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Mo YK, Chen XP, Hong LL, Hu YR, Lin DY, Xie LC, Dai ZZ. Gastric schwannoma: Computed tomography and perigastric lymph node characteristics. World J Gastrointest Oncol 2025; 17:102085. [DOI: 10.4251/wjgo.v17.i4.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 02/05/2025] [Accepted: 02/24/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Gastric schwannoma (GS) is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter. However, these two types differ significantly in pathology and biological behavior.
AIM To evaluate the computed tomography characteristics of GS and provide insights into its accurate diagnosis.
METHODS Twenty-three cases of GS confirmed between January 2011 and December 2023 were assessed clinically and radiologically. Imaging characteristics, including tumor location, size, contour, ulceration, growth pattern, enhancement degree and pattern, cystic change, calcification, and perigastric lymph nodes (PLNs), were reviewed by two experienced radiologists.
RESULTS Our sample included 18 females and 5 males, with a median age of 54.7 years. A total of 39.1% of cases were asymptomatic. GSs appeared as oval and well-defined submucosal tumors, with exophytic (43.5%) or mixed (endoluminal + exophytic; 43.5%) growth patterns. The tumors were primarily located in the gastric body (78.3%). Ulcerations were observed in 8 cases (34.5%), and PLNs were observed in 15 cases (65%). The average degree of enhancement was 48.3 Hounsfield units. Twenty cases (87%) showed peak enhancement in the delayed phase. Most GSs were homogeneous, while cystic change (13.0%) and calcification (17.4%) were rare.
CONCLUSION GS predominantly showed gradual homogenous enhancement with peak enhancement in the delayed phase. PLNs around GS are helpful in differentiating GS from other gastric submucosal tumors.
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Affiliation(s)
- Yong-Kang Mo
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Xia-Pu Chen
- Department of Radiology, Shantou Central Hospital, Shantou 515000, Guangdong Province, China
| | - Liang-Li Hong
- Department of Pathology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yi-Ru Hu
- Clinical Research Center, Shantou Central Hospital, Shantou 515000, Guangdong Province, China
| | - Dai-Ying Lin
- Department of Radiology, Shantou Central Hospital, Shantou 515000, Guangdong Province, China
| | - Li-Chun Xie
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Zhuo-Zhi Dai
- Department of Radiology, Shantou Central Hospital, Shantou 515000, Guangdong Province, China
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2
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Zhang PC, Wang SH, Li J, Wang JJ, Chen HT, Li AQ. Clinicopathological features and treatment of gastrointestinal schwannomas. World J Gastroenterol 2025; 31:101280. [PMID: 39926216 PMCID: PMC11718610 DOI: 10.3748/wjg.v31.i5.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 11/11/2024] [Accepted: 12/13/2024] [Indexed: 12/30/2024] Open
Abstract
BACKGROUND Gastrointestinal schwannomas (GIS) are rare neurogenic tumors arising from Schwann cells in the gastrointestinal tract. Studies on GIS are limited to small case reports or focus on specific tumor sites, underscoring the diagnostic and therapeutic challenges they pose. AIM To comprehensively examine the clinical features, pathological characteristics, treatment outcomes, associated comorbidities, and prognosis of GIS. METHODS The study population included patients diagnosed with GIS at the First Affiliated Hospital, Zhejiang University School of Medicine, between June 2007 and April 2024. Data were retrospectively collected and analyzed from medical records, including demographic characteristics, endoscopic and imaging findings, treatment modalities, pathological evaluations, and follow-up information. RESULTS In total, 229 patients with GIS were included, with a mean age of 56.00 years and a male-to-female ratio of 1:1.83. The mean tumor size was 2.75 cm, and most (76.9%) were located in the stomach. Additionally, 6.6% of the patients had other malignant tumors. Preoperative imaging and endoscopy frequently misdiagnosed GIS as gastrointestinal stromal tumors. However, accurate preoperative diagnosis was achieved using endoscopic ultrasound-guided fine-needle aspiration combined with immunohistochemical analysis, in which S100 and SOX-10 markers were mostly positive. Smaller tumors were typically managed with endoscopic resection, while larger lesions were treated with surgical resection. Follow-up results showed that most patients experienced favorable outcomes. CONCLUSION Preoperative diagnosis of GIS via clinical characteristics, endoscopy, and imaging examinations remains challenging but crucial. Endoscopic therapy provides a minimally invasive and effective option for patients.
