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HOME > Clin Endosc > Volume 58(6); 2025 > Article
Image of Issue Successful endoscopic resection of a rectal schwannoma with mesorectal adventitial invasion
Sung Wook Lee1orcid, Sang Jin Park1orcid, Dong Min Kang2orcid, Myung Jin Ju3orcid, Jin Woong Cho1orcid
Clinical Endoscopy 2025;58(6):930-932.
DOI: https://doi.org/10.5946/ce.2025.091
Published online: July 16, 2025

1Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea

2Department of Radiology, Presbyterian Medical Center, Jeonju, Korea

3Department of Pathology, Presbyterian Medical Center, Jeonju, Korea

Correspondence: Jin Woong Cho Department of Internal Medicine, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju 54987, Korea E-mail: jeja-1004@hanmail.net
• Received: March 25, 2025   • Revised: April 14, 2025   • Accepted: April 21, 2025

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 73-year-old man was referred for evaluation of a rectal mass. Endoscopy revealed an ovoid, smooth, elevated lesion covered with normal mucosa which was located 10 cm from the anal verge. Endoscopic ultrasonography showed a 10 mm homogenous hypoechoic mass in the muscularis propria with exophytic growth into the mesorectal adventitia (Fig. 1). Computed tomography identified a subepithelial tumor (SET) in the rectum without lymph node or distant metastases.
Endoscopic resection began with markings, followed by submucosal injection of saline mixed with indigo carmine. Using an I-type knife (FM-EK0003-2; Finemedix), submucosal dissection was performed after circumferential mucosal incision along the peripheral margin of the tumor. The mesorectal adventitia was exposed with muscularis penetration, and further dissection of the mesorectal adventitia was cautiously performed. The deep-tissue defect was closed with metal clips (Fig. 2). The procedure was completed without adverse events. Histopathological examination confirmed rectal schwannoma (Fig. 3).
Few reports have discussed the endoscopic resection of colorectal SETs originating from the muscularis propria layer.1 In our case, the patient had a rectal schwannoma with outward growth. Schwannomas contain dense peritumoral fibrotic tissue, making mesorectal dissection challenging.2 Recently, successful dissection of the mesorectal adventitia was reported for rectal gastrointestinal stromal tumor.1 Muscular penetration and dissection are crucial for mesorectal adventitious dissection, emphasizing the importance of establishing an adequate subserosal cushion before muscular penetration.3 Written informed consent was obtained from the patient before publication of this report.
Fig. 1.
Rectal subepithelial tumor (SET) with mesorectal extension. (A) Endoscopy reveals a subepithelial lesion in the rectum. (B) Endoscopic ultrasonography shows the SET extending into the mesorectal adventitia.
ce-2025-091f1.jpg
Fig. 2.
Endoscopic resection of rectal subepithelial tumor (SET). (A) Exposure of SET during submucosal dissection. (B) Deep defect following mesorectal adventitia dissection. (C) Closure with metallic clip.
ce-2025-091f2.jpg
Fig. 3.
Histopathological examination of rectal schwannoma. (A) Immunohistochemical staining shows strong S-100 positivity in spindle cells (×100). (B) Smooth muscle actin staining is negative (×100), excluding smooth muscle origin.
ce-2025-091f3.jpg
  • 1. Dang H, Dekkers N, Hardwick JC, et al. Endoscopic adventitial dissection of a rectal GI stromal cell tumor. VideoGIE 2022;8:84–88.ArticlePubMedPMC
  • 2. Rodríguez-Luna MR, Guarneros-Zárate JE, Tueme-Izaguirre J. Total Mesorectal Excision, an erroneous anatomical term for the gold standard in rectal cancer treatment. Int J Surg 2015;23(Pt A):97–100.ArticlePubMed
  • 3. Cho JW. Endoscopic resection penetrating the muscularis propria for gastric gastrointestinal stromal tumors: advances and challenges. Clin Endosc 2024;57:329–331.ArticlePubMedPMCPDF

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        Successful endoscopic resection of a rectal schwannoma with mesorectal adventitial invasion
        Clin Endosc. 2025;58(6):930-932.   Published online July 16, 2025
        DOI: https://doi.org/10.5946/ce.2025.091
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      Successful endoscopic resection of a rectal schwannoma with mesorectal adventitial invasion
      Image Image Image
      Fig. 1. Rectal subepithelial tumor (SET) with mesorectal extension. (A) Endoscopy reveals a subepithelial lesion in the rectum. (B) Endoscopic ultrasonography shows the SET extending into the mesorectal adventitia.
      Fig. 2. Endoscopic resection of rectal subepithelial tumor (SET). (A) Exposure of SET during submucosal dissection. (B) Deep defect following mesorectal adventitia dissection. (C) Closure with metallic clip.
      Fig. 3. Histopathological examination of rectal schwannoma. (A) Immunohistochemical staining shows strong S-100 positivity in spindle cells (×100). (B) Smooth muscle actin staining is negative (×100), excluding smooth muscle origin.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Successful endoscopic resection of a rectal schwannoma with mesorectal adventitial invasion
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