Schwannomas are tumors arising from the nervous system that also occur infrequently in the gastrointestinal tract, most commonly in the stomach. This report characterizes 29 patients with benign or malignant gastric schwannomas. Surgical data and clinical follow-up information were available for 28 cases with a median postoperative duration of 57 months. Clinicopathological and immunohistochemical characteristics of benign and malignant schwannomas were analysed. Four cases (13.7%) were histologically diagnosed with malignant schwannoma. All tumors were positive for S-100 and CD56 proteins, displaying a diffuse staining pattern. Vimentin was expressed in 100% cases and all schwannomas were negative for smooth muscle actin, c-kit, and HMB-45. A significant difference was observed between the group of benign and malignant schwannomas as regards recurrences and metastasis after complete resection (P = 0.015). The survival time of patients with benign schwannomas was longer than the malignant group (P = 0.013), so gastric malignant schwannomas have a potential for recurrence and metastasis, with subsequently short survival. Complete resection with an attempt to remove all tumor tissue with negative margins is of paramount importance in the management of gastric schwannomas, particularly when they turn out to be malignant.

https://downloads.hindawi.com/journals/grp/2014/202960.pdf

Clinicopathological and immunohistochemical characterisation of gastric schwannomas in 29 cases.

Gastric schwannomas (GSs) are rare mesenchymal neoplasms of the gastrointestinal tract. Diagnosis is often achieved postoperatively, based on pathology reports of retrieved specimens. The aim of the present study is to follow up all patients with gastric schwannoma (Gs) undergoing endoscopic, partial, or more extended surgery and to evaluate the appearance of local or distant recurrence. A PubMed, Cochrane, and Embase systematic review of the literature has been performed. Original papers, review articles, and case reports published between 1988 and 2019 were considered eligible. All the studies who met the inclusion criteria were analyzed. Statistical analysis of data has been performed using GraphPad Prism 7 software. Three hundred twenty-eight articles were found, and a total of 102 were included and analyzed in depth. Fifty-three papers reported the follow-up information, ranging from 1 to 417 months across different studies. Among them, 31 patients underwent endoscopic removal of the gastric lesions; 140 patients underwent local surgery, including wedge resection or partial gastrectomy; and 148 patients underwent subtotal or total gastrectomy. The median follow-up was of 27-38-33 months, respectively. No recurrence or distant metastasis was detected in the endoscopy group. Among local surgery group, liver metastasis was reported in one case; in extended surgery group, one patient died for multiple liver metastases. Local or more extended surgery involved a larger cohort of patients and reported satisfactory long-term results compared with endoscopy group. Surgery in absence of a definite preoperative diagnosis is considered the gold standard treatment for resectable Gs.

What About Gastric Schwannoma? A Review Article.

Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review

Pleksiform schwannoma, periferik sinir k›l›f›n›n bir tumoru olup plexiform yap›da dizilmifl schwan hucrelerinden oluflur. Coun- lukla cilt tutulumu ile kendini gosterir. Duodenumun pleksiform schwannomas› flimdiye kadar henuz rapor edilmemifltir. Biz bu yaz›m›zda ilk olarak duodenumun pleksiform schwannomas›n› rapor ettik. Altm›fl yafl›nda erkek hasta oral al›mda gucluk, epigas- trik ar›, kar›nda dolgunluk ve gaz, kusma ve kilo kayb› ile hastanemize baflvurdu. Hastada klinik olarak neurofibromatosis bul- gusu bulunmamaktad›r. Endoskopik incelemede normal mukoza ile kapl› pilor stenozu olduu goruldu. Bilgisayarl› tomografi in- celemesinde pilorun 18 mm kadar ulaflan konsantrik olarak kal›nlaflt›¤›, kontrast geciflinin azald›¤› rapor edildi. Hastaya antrek- tomi ve gastrojejunostomi ameliyat› yap›ld›. Lezyon patolojik olarak incelendiinde pilorun cepecevre olarak 15 mm kadar kal›n- laflt›¤›, pilorun duodenum yuzunde yuzeyi salam duodenum mukozas› ile kapl› 5 mm capl› beyaz renkte sert noduler yap› olduu goruldu. Mikroskopik incelemede bu noduler yap›n›n fasikuler yap›da dizilmifl atipi ve mitoz gostermeyen isi hucrelerden olufltu- ¤u goruldu. ‹mmunohistokimyasal incelemede ise bu hucrelerin yayg›n ve kuvvetli olarak S100 ile boyan›rken, CD117, duz kas ak- tin, desmin ve CD34 ile boyanmad›¤› gorulerek pleksiform schwannoma olduu teflhis edildi. Anahtar kelimeler: Duodenum, gastrointestinal stromal tumorler, sinir k›l›f› tumorleri, pleksiform schwannoma Plexiform schwannoma is a benign peripheral nerve sheath tumor and is composed of Schwann cells arranged in a plexiform pat- tern. Most plexiform schwannomas are skin tumors, and there has been no case report of this tumor originating in the duodenum. We describe the first known case of plexiform schwannoma of the duodenum. A 60-year-old man presented with a short history of food intolerance, epigastric discomfort, fullness and bloatedness, sometimes vomiting, and weight loss, without any clinical picture of neurofibromatosis. Upper gastrointestinal endoscopy revealed pyloric stenosis with normal mucosal lining. The computed tomog- raphy demonstrated circumferentially and concentrically thickened pylorus up to 18 mm with narrowed lumen and limited contrast passage. Antrectomy and gastrojejunostomy were performed due to unknown etiology of the obstruction. The cut surface of the lesi- on revealed thickened pylorus up to 15 mm in a circumferential manner. It contained a 5 mm tumor consisted of multiple white no- dules in the submucosal and subserosal layers with overlying duodenal mucosa. Microscopic examination revealed nodular struc- tures composed of spindle cells within fascicular pattern without any atypia or mitosis. Immunohistochemical examination revea- led that the cells diffusely and strongly expressed S100 proteins in a nuclear and cytoplasmic pattern, but not CD117, smooth musc- le actin, desmin, or CD34, confirming plexiform schwannoma.

Plexiform schwannoma of the duodenum accompanying pyloric stenosis: report of a case.

Gastrointestinal schwannoma is a rare, slow-growing and benign tumor that mostly originates in the Auerbach myenteric nerve plexus in the gastrointestinal tract. The clinical manifestations may be associated with the location, size, differentiation type, and degree of malignancy of the tumor. Endoscopy, ultrasound and imaging examinations serve an important auxiliary role in the clinical identification, diagnosis and differential diagnosis of lesions; assessment of risk; and preparation for surgery. S-100 positivity is a hallmark of schwannoma. CD34, CD117, discovered on GIST-1, P53, ALK, β-catenin, smooth muscle actin and Desmin negativity are helpful for the identification of other gastrointestinal stromal tumors. Surgical removal of the tumor is the main treatment for schwannoma. Benign gastrointestinal schwannoma has a good prognosis without recurrence and metastasis; malignant transformation is extremely rare and has a poor prognosis.

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Current status of the diagnosis and treatment of gastrointestinal schwannoma

Schwannomas, or neurinomas, are generally benign, slow-growing, asymptomatic neoplasms originating from the Schwann cells of a nerve sheath. As a part of spindle cell mesenchymal tumours, schwannomas arising from the gastrointestinal tract (GIT) are unusual; however, when they occur, the most common site involved is the stomach, which represents 0.2% of all gastric tumours. We report the case of a 35-year-old female patient with a history of pulmonary tuberculosis presenting with a large palpable abdominal mass reaching up to the peritoneal cavity. The initial clinical impression was a tuberculous abdominal mass, a cyst, or a teratoma. However, intra-operative findings during a subtotal gastrectomy revealed an exophytic gastric serosal mass, which suggested a gastrointestinal stromal tumour (GIST). Post-operative histopathological findings showed a fascicular arrangement of neoplastic spindle cells with pallisading nuclei that showed intense positivity for S-100 protein, and were negative for CD117 and desmin in immunohistochemistry studies. These results confirmed the final diagnosis of a gastric schwannoma.

Hafiz Mansoor-Ul-Haq

Papers

Gastric schwannoma in a female patient with pulmonary tuberculosis - a clinicopathological assessment and diagnosis.