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Affiliation(s)
- Peng-Cheng Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Shu-Hui Wang
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
| | - Jun Li
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jing-Jie Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Ai-Qing Li
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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3
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Miao G, Zhang D, Li J, Deng Y, Gu X, Feng T. Gastric schwannoma with post-surgical gastroparesis: a case report and literature review. Front Oncol 2025; 14:1496074. [PMID: 39871940 PMCID: PMC11769998 DOI: 10.3389/fonc.2024.1496074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 12/27/2024] [Indexed: 01/29/2025] Open
Abstract
Gastric schwannoma is a relatively rare submucosal mesenchymal tumor with low probability of metastasis and arises from Schwann cells of the gastrointestinal nervous plexus. Surgical therapy is the main treatment of gastric schwannoma with symptoms or malignant tendency. Gastroparesis is a potential complication following gastrointestinal surgery, which is a clinical syndrome caused by gastric emptying disorder and characterized by nausea, vomiting, and bloating, resulting in insufficient nutrient intake. Generally, post-surgical etiology is the main potential etiology of gastroparesis, while the most common underlying etiology is diabetes mellitus. So far, reports of gastroparesis arising from resection of gastric schwannoma are rare. We present an 80-year-old woman who was diagnosed with gastrointestinal stromal tumor (GIST) primarily and has undergone laparoscopic wedge-shaped gastrectomy. The pathological and immunohistochemical examination ultimately established the diagnosis of gastric schwannoma. The patient experienced belching, nausea, vomiting, and bloating 1 week after the surgery and confirmed as gastroparesis through gastrointestinal series and gastroscopic examination. A series of treatments were performed, including correcting fluid-electrolyte disorders and vitamin deficiencies, and nutritional support and pharmacological treatments. The patient ultimately recovered well, and the relevant literatures were reviewed to identify and handle similar cases hereafter.
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Affiliation(s)
- Ganggang Miao
- Department of General Surgery, The People’s Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, Jiangsu, China
- Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - De Zhang
- Department of General Surgery, The People’s Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, Jiangsu, China
| | - Jiajing Li
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui, China
| | - Yanxiang Deng
- Department of General Surgery, The People’s Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, Jiangsu, China
| | - Xingwei Gu
- Department of General Surgery, The People’s Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, Jiangsu, China
| | - Tingting Feng
- Central Laboratory, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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4
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Pais DP, Andrade S, Colaco IB, Luis M, Azenha N, Couceiro A, Cecilio JV. Gastric Schwannoma: A Rare Cause of Gastric Bleeding. J Med Cases 2024; 15:371-375. [PMID: 39610909 PMCID: PMC11602179 DOI: 10.14740/jmc4312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 10/14/2024] [Indexed: 11/30/2024] Open
Abstract
Gastric schwannomas and gastrointestinal stromal tumors (GISTs) are two types of mesenchymal tumors, which represent a group of rare tumors of the gastrointestinal tract. The differential diagnosis between these two tumors is difficult given their very similar appearance and clinical features. The authors present a case of a 63-year-old man with melena and epigastric pain. An upper digestive endoscopy was performed, revealing an ulcerated gastric subepithelial lesion suspected to be a GIST. Further imaging with a computed tomography (CT) scan revealed a well-defined hypodense solid nodular mass, with homogeneous enhancement, measuring 22 × 18 mm, on the anterior wall of the transition between the body and gastric antrum, situated within the submucosal layer. The patient subsequently underwent a laparoscopic atypical gastrectomy, which proceeded without complications. The pathological examination of the excised lesion confirmed it to be a gastric schwannoma, with complete excision. This case report illustrates a rare cause of gastrointestinal bleeding, that requires immediate action, and en bloc resection is usually curative. Given the excellent prognosis after complete resection, a correct diagnosis is essential.
