola J. [Mucosal Schwann cells hamartoma: Review of a recently described entity]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 51:49-54. [PMID: 29290324 DOI: 10.1016/j.patol.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/14/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
Abstract
Neural lesions of the colon may be masses (schwannomas and neurofibromas) or, more frequently, small polyps including perineuromas, ganglioneuromas and granular cell tumors. Some neural lesions are associated with congenital syndromes (neurofibromatosis-1, multiple endocrine neoplasia-2B). Recently, a new entity has been described named mucosal Schwann cell hamartoma, consisting of an intramucosal neural proliferation; to date, less than forty cases have been reported. We report a further case in a patient from whom a polyp was extirpated during colonoscopy screening. Histologically, the polyp showed a lamina propia that contained spindle-shaped cells of neural aspect which could only be identified after a histochemical and immunohistochemical study.
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Affiliation(s)
- Francisco García-Molina
- Servicio de Anatomía Patológica, Hospital General Universitario Morales Meseguer, Murcia, España.
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38
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Díaz del Arco C, Esteban Collazo F, Ortega Medina L, Estrada Muñoz L, González Morales ML, Fernández Aceñero MJ. Schwannomas gastrointestinales: revisión de la literatura a propósito de 5 casos en intestino. REVISTA ESPAÑOLA DE PATOLOGÍA 2017; 50:179-183. [DOI: 10.1016/j.patol.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/09/2024]
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Vila RDD, Michaelsen MMC, Bonamigo KS, Cerato NL, Garcia VCMD, Passos PDS, Garcia AC. GASTROINTESTINAL SCHWANNOMA: CASE REPORT. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:211. [PMID: 27759789 PMCID: PMC5074677 DOI: 10.1590/0102-6720201600030019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/05/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Rafael Dienstmann Dutra Vila
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
| | - Marlise Mello Cerato Michaelsen
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
| | - Karine Sabrina Bonamigo
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
| | - Nilo Luiz Cerato
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
| | - Valério Celso Madruga de Garcia
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
| | - Patrícia da Silva Passos
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
| | - Adriano Calcagnotto Garcia
- Serviço de Coloproctologia, Hospital Ernesto Dornelles (Coloproctology Service, Hospital Ernesto Dornelles), Porto Alegre, RS, Brazil
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40
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Kang JH, Kim SH, Kim YH, Rha SE, Hur BY, Han JK. CT Features of Colorectal Schwannomas: Differentiation from Gastrointestinal Stromal Tumors. PLoS One 2016; 11:e0166377. [PMID: 28005903 PMCID: PMC5179024 DOI: 10.1371/journal.pone.0166377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/27/2016] [Indexed: 01/22/2023] Open
Abstract
Purpose To find differential CT features of colorectal schwannomas from gastrointestinal stromal tumors (GISTs). Materials and Methods CT features of 13 pathologically proven colorectal schwannomas and 21 GISTs were retrospectively reviewed. The following CT items were analyzed: size, longitudinal and transverse location, shape, margin, homogeneity, necrosis, surface ulceration, calcification, degree of attenuation, the presence of enlarged lymph node (LN), and metastasis. Among the features, significant variables were evaluated using univariate statistical tests. The optimal cut-off point of tumor size was obtained by ROC analysis. Binary logistic regression analysis was used to find the most independent CT variables. Results Small size, non-rectum location, smooth margin, homogeneous high attenuation without necrosis, and the presence of enlarged LNs were found to be significant variables to differentiate schwannomas from GISTs (P<0.05). The optimized cut-off point for tumor size in distinguishing GISTs from schwannomas was 3.9 cm (AUC = 0.808, sensitivity = 66.7%, specificity = 92.3%, P<0.0001). Binary regression analysis revealed that only non-rectum location remained independent predictor for schwannomas differentiated from GISTs (odds ratio = 31.667, P = 0.001). Conclusion Colorectal schwannomas usually located in non-rectum and appear as small subepithelial nodules showing homogeneous high attenuation and smooth margin. Schwannomas exclusively accompany with enlarged LNs.
