Clinical Endoscopy

Case Report

A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma: Dong Hwahn Kahng, Gwang Ha Kim, Sang Gyu Park, So Jeong Lee, Do Youn Park; Clin Endosc 2018;51(6):587-590. Published online May 15, 2018; DOI: https://doi.org/10.5946/ce.2018.050

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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Original Article

Endosonographic Features of Gastric Schwannoma: A Single Center Experience: Jong Min Yoon, Gwang Ha Kim, Do Youn Park, Na Ri Shin, Sangjeong Ahn, Chul Hong Park, Jin Sung Lee, Key Jo Lee, Bong Eun Lee, Geun Am Song; Clin Endosc 2016;49(6):548-554. Published online March 15, 2016; DOI: https://doi.org/10.5946/ce.2015.115

Abstract PDF PubReader ePub

Background
/Aims: Gastric schwannomas are rare benign mesenchymal tumors that are difficult to differentiate from other mesenchymal tumors with malignant potential, such as gastrointestinal stromal tumors. This study aimed to evaluate the characteristic findings of gastric schwannomas via endoscopic ultrasonography (EUS).
Methods
We retrospectively reviewed the EUS findings of 27 gastric schwannoma cases that underwent surgical excision at Pusan National University Hospital during 2007 to 2014.
Results
Gastric schwannomas were mainly located in the middle third of the stomach with a mean tumor size of 32 mm. All lesions exhibited hypoechoic echogenicity, and 24 lesions (88.9%) exhibited heterogeneous echogenicity. Seventeen lesions (63.0%) exhibited decreased echogenicity compared to the normal proper muscle layer. Distinct borders were observed in 24 lesions (88.9%), lobulated margins were observed in six lesions (22.2%), and marginal haloes were observed in 24 lesions (88.9%). Hyperechogenic spots were observed in 21 lesions (77.8%), calcifications were observed in one lesion (3.7%), and cystic changes were observed in two lesions (7.4%).
Conclusions
During EUS, gastric schwannomas appear as heterogeneously hypoechoic lesions with decreased echogenicity compared to the normal proper muscle layer. These features may be helpful for differentiating gastric schwannomas from other mesenchymal tumors.

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Case Report

Gastric Schwannoma Diagnosed by Endoscopic Ultrasonography-Guided Trucut Biopsy: Sung Wook Hong, Won Young Cho, Jin-Oh Kim, Chang Gyun Chun, Kwang Yeun Shim, Gene Hyun Bok, Wook Hyun Um, Ji Eun Lee; Clin Endosc 2013;46(3):284-287. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.284

Abstract PDF PubReader ePub

Schwannomas of the gastrointestinal (GI) tract are rare subepithelial tumors comprising approximately 3.3% to 12.8% of all mesenchymal tumors of the GI tract. On endoscopic ultrasound (EUS) they are seen as hypoechoic tumors arising most commonly from the 4th proper muscle layer. Although EUS helps to distinguish tumor characteristics, tissue sampling is required for differentiation with other more common tumors such as GI stromal tumors. Both EUS-guided fine needle aspiration and EUS-guided trucut biopsy (EUS-TCB) can be used for tissue sampling. However, only EUS-TCB allows core biopsy and a high yield of immunohistochemical staining. We report a case of a gastric schwannoma diagnosed by EUS-TCB.

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Vishali Moond, Preeti Diwaker, Reshma Golamari, Rohit Jain
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Changsheng Pu, Keming Zhang
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Quanyong Cheng, Kun Zhao, Jing Wang, Yu Guo, Hui Pang
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Jesús Morales-Maza, Francisco Ulises Pastor-Sifuentes, Germán E Sánchez-Morales, Emilio Sanchez-Garcia Ramos, Oscar Santes, Uriel Clemente-Gutiérrez, Adriana Simoneta Pimienta-Ibarra, Heriberto Medina-Franco
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Hager Aref, Georges A. Abizeid
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Spectral Computed Tomography Imaging of Gastric Schwannoma and Gastric Stromal Tumor
Jianli Liu, Yanjun Chai, Junlin Zhou, Chi Dong, Wenjuan Zhang, Bin Liu
Journal of Computer Assisted Tomography.2017; 41(3): 417. CrossRef
Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma
Jinlong Hu, Xiang Liu, Nan Ge, Sheng Wang, Jintao Guo, Guoxin Wang, Siyu Sun
Medicine.2017; 96(25): e7175. CrossRef
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Diogo Sousa, Miguel Allen, Alda Pinto, Andreia Ferreira, Ana Cruz, Diogo Marinho, Pierpaolo Cusati, José Augusto Martins
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Huge Gastric Schwannoma Characterized by a Gastric Ulcer During Endoscopy: Chang Jung Lee, M.D., Suk Joon Park, M.D., Seong Yong Woo, M.D., Hyun Jong Oh, M.D., Mi Kyung Sung, M.D., Byeong Ho Lee, M.D., Sung Bae An, M.D. and Hyun Ju Yoo, M.D.^*; Korean J Gastrointest Endosc 2011;43(1):33-37. Published online July 28, 2011