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Affiliation(s)
- Daniela Pato Pais
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
| | - Sara Andrade
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
| | - Ines Bertao Colaco
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
| | - Margarida Luis
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
| | - Nuno Azenha
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
| | - Ana Couceiro
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
| | - Jose Valente Cecilio
- Department of Surgery, Hospital Distrital da Figueira da Foz, Rua do Hospital 3094-001, Figueira da Foz, Portugal
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5
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Dong W, Zhu J, Tan X, Li W. Gastric schwannoma: A case report. Asian J Surg 2024:S1015-9584(24)02620-4. [PMID: 39603935 DOI: 10.1016/j.asjsur.2024.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024] Open
Affiliation(s)
- Weikai Dong
- Department of Cardiovascular Surgery, Binzhou Medical University Hospital, Binzhou, Shandong province, 256600, China.
| | - Jun Zhu
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong province, 256600, China
| | - Xiaolong Tan
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong province, 256600, China
| | - Wei Li
- Department of Cardiovascular Surgery, Binzhou Medical University Hospital, Binzhou, Shandong province, 256600, China
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Varanese M, Spadaccini M, Facciorusso A, Franchellucci G, Colombo M, Andreozzi M, Ramai D, Massimi D, De Sire R, Alfarone L, Capogreco A, Maselli R, Hassan C, Fugazza A, Repici A, Carrara S. Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1695. [PMID: 39459482 PMCID: PMC11509196 DOI: 10.3390/medicina60101695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 10/07/2024] [Accepted: 10/12/2024] [Indexed: 10/28/2024]
Abstract
Background and objectives: Subepithelial lesions (SELs) of the gastrointestinal (GI) tract present a diagnostic challenge due to their heterogeneous nature and varied clinical manifestations. Usually, SELs are small and asymptomatic; generally discovered during routine endoscopy or radiological examinations. Currently, endoscopic ultrasound (EUS) is the best tool to characterize gastric SELs. Materials and methods: For this review, the research and the study selection were conducted using the PubMed database. Articles in English language were reviewed from August 2019 to July 2024. Results: This review aims to summarize the international literature to examine and illustrate the progress in the last five years of endosonographic diagnostics and treatment of gastric SELs. Conclusions: Endoscopic ultrasound is the preferred option for the diagnosis of sub-epithelial lesions. In most of the cases, EUS-guided tissue sampling is mandatory; however, ancillary techniques (elastography, CEH-EUS, AI) may help in both diagnosis and prognostic assessment.
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Affiliation(s)
- Marzia Varanese
- Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy;
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Gianluca Franchellucci
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Daryl Ramai
- Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84113, USA
| | - Davide Massimi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Roberto De Sire
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Ludovico Alfarone
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Antonio Capogreco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Roberta Maselli
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital—IRCCS, Rozzano, 20089 Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milano, Italy
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7
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Patel PS, Rodgers M, Kulasegaran S. Gastric cardia submucosal tumours - histopathological diagnosis and challenges in management. ANZ J Surg 2024; 94:1869-1870. [PMID: 39286950 DOI: 10.1111/ans.19233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/22/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Preekesh Suresh Patel
- Upper Gastrointestinal Unit, Department of General Surgery, Te Whatu Ora - Waitemata, Waitemata, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michael Rodgers
- Upper Gastrointestinal Unit, Department of General Surgery, Te Whatu Ora - Waitemata, Waitemata, New Zealand
| | - Suheelan Kulasegaran
- Upper Gastrointestinal Unit, Department of General Surgery, Te Whatu Ora - Waitemata, Waitemata, New Zealand
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8
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AlAli MN, AlDayel AK, Alshammari AT, Essa MS, AlAmodi M, Alrashed M, Amer SM, Meaigel MA, AlTahan TM, Ahmad KS. A huge benign gastric schwannomas presented with upper and lower gastrointestinal bleeding: a case report and literature review. J Surg Case Rep 2024; 2024:rjae267. [PMID: 38681480 PMCID: PMC11052595 DOI: 10.1093/jscr/rjae267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
Gastric schwannomas (GS) are rare mesenchymal tumors from Schwann cells in the gastrointestinal (GI) tract, representing 2-6% of such tumors. We report a 52-year-old woman who experienced abdominal pain, hematemesis, and melena, initially suspected of having a GI stromal tumor through ultrasound and computed tomography abdomen. Despite no active bleeding found during an upper endoscopy, she underwent a successful open subtotal gastrectomy, with histopathology confirming GS. The diagnosis of GS, which may mimic other GI conditions, relies heavily on imaging and histopathological analysis due to its nonspecific symptomatology, including the potential for both upper and lower GI bleeding. This case underscores the diagnostic challenges of GS and highlights surgical resection as the preferred treatment, generally leading to a favorable prognosis.