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Affiliation(s)
- Ji Hee Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Eun Rha
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
| | - Bo Yun Hur
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 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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41
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Uhr A, Singh AP, Munoz J, Aka A, Sion M, Jiang W, Goldstein SD, Rosato EL. Colonic Schwannoma: A Case Study and Literature Review of a Rare Entity and Diagnostic Dilemma. Am Surg 2016. [DOI: 10.1177/000313481608201224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
An asymptomatic 73-year-old woman was found to have a submucosal mass in the descending colon on routine colonoscopy. A CT scan revealed a 31 X 28 X 31 mm lesion in the same location. Previous biopsy proved to be nondiagnostic, and the patient underwent a laparoscopic descending colon resection. Histologic evaluation of the tumor revealed a low grade spindle cell neoplasm with strong, diffuse positivity for S-100 protein by immunohistochemistry, leading to the diagnosis of schwannoma. A review of the literature revealed intestinal schwannoma to be a rare disease entity, with only about 50 cases previously reported.
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Affiliation(s)
- Alex Uhr
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Awinder P. Singh
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jose Munoz
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Allison Aka
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Melanie Sion
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Wei Jiang
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Ernest L. Rosato
- From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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42
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Virani N, Pang J, Lew M. Cytologic and Immunohistochemical Evaluation of Low-Grade Spindle Cell Lesions of the Gastrointestinal Tract. Arch Pathol Lab Med 2016; 140:1038-44. [DOI: 10.5858/arpa.2016-0235-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spindle cell lesions of the gastrointestinal tract are relatively uncommon compared with the frequency of their epithelial counterparts. Although gastrointestinal stromal tumors and leiomyomas are the most commonly encountered spindle cell lesions in the stomach and esophagus, respectively, there are other less common diagnostic entities that should be considered for accurate diagnoses as well as appropriate patient treatment and clinical follow-up. Given the morphologic overlap of low-grade spindle cell lesions on cytologic preparations, ancillary studies play a key role in differentiating these lesions from one another.
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Affiliation(s)
- Nilam Virani
- From the Department of Pathology, University of Michigan, Ann Arbor
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Kudose S, Kyriakos M, Awad MM. Gastric plexiform schwannoma in association with neurofibromatosis type 2. Clin J Gastroenterol 2016; 9:352-357. [PMID: 27696205 DOI: 10.1007/s12328-016-0687-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/22/2016] [Indexed: 12/27/2022]
Abstract
Plexiform schwannoma (PS) is an uncommon variant of schwannoma characterized by a multinodular (plexiform) growth pattern. It comprises up to 5 % of all schwannomas. The association between PS and neurofibromatosis type 1 or type 2 (NF1/NF2) is only rarely reported. Most cases of PS occur in the skin and subcutaneous soft tissue, with only a few reports of digestive tract involvement. We describe an 18-year-old male with NF2 who had bilateral vestibular schwannomas and multiple cutaneous PSs, and a 3-year history of abdominal pain. The patient ultimately underwent a distal gastrectomy for a partially obstructing submucosal antral mass, associated with an overlying ulcer. Histopathologic examination showed the mass to be a PS. The patient is alive and well, without symptoms, 12 months postoperatively. A review of the English language medical literature yielded only ten examples of PS arising in the digestive tract. Our patient is the first to be reported to have a gastric PS, and only the second patient to be reported with a digestive tract PS to have NF2, and the only patient reported to have both digestive tract and cutaneous PSs. Despite its rare occurrence with NF2, the finding of PS at any site should stimulate an examination for other manifestations of this disorder. CLINICAL TRIAL REGISTRATION None.
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Affiliation(s)
- Satoru Kudose
- Division of Surgical Pathology, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Pathology and Immunology, Washington University, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, USA.