Abstract PDF: Gastric schwannomas are very rare mesenchymal tumors that can occur throughout the gastrointestinal tract, but are most commonly found in the stomach. The majority of patients have no symptoms, while others may complain of epigastric pain or upper gastrointestinal ulcer bleeding. Endoscopic examination of a gastric schwannoma commonly reveals a protrusive mass, but, as in this case, many types of ulceration can be observed with central necrosis. We report on a 62-year-old woman with endoscopic findings of 1 cm sized necrotizing ulceration and an 11 cm sized submucosal mass on radiological examinations. The patient underwent a wedge-shaped resection of the stomach and segmental resection of the transverse colon. Both histological and immunohistochemical staining revealed a gastric schwannoma. (Korean J Gastrointest Endosc 2011;43:33-37)

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A Case of an Esophageal Schwannoma with Intense FDG Uptake as Detected on PET-CT: Seong Hoon Yoon, M.D., Gwang Ha Kim, M.D., Do Youn Park, M.D.*, Ho Seok Lee, M.D.^†, Jung Ho Bae, M.D., Jin Hyun Park, M.D., Su Bum Park, M.D. and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2008;37(5):339-343. Published online November 30, 2008

Abstract PDF: An esophageal schwannoma originating in a schwann cell of a neuron presents as a type of submucosal tumor. An esophageal schwannoma is extremely rare, with only 30 reported cases. It is usually a benign tumor. However, three cases with malignant findings and one case with local recurrence have been reported. Reviews of previous reports indicate that benign schwannomas are usually located in the upper esophagus and occur in middle aged- women. An esophageal schwannoma is usually asymptomatic but sometimes causes dysphagia as an initial symptom and dyspnea by trachea compression. The differentiation of a schwannoma from the other submucosal tumors is very difficult on a preoperative examination with the use of esophagoscopy, endoscopic ultrasound and computed tomography. A definite diagnosis of the tumor requires a histological examination and immunohistochemical staining. Positive immunostaining for s-100 protein supports the schwann cell origin of the tumor. We report a case of an esophageal schwannoma with intense FDG uptake as detected on PET-CT. (Korean J Gastrointest Endosc 2008;37:339-343)

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A Case of Esophageal Benign Schwannoma Removed by Endoscopic Mucosal Resection: Seok Cho, M.D., Chang Hwan Park, M.D., Dae Yeul Ryang, M.D., Sung Ryoun Lim, M.D., Kyoung Myeun Chung, M.D., Hye Kyong Jeong, M.D., Phil Jin Jung, M.D., Seung Hwan Lee, M.D., Kyoung Won Yoon, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D. and Jong Sun Rew,; Korean J Gastrointest Endosc 2008;36(6):361-365. Published online June 30, 2008

Abstract PDF: Esophageal schwannoma is a very rare neoplasm. The differentiation of schwannoma from the other submucosal tumors such as GISTs or leiomyoma is very difficult to do on the preoperative examination with performing esophagoscopy and computed tomography. The diagnosis is generally not confirmed until the histologic and immunohistochemical tests of the tumor are performed. A 38- year-old man presented to us with neck discomfort. The endoscopy showed a middle esophageal submucosal tumor that measured 12 mm in size and there were no mucosal changes. The endoscopic ultrasonography showed a tumor in the muscluaris mucosa layer without lymphadenopathy. After band ligation of the lower part of the tumor, it was removed by performing endoscopic mucosal resection and using a snare. A definitive diagnosis of esophageal benign schwannoma was made from the pathologic findings, which included positive immunohistochemical staining for S-100 protein and negative staining for C-kit, CD34 and actin. We report here on an esophageal benign schwannoma that was removed by endoscopic mucosal resection. (Korean J Gastrointest Endosc 2008;36:361-365)

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Two Cases of Gastric Schwannomas - with Ulcer and without Ulcer -: Pyo Jun Kim, M.D., Gwang Ha Kim, M.D., Jin Kang, M.D., Tae Ik Park, M.D., Dong Hoon Shin, M.D., Tae Yong Jeon, M.D. and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2007;35(4):243-249. Published online October 30, 2007