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Affiliation(s)
- Mohammed N AlAli
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Aya K AlDayel
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Afraj T Alshammari
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed S Essa
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
- General Surgery Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Maha AlAmodi
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Muath Alrashed
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Sadiq M Amer
- Department of Pathology, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed A Meaigel
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Talal M AlTahan
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Khalid S Ahmad
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
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9
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Majdoubi A, El Achchi A, El Hammouti M, Bouhout T, Serji B. Gastric schwannoma: The gastrointestinal tumor simulator - case report and review of the literature. Int J Surg Case Rep 2024; 116:109389. [PMID: 38367421 PMCID: PMC10944005 DOI: 10.1016/j.ijscr.2024.109389] [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: 01/23/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastric schwannoma is a rare and benign tumor originating from the peripheral nerves of the stomach. Despite its benign nature, this tumor typically remains asymptomatic for an extended period, and its radiological and endoscopic presentation poses challenges in distinguishing it from other gastric mesenchymal tumors. CASE PRESENTATION Here, we present a rare case of a patient experiencing gastric pain and melena secondary to a gastric mass. The initial preoperative diagnosis indicated a gastrointestinal stromal tumor, but subsequent pathological and immunohistochemical staining of the surgical specimen confirmed the presence of gastric schwannoma. DISCUSSION To gain insights into this uncommon condition, we conducted an electronic search on PubMed using the keywords "gastric schwannoma" and "gastric neurinoma." Our focus centered on case series containing more than five cases of gastric localization, resulting in the analysis of 14 case series involving a total of 321 patients. Our review aims to comprehensively discuss the clinical, radiological, and therapeutic aspects associated with this rare disease. CONCLUSION In the absence of a definitive preoperative diagnosis, the surgical approach is considered the primary treatment for resectable gastric schwannoma, given its excellent long-term outcomes. However, further studies are imperative to better define the role of endoscopic resection in managing this condition.
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Affiliation(s)
- Amine Majdoubi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco.
| | - Anass El Achchi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Mohamed El Hammouti
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tareq Bouhout
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Badr Serji
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
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10
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Pohekar M, Rampurwala J, Sabireen, Shinde RS. Gastric Schwannoma-Two Unusual Cases with Usual Presentation and Review of Literature. Indian J Surg Oncol 2024; 15:117-120. [PMID: 38511014 PMCID: PMC10948721 DOI: 10.1007/s13193-023-01847-0] [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: 09/01/2023] [Accepted: 11/11/2023] [Indexed: 03/22/2024] Open
Abstract
Schwannomas, also known as neurilemmomas, are characteristically benign, slow growing neoplasms originating from Schwann cell sheath. Gastrointestinal schwannomas are very rare with stomach being the most affected organ representing approximately 0.2% of all gastric tumours. Malignant transformation is rarely reported in these tumors and complete surgical resection with negative margins is the recommended treatment. Herein, we report our experience of 2 cases of gastric submucosal spindle cell tumour (SMT), which were preoperatively assumed to be as gastrointestinal stromal tumor (GIST), however postoperatively confirmed as schwannoma on immunohistochemical examination.
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Affiliation(s)
- Monika Pohekar
- Department of Surgical Oncology, Bombay Hospital Institute of Medical Sciences, Marine Lines, Mumbai, 400020 India
| | - Jakiyuddin Rampurwala
- Department of Surgical Oncology, Bombay Hospital Institute of Medical Sciences, Marine Lines, Mumbai, 400020 India
| | - Sabireen
- Department of Surgical Oncology, Bombay Hospital Institute of Medical Sciences, Marine Lines, Mumbai, 400020 India
| | - Rajesh S Shinde
- Department of Surgical Oncology, Bombay Hospital Institute of Medical Sciences, Marine Lines, Mumbai, 400020 India
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11
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ANDO R, OKADA N, SATO S, KANNO C, MAEDA Y, IAMOHBHARS N, MARKBORDEE B, PARK CH, TAKAHASHI F, KAWAGUCHI H. Cardiac tumor comprising a malignant peripheral nerve sheath tumor and spontaneous atrial osseous metaplasia in a sheep. J Vet Med Sci 2024; 86:111-115. [PMID: 37967950 PMCID: PMC10849854 DOI: 10.1292/jvms.23-0247] [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: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023] Open
Abstract
Primary cardiac tumors in animals are very rare. The purpose of this report was to describe the first case of a cardiac tumor comprising a malignant peripheral nerve sheath tumor and spontaneous atrial osseous metaplasia in a Corriedale sheep. Histologically, the tumor in the bilateral atrial pericardium consisted of dense cellular components comprising tumor cells and a sparse cellular area, and non-neoplastic mature bone tissue. The tumor cells were spindle-shaped, round, or polygonal, and proliferating, with fascicular, storiform, palisading, and sheet patterns. Immunohistochemically, the tumor cells were positive for vimentin, S-100, occasionally positive for myeline basic protein, glial fibrillary acidic protein, neurofilament, neuron specific enolase, and neuron growth factor receptor suggesting that they originated from the nervous system. On the basis of these findings, the final diagnosis was a malignant peripheral nerve sheath tumor and spontaneous atrial osseous metaplasia.