| | - Michael Kyriakos
- Division of Surgical Pathology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Magdi Awad
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Mohanty SK, Jena K, Mahapatra T, Dash JR, Meher D, John A, Nayak M, Bano S. Gastric GIST or gastric schwannoma-A diagnostic dilemma in a young female. Int J Surg Case Rep 2016; 28:60-64. [PMID: 27689519 PMCID: PMC5043394 DOI: 10.1016/j.ijscr.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 12/17/2022] Open
Abstract
Gastric Schwannoma is a rare neoplasm of stomach. It mimic clinically and radiologically with Gastric GIST. Immunohistochemical study can differentiate these two tumors. Introduction Gastrointestinal stromal tumor (GIST) is the commonest mesenchymal tumor of GI tract and 60–70% of it seen in the stomach, whereas Gastric schwannoma is a benign, slow growing and one of the rare neoplasms of stomach. Age distribution, clinical, radiological features and gross appearance of both tumors are similar. Presentation of case We report a rare case of gastric schwannoma in a 20-year-old girl, who underwent subtotal gastrectomy with the suspicion of a GIST preoperatively but later confirmed to be gastric schwannoma postoperatively after immunohistochemical study. Discussion Accordingly, the differential diagnosis for gastric submucosal mass should be gastric schwannoma. Furthermore, Gastric schwannoma is a benign neoplasm with excellent prognosis after surgical resection, whereas 10–30% of GIST has malignant behavior. Therefore, it is important to distinguish between gastric schwannoma and GIST so as to make an accurate diagnosis for optimally guide treatment options. Conclusion Due to the paucity of gastric schwannoma, the index of suspicion for this diagnosis is low. So it is important to include gastric schwannoma in the differential diagnosis when preoperative imaging studies reveal submucosal exophytic gastric mass and after resection of the tumor with a negative margin, it should be sent for immunohistochemical study for confirmation of diagnosis.
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Affiliation(s)
- Sudhir Kumar Mohanty
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Kumarmani Jena
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Tanmaya Mahapatra
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Jyoti Ranjan Dash
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Dibyasingh Meher
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Ajax John
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Manjushree Nayak
- Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
| | - Shafqat Bano
- Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, 753007, India.
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Clinical, Morphologic, and Pathologic Features Associated With Increased FDG Uptake in Schwannoma. AJR Am J Roentgenol 2016; 207:1288-1296. [PMID: 27657364 DOI: 10.2214/ajr.15.14964] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the clinical, morphologic, and pathologic features associated with increased 18F-FDG uptake in benign schwannomas. MATERIALS AND METHODS Twenty-two schwannomas in 22 patients (age range, 25-81 years) who had FDG PET or PET/CT scans and subsequently underwent surgical re-section were retrospectively analyzed. The maximum standardized uptake value (SUVmax) was compared with patient age, sex, tumor location (gastrointestinal vs nongastrointestinal origin), tumor size, gross appearance, intratumoral cellularity, intratumoral infiltration of inflammatory cells, presence of peritumoral lymphoid cuffs, and expression status of glucose transporters 1 and 3 on tumor cells. RESULTS The SUVmax of schwannomas ranged from 1.5 to 17.3 (median, 3.7). Significantly higher SUVmax was observed in gastrointestinal schwannomas (n = 4) compared with nongastrointestinal schwannomas (n = 18, p = 0.007) and in schwannomas with peritumoral lymphoid cuffs (n = 5) compared with those without peritumoral lymphoid cuffs (n = 17, p = 0.001). A significant correlation was seen between tumor location and the presence of peritumoral lymphoid cuffs (p < 0.001). Age, sex, tumor size, gross appearance, intratumoral cellularity, intratumoral inflammatory cell infiltration, and expression status of glucose transporters 1 and 3 on tumor cells had no significant correlation with SUVmax. CONCLUSION Gastrointestinal schwannomas and schwannomas with peritumoral lymphoid cuffs may be associated with elevated FDG uptake. Knowledge of the features of schwannomas associated with increased uptake may be helpful to avoid misinterpretation of benign schwannomas as malignancy.