Abstract PDF: A Schwannoma is a benign tumor that originates from Schwann cells in the gastric wall. The tumor is mainly asymptomatic but sometimes can cause bleeding of the upper GI tract. We encountered a Schwannoma that was identified by gastroscopy as a submucosal mass that might be malignant. Therefore, surgery was considered as the primary treatment. The Schwannoma was confirmed retrospectively by a pathologic examination after excising the mass. This case report is a comparative study into Schwanoma with and without central ulceration. Pathologically, atypia of the cell was discovered in the case accompanied by an ulcer, which is a secondary phenomenon caused by the degeneration that does not indicate the malignancy. (Korean J Gastrointest Endosc 2007; 35:243-249)

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A Case of Gastric Schwannoma in a Male Patient: Soo-youn Moon, M.D., Young-Woon Chang, M.D., Chang Kyun Lee, M.D., Jae Young Jang, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byoung-Ho Kim, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2007;34(4):210-213. Published online April 30, 2007

Abstract PDF: Gastric schwannoma that originates from nerve sheath comprises about 0.2% of all gastric tumors and 4% of all benign gastric tumors. It is difficult to precisely diagnose gastric schwannoma via endoscopic biopsy or imaging studies. A 57-year-old male was referred to our hospital from a private clinic for further evaluation of a gastric tumor-mass that was diagnosed by gastroscopy. Gastroscopy and endoscopic ultrasonography showed a submucosal mass larger than 3 cm in size at the low body of the stomach. That the mass had malignant potential could not be excluded because of its size and shape. The patient underwent subtotal gastrectomy. The tumor cells showed immunoreactivity to S-100 protein. This submucosal tumor was diagnosed as a gastric schwannoma on the basis of these findings. Gastric schwannoma is known to occur more frequently in females than males. This is the first reported case of gastric schwannoma that's occurred in a Korean male patient. (Korean J Gastrointest Endosc 2007;34:210⁣213)

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A Case of Early Gastric Adenocarcinoma and Intraabdominal Schwannoma in a Patient with Neurofibromatosis Type I: Dong Han Im, M.D., Hyun Chul Whang, M.D., Joon Seok Oh, M.D., Hyun Ju Kim, M.D., Hwa Mock Lee, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Jong Yun Cheong, M.D., Won Il Park, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2007;34(2):83-87. Published online March 2, 2007

Abstract PDF: Neurofibromatosis is an autosomal dominant hereditary disorder with an overall incidence of one in 3,000∼4,000, and type 1 (Von Recklinghausen's neurofibromatosis) characterized by the presence of multiple cutaneous neurofibromas, axillary and groin freckling, and cafe- au-lait spot. The neurofibromatosis type 1 gene is a tumor suppressor gene. Patients with the neurofibromatosis type 1 are at increased risk of developing nervous system neoplasm, including plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas. Neurofibromas may undergo secondary malignant degeneration and sarcomatous changes. Patients with neurofibromatosis type 1 show a high incidence of Wilm's tumor, rhabdomyosarcoma, nonlymphocytic leukemia, and pheochromocytoma but the gastrointestinal involvement appears to be relatively rare and usually consists of neurofibroma, ganglioneuroma, and leiomyoma. We have identified a case of early gastric adenocarcinoma and intraabdominal schwannoma in a 65-year-old man afflicted with neurofibromatosis type 1.

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증례 : 식도 위장관 ; 위 점막하 종양으로 나타난 신경초종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Schwannoma Presenting with Submucosal Tumor ): Korean J Gastrointest Endosc 1998;18(6):908-915. Published online November 30, 1997

Abstract PDF: Most submucosal tumors of the stomach are of mesenchymal origin. According to the advances of immunohistochemical staining and electron microscopy, spindle cell tumors which were considered as leiomyoma or leiomyosarcoma appeared to be heterogeneous group; from smooth muscle cell, neural, bidirectionally differentiated cells of smooth muscle cell and neural cell, or immature mesenchymal cell. Therefore, the gastrointestinal mesenchymal tumors are referred to as gastrointestinal stromal tumors. The biologic behavior of gastrointestinal stromal tumors is difficult to predict, except benign leiomyoma and schwannoma. Recently, we experienced a case of 5 cm-diameter submucosal tumor with a central ulcer on body of the stomach, endoscopically. The tumor was a well cir- cumscribed submucosal mass located in the midbody along greater curvature. Micros- copically, the tumor was composed of fasciculating bundles of spindle cells with benign nuclear atypia and peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. Ultrastructurally, many tumor cells showed a number of thin elon-gated and interdigitating dendritic-like cell processes, distinct uniform basal laminae, frequent cellular attachments and microfilaments. The findings supported the schwannian nature of the tumor. (Korean J Gastrointest Endosc 18: 908-913, 1998)

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