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Affiliation(s)
- Ryo ANDO
- School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Norika OKADA
- School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Shogo SATO
- School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Chihiro KANNO
- School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Yosuke MAEDA
- School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | | | | | - Chun-Ho PARK
- School of Veterinary Medicine, Kitasato University, Aomori, Japan
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12
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Li J, Chen JH, Huang WF, Liu M, Hong SK, Zhang JY. Gastric schwannoma: A retrospective analysis of clinical characteristics, treatments, and outcomes. Asian J Surg 2024; 47:407-412. [PMID: 37741754 DOI: 10.1016/j.asjsur.2023.09.042] [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: 04/20/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical characteristics, treatment options, and prognosis of patients with gastric schwannoma (GS). METHODS Patients who were pathologically diagnosed with GS between April 2011 and October 2022 were enrolled. The data of clinical characteristics, pathological features, treatment options, and clinical outcomes were collected and compared between GS patients who underwent endoscopic resection (ER) and surgical resection (SR). RESULTS Of the 32 cases, 23 underwent SR and nine underwent ER. The median tumor size was significantly smaller in ER group than in SR group (12.0 vs. 40.0 mm, P < 0.001), while patients in SR group were older than those in ER group (54.5 ± 10.6 vs. 45.3 ± 10.9 years, P = 0.036). Moreover, tumors in ER group were more likely to exhibit an intraluminal pattern (100% vs. 26.1%, P < 0.001). Patients in ER group had significantly lower hospitalization cost (25859.2 ± 8623.9 vs. 44953.0 ± 13083.8 RMB, P = 0.011) than those in SR group. No differences were found between the two groups in terms of R0 resection rate, operative time, estimated blood loss, adverse events, and recurrence rate. All patients were followed up for 4-96 months (mean: 35 months; median: 23 months), during which no evidence of recurrence or metastasis was observed. CONCLUSIONS Both ER and SR are safe and effective treatment modalities for the management of GS, with ER being associated with lower medical costs compared to SR. The majority of GS are benign and do not recur, with little possibility of malignant transformation.
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Affiliation(s)
- Ji Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Hai Chen
- Endoscopy Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Ming Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shao-Kun Hong
- Department of General Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Cordeiro R, Morgado M, Oliveira V, Bispo M, Castillo-Martin M, Matos C. Gastric schwannoma: Two case reports and review of the literature. Radiol Case Rep 2023; 18:4465-4473. [PMID: 37860780 PMCID: PMC10582295 DOI: 10.1016/j.radcr.2023.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
Gastric schwannomas are rare, slow-growing tumors whose clinical presentation is nonspecific. These are mostly benign, with a low probability of malignant transformation and an excellent prognosis. We present 2 cases of gastric schwannomas with distinct clinical features and imaging patterns, whose therapeutic approach differed. Case 1 is a 73-year-old woman with a voluminous subepithelial lesion in the greater gastric curvature, with predominantly endoluminal growth. Clinically the patient presented with nonspecific abdominal complaints and underwent complete surgical excision. Case 2 is a 69-year-old woman with an exophytic lesion adjacent to the gastric antrum, diagnosed incidentally and managed conservatively, with imaging follow-up, for the last 5 years and stable ever since. This article aims to focus on this rare disease, illustrating its main imaging findings, particularly in magnetic resonance imaging, along with pathological correlation, as well as reviewing the literature, discussing the differential diagnosis, and exploring clinical management and prognosis.
