He CH, Lin SH, Chen Z, Li WM, Weng CY, Guo Y, Li GD. Laparoscopic-assisted endoscopic full-thickness resection of a large gastric schwannoma: A case report. World J Gastrointest Surg 2022; 14(4): 362-369 [PMID: 35664360 DOI: 10.4240/wjgs.v14.i4.362]
Corresponding Author of This Article
Guo-Dong Li, Doctor, Chief Doctor, Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou 310000, Zhejiang Province, China. hzseliguodong@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Cheng-Hai He, Wei-Min Li, Yun Guo, Guo-Dong Li, Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
Shi-Hua Lin, Department of Internal Medicine, Zhejiang Hospital, Hangzhou 310000, Zhejiang Province, China
Zhen Chen, Department of Pathology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, Zhejiang Province, China
Chun-Yan Weng, Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: He CH and Lin SH reviewed the literature and contributed to manuscript drafting; Li GD drafted the manuscript and revised manuscript; Chen Z performed the pathology analyses and interpretation and contributed to manuscript drafting; Li WM and Weng CY analyzed and interpreted the imaging findings; Li GD and Guo Y were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported byZhejiang Provincial Natural Science Foundation of China, No. LGF18H160036.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Dong Li, Doctor, Chief Doctor, Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou 310000, Zhejiang Province, China. hzseliguodong@sina.com
Received: December 8, 2021 Peer-review started: December 8, 2021 First decision: January 8, 2022 Revised: February 24, 2022 Accepted: March 27, 2022 Article in press: March 27, 2022 Published online: April 27, 2022 Processing time: 136 Days and 19.5 Hours
Abstract
BACKGROUND
Schwannomas, also known as neurinomas, are benign tumors derived from Schwann cells. Gastrointestinal schwannomas are rare and are most frequently reported in the stomach. They are usually asymptomatic and are difficult to diagnose preoperatively; however, endoscopy and imaging modalities can provide beneficial preliminary diagnostic data. There are various surgical options for management. Here, we present a case of a large gastric schwannoma (GS) managed by combined laparoscopic and endoscopic surgery.
CASE SUMMARY
A 28-year-old woman presented with a 2-mo history of epigastric discomfort and a feeling of abdominal fullness. On upper gastrointestinal endoscopy and endoscopic ultrasonography, a hypoechogenic submucosal mass was detected in the gastric antrum: It emerged from the muscularis propria and projected intraluminally. Computed tomography showed a nodular lesion (4 cm × 3.5 cm), which exhibited uniform enhancement, on the gastric antrum wall. Based on these findings, a preliminary diagnosis of gastrointestinal stromal tumor was established, with schwannoma as a differential. Considering the large tumor size, we planned to perform endoscopic resection and to convert to laparoscopic treatment, if necessary. Eventually, the patient underwent combined laparoscopic and gastroscopic surgery. Immunohistochemically, the resected specimen showed positivity for S-100 and negativity for desmin, DOG-1, α-smooth muscle actin, CD34, CD117, and p53. The Ki-67 index was 3%, and a final diagnosis of GS was established.
CONCLUSION
Combined laparoscopic and endoscopic surgery is a minimally invasive and effective treatment option for large GSs.
Core Tip: Gastric schwannomas (GSs) do not have specific clinical and endoscopic characteristics. Therefore, preoperative diagnosis may be difficult, and they can be misdiagnosed as gastrointestinal stromal tumors. In addition, while laparoscopic resection is possible, it is difficult to determine the location of intraluminal tumors. In contrast, endoscopic resection is only suitable for small submucosal tumors. Here, we present a case of a GS excised using laparoscopic-gastroscopic cooperative surgery. Additionally, we performed a literature review on computed tomography findings and surgical interventions used in the management of gastrointestinal stromal tumors and GSs.