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Kane JR, Lewis N, Lin R, Villa C, Larson A, Wayne JD, Yeldandi AV, Laskin WB. Plexiform fibromyxoma with cotyledon-like serosal growth: A case report of a rare gastric tumor and review of the literature. Oncol Lett 2016; 11:2189-2194. [PMID: 26998147 DOI: 10.3892/ol.2016.4185] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 09/29/2015] [Indexed: 12/14/2022] Open
Abstract
Plexiform fibromyxoma is a rare, benign mesenchymal neoplasm that predilects the gastric antrum and has potential for misdiagnosis as a gastrointestinal stromal tumor (GIST). The histology of the tumor is characterized by interwoven fascicular growth of cytologically bland spindled cells within a variably myxoid stroma. The current study reports the clinicopathological and immunohistochemical findings of a plexiform fibromyxoma resected from a 28-year-old Vietnamese female. The patient presented with acute, severe abdominal pain and worsening anemia. The initial fine-needle aspiration and needle core biopsy of the gastric antral mass led to an initial diagnosis of GIST. The subsequent distal partial gastrectomy revealed a 5.5-cm transmural antral mass that ulcerated the overlying mucosa and grew as variably elongated, myxoedematous, polypoid (cotyledon-like) excrescences from the serosal surface. Microscopically, the tumor demonstrated plexiform and multinodular growth of cytologically bland spindled cells proliferating in an abundant myxocollagenous stroma with a prominent capillary network. Tumor cells immunohistochemically expressed smooth muscle actin and CD10, but did not express CD117, Discovered on GIST-1 or nuclear β-catenin. Follow-up evaluation 23 months post surgery revealed no evidence of residual tumor. A review the cases of this rare entity reported in the English language literature is also provided.
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Affiliation(s)
- Joshua Robert Kane
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Natasha Lewis
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Rebecca Lin
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Celina Villa
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Alexandra Larson
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jeffrey D Wayne
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Anjana V Yeldandi
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - William B Laskin
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abstract
This article presents an overview of soft tissue tumors that have a plexiform histomorphology. The more commonly encountered entities, including plexiform fibrohistiocytic tumor, cellular neurothekeoma, dermal nerve sheath myxoma, plexiform schwannoma, and plexiform neurofibroma, are discussed in detail, and other tumors are noted. Information on clinical features, microscopic findings, ancillary studies, differential diagnosis, and prognosis is provided for each entity.
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Affiliation(s)
- Hillary Elwood
- Department of Pathology, The Johns Hopkins Hospital, Path 401, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Janis Taube
- Departments of Dermatology and Pathology, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Daley MJ, Trust MD, Peterson EJ, Luftman K, Miller AH, Ali S, Clark A, Aydelotte JD, Coopwood TB, Brown CV. Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. Am Surg 2016. [DOI: 10.1177/000313481608200224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity.
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Affiliation(s)
| | - Marc D. Trust
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | | | - Kevin Luftman
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Andrew H. Miller
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Sadia Ali
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | - Adam Clark
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
| | | | | | - Carlos V.R. Brown
- Trauma Services, University Medical Center Brackenridge, Austin, Texas
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Tashiro Y, Matsumoto F, Iwama K, Shimazu A, Matsumori S, Nohara S, Miura H, Takei M, Namekata K, Takase M, Okada M, Tsumura H. Laparoscopic resection of schwannoma of the ascending colon. Case Rep Gastroenterol 2015; 9:15-9. [PMID: 25759634 PMCID: PMC4327572 DOI: 10.1159/000373882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Schwannomas of the colon are rare and difficult to diagnose preoperatively. We report a case of schwannoma of the ascending colon that was resected laparoscopically. A 64-year-old woman was referred to our hospital by her local clinic for further evaluation and management of a submucosal tumor of the ascending colon. A definitive preoperative diagnosis could not be reached despite examinations. Gastrointestinal stromal tumor, leiomyoma and lymphoma were the differential diagnoses. We performed a laparoscopic right hemicolectomy with D2 lymph node dissection. Histological findings with hematoxylin-eosin staining revealed spindle-like tumor cells, and immunohistochemical analysis showed that the tumor was positive for S-100 but negative for c-kit, CD34, smooth muscle actin and desmin, with a Ki-67 index of <5%. Thus, the diagnosis in this case was benign schwannoma of the ascending colon.
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Affiliation(s)
- Yoshihiko Tashiro
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Fumio Matsumoto
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Keiko Iwama
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Ai Shimazu
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Sei Matsumori
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Shigeo Nohara
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Hiroyoshi Miura
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Masahiko Takei
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Koji Namekata
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Masaru Takase
- Department of Pathology, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Motoi Okada
- Department of Pathology, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Hidenori Tsumura
- Department of Surgery, Koshigaya Municipal Hospital, Koshigaya, Japan
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