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Affiliation(s)
- Rodrigo Cordeiro
- Department of Radiology, Hospital do Divino Espírito Santo de Ponta Delgada, Av. D. Manuel I, 9500-370 Ponta Delgada, Azores, Portugal
| | - Margarida Morgado
- Department of Radiology, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Vera Oliveira
- Digestive Unit, Champalimaud Clinical Center, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Miguel Bispo
- Digestive Unit, Champalimaud Clinical Center, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Mireia Castillo-Martin
- Department of Pathology, Champalimaud Clinical Center, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Celso Matos
- Department of Radiology, Champalimaud Clinical Center, Avenida de Brasília, Lisboa 1400-038, Portugal
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Jiang X, Zhao M, Wu J, Ding Y, Wang J. Laparoscopic resection for gastric schwannoma larger than 30 mm with long-term outcomes. BMC Surg 2023; 23:284. [PMID: 37726737 PMCID: PMC10510170 DOI: 10.1186/s12893-023-02190-5] [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: 06/18/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND AIMS Laparoscopic resection has been reported as effective and safe for gastric schwannoma (GS) in the form of case reports. However, study on laparoscopic surgery in patients with GS larger than 30 mm has been rarely reported. To this end, the present study aimed to evaluate the safety and efficacy of laparoscopic resection for the treatment of GS larger than 30 mm and its long-term outcomes. METHODS This is a retrospective case series study of patients with GS larger than 30 mm who underwent laparoscopic resection at our hospital between January 2014 and December 2020. Clinical pathology, surgical and follow-up data were collected and analyzed. RESULTS A total of 10 patients with a mean age of 51.6 years were included. Seven tumors were located in gastric body, 2 in antrum and 1 in fundus. Laparoscopic gastric wedge resection was performed in 7 patients, while laparoscopic gastric local resection was performed in 3 patients. All patients achieved complete resection. The mean operation time was 112.6 ± 34.3 min, and the mean postoperative hospital stay was 13.8 ± 5.1 days. Postoperative gastroplegia occurred in 2 patients and was treated with conservative therapy. No recurrence, metastasis or residue was found during the follow-up of mean 45.1 months. CONCLUSIONS Laparoscopic resection is a safe and effective method for treating GS larger than 30 mm with favorable long-term follow-up outcomes. Laparoscopic resection may be considered as the first-line treatment for GS larger than 30 mm.
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Affiliation(s)
- Xuetong Jiang
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Mingzuo Zhao
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Jianqiang Wu
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Yang Ding
- Department of Pathology, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China
| | - Jian Wang
- Department of Gastrointestinal Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), No. 138 Huanghe South Road, Suqian, 223800, China.
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Kumari S, Saeed MI, Urrehman A. Gastric Schwannoma: A Rare Subepithelial Lesion of the Stomach. Cureus 2023; 15:e44577. [PMID: 37790036 PMCID: PMC10545006 DOI: 10.7759/cureus.44577] [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: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
Gastric schwannomas (GS) are rare, slow-growing, benign subepithelial (SE) lesions of the stomach. These are difficult to differentiate preoperatively from other types of SE lesions, as the gross appearance and clinical presentation are very similar especially the gastrointestinal stromal tumors (GISTs), which are the most common SE lesions of the stomach. We present the case of a 35-year-old Asian man with a one-month history of intermittent, right, upper quadrant pain and hematemesis. Preoperatively, intravenous contrast-enhanced computer tomography scan (CECT) showed a well-circumscribed lesion in the upper abdomen closer to the stomach's lesser curvature. Endoscopic ultrasound revealed an ulcerated subepithelial lesion and subsequent biopsy with a 22-gauge fine-needle biopsy (22G FNB) needle confirmed the diagnosis of GS. The patient underwent distal gastrectomy and a Bilroth 1 procedure. The postoperative biopsy was consistent with the initial one, therefore supporting the diagnosis of gastric schwannoma. Postoperatively, the recovery remained uneventful.
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Affiliation(s)
- Sameeta Kumari
- Gastroenterology, Aga Khan University Medical College, Karachi, PAK
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Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, Triantafyllou K, Facciorusso A, Papanikolaou IS. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics (Basel) 2023; 13:2176. [PMID: 37443568 DOI: 10.3390/diagnostics13132176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Gastric subepithelial lesions (SELs) are intramural lesions that arise underneath the gastric mucosa. SELs can be benign, but can also be malignant or have malignant potential. Therefore, correct diagnosis is crucial. Endosonography has been established as the diagnostic gold standard. Although the identification of some of these lesions can be carried out immediately, solely based on their echo characteristics, for certain lesions histological examination is necessary. Sometimes histology can be inconclusive, especially for smaller lesions. Therefore, new methods have been developed in recent years to assist decision making, such as contrast enhanced endosonography, EUS elastography, and artificial intelligence systems. In this narrative review we provide a complete overview of the gastric SELs and summarize the new data of the last ten years concerning the diagnostic advances of endosonography on this topic.
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Affiliation(s)
- Thomas Vasilakis
- Hepatology and Gastroenterology Clinic, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Dimitrios Ziogas
- 1st Department of Internal Medicine, 251 Hellenic Air Force & VA General Hospital, 3 Kanellopoulou Str., 11525 Athens, Greece
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Eleni Koukoulioti
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christina Kapizioni
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, 71122 Foggia, Italy
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Peng H, Han L, Tan Y, Chu Y, Lv L, Liu D, Zhu H. Clinicopathological characteristics of gastrointestinal schwannomas: A retrospective analysis of 78 cases. Front Oncol 2022; 12:1003895. [PMID: 36582806 PMCID: PMC9792477 DOI: 10.3389/fonc.2022.1003895] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Schwannomas are tumors arising from Schwan cells of the neural sheath, which rarely occur in the gastrointestinal tract. The aim of the present study was to analyze the clinicopathological features and treatment outcomes of gastrointestinal schwannomas (GISs). Methods Patients who were diagnosed with GISs in our hospital from January 2010 to December 2021 were selected. Data about demographic characteristics, clinical symptoms, treatment methods and outcomes, pathological results, and follow-up results were retrospectively collected and analyzed. Results A total of 78 patients with 79 GISs were included, the female-to-male ratio was 55:23, and the average age was 52.12 ± 12.26 years. One-third (26/78) of the patients were asymptomatic. A total of 79 GISs were removed, and the average size was 3.63 ± 2.03 cm (range, 0.3-10 cm). As for tumor location, 54 GISs were located in the stomach, 14 in the esophagus, 2 in the duodenum, 6 in the colorectum (4 in the colon and 2 in the rectum), and the other 3 in the small intestine. A total of 23 and 55 patients underwent endoscopic and surgical resections, respectively. Compared with surgical resection, endoscopic resection is associated with a smaller diameter, lower cost, and shorter hospital stay. Pathological results revealed that S100 was positive in all the GISs. No recurrence was noticed during a median follow-up of 45 months (range, 6-148 months). Conclusion GISs are rare gastrointestinal tumors with favorable prognoses, which are most commonly seen in the stomach and diagnosed by pathological findings with immunohistochemical staining. Surgical resection remains the standard method for removing GISs, while endoscopic resection may serve as an alternative method for selected patients with GISs and may be attempted in GISs with a diameter of <3 cm and no signs of malignancy.
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Affiliation(s)
- Hailing Peng
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Liu Han
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Yi Chu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Hongyi Zhu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Research Center of Digestive Disease, Central South University, Changsha, Hunan, China,*Correspondence: Hongyi Zhu,
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18
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Yin L, Sun Y, Cao Q, Yang T, Li W, Zhu Y, Liu T, Li B. Two giant connected retroperitoneal schwannomas: a rare case report. J Int Med Res 2022; 50:3000605221119423. [PMID: 36036264 PMCID: PMC9434686 DOI: 10.1177/03000605221119423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Schwannoma is a type of tumor originating from Schwann cells of peripheral
nerves. In this study, we report a rare case of two giant connected
retroperitoneal schwannomas. The patient presented to our department with a
1-day history of abdominal pain and without other symptoms. There were no
abnormalities in the patient’s tumor markers. Abdominal plain computed
tomography (CT) revealed two (combined) retroperitoneal masses appearing as soft
tissue-density shadows with uneven internal density, cystic low-density shadows,
and patchy calcification shadows. The larger mass measured approximately
12.0 cm × 12.3 cm in size. The tumors were completely excised by a reasonable
surgical approach while the surrounding organs closely related to the tumor were
preserved. Postoperative pathology confirmed that the tumors were benign
schwannomas. In the 18-month follow-up, the patient had no recurrences and was
asymptomatic. We summarize the diagnosis and treatment of two rare combined
giant retroperitoneal schwannomas in a single patient. Laparotomy for the
management of retroperitoneal giant schwannomas may be safe and effective.
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Affiliation(s)
- Liquan Yin
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yao Sun
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Qian Cao
- Department of Education, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Tao Yang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Wei Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Yuecheng Zhu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Tongjun Liu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun Jilin, China
| | - Bo Li
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
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