Thoracoscopic resection of a large lower esophageal schwannoma: A case report and review of the literature

Table 1 Clinical characteristics of lower schwannoma and upper/middle schwannomas

Characteristics		Lower schwannoma, n (%)	Upper/middle schwannoma, n (%)
Total		13	57
Sex
	Male	9 (69.2%)	14 (24.6%)
	Female	4 (30.8%)	43 (75.4%)
Age
	20–29 yr	2 (15.4%)	2 (3.5%)
	30–39 yr	1 (7.7%)	7 (12.3%)
	40–49 yr	2 (15.4%)	12 (21.1%)
	50–59 yr	5 (38.5%)	13 (22.8%)
	60–69 yr	2 (15.4%)	17 (29.8%)
	70–79 yr	1 (7.7%)	6 (10.5%)

Table 2 Literature review of lower esophageal schwannoma

Case	Ref.	Age (yr)/Sex	Presenting symptom	Immunohistochemical studies	Location	Tumor size	Benign or malignant	Treatment	Postoperative complications
1	Matteo et al[17]	22/Male	Dysphagia, chest pain, esophageal reflux-like symptom	Reactive with S100 protein and negative for desmin, DOG1, CD117, EMA, HMB45, Melan A, synaptophysin and neurofilaments	34 to 41 cm	75 mm	Benign but locally advanced	A subtotal esophagectomy via a muscle sparing lateral thoracotomy	No
2	Mishra et al[18]	27/Female	Dysphagia, palpitations, weight loss, loss of appetite	Immunopositive for S100 and negative for DOG-1, CD117, CD34, and SMA	30 cm	120 mm × 100 mm × 100 mm	Low-grade malignant	Esophagectomy through a left thoraco-abdominal incision	Right recurrent laryngeal nerve palsy
3	Naus et al[21]	39/Male	Burning epigastric pain	Positive for S100 protein	34 cm	15 mm	Benign	Endoscopic removal	No
4	Zhang et al[19]	48/Female	Dysphagia	Positive for S100	30 cm	70 mm × 60 mm × 40 mm	Benign	Robot-assisted thoracoscopic excision	No
5	Li et al[8]	49/Male	Dysphagia	Positive staining of the tumor cells for S100, Lea-7, and PG9.5 protein, and negative staining for CD117, CD34, DOG-1, DES, and smooth muscle actin	35 cm	28 mm × 22 mm	Benign	STER: Submucosal tunneling endoscopic resection. The lesion was resected in a piecemeal fashion	No
6	Hsu et al[13]	54/Male	Dysphagia	Positive for S100 protein and negative staining for actin	35 cm	25 mm × 20 mm × 15 mm	Benign	Submucosal tumor enucleation via left thoracotomy	No
7	Sánchez et al[14]	54/Male	Dysphagia, weight loss	Positive for S100 and vimentin and negative for CD117	34 to 40 cm	60 mm	Malignant	Ivor-Lewis esophagectomy with gastric-tube reconstruction	No
8	Trindade et al[15]	54/Male	Esophageal reflux-like symptom	Positive for S100 and negative for smooth muscle markers	In the distal third of the esophagus	6 mm	Benign	Endoscopic mucosal resection	No
9	Shimamura et al[16]	56/Male	Esophageal reflux-like symptom	Strongly positive for S100 and not stain for CD117, SMA, CD68 and inhibin S100	Distal esophagus	5 mm	Benign	Endoscopic mucosal resection	No
10	Li et al[8]	59/Male	Upper abdominal distension, esophageal reflux-like symptom	Positive staining of the tumor cells for S100, Lea-7, and PG9.5 protein, and negative staining for CD117, CD34, DOG-1, DES, and smooth muscle actin	35 cm	14 mm × 5 mm	Benign	ESE: Endoscopic submucosal excision	No
11	Shichinohe et al[20]	61/Female	Dysphagia	positive staining of S100, and negative staining of c-kit and α-SMA	In the lower thoracic esophagus	45 mm × 30 mm	Benign	Thoracoscopic esophageal submucosal tumor enucleation	No
12	Our case	62/Male	Dysphagia, chest pain, palpitations, chest tightness, shortness of breath, back pain	Positivity for S100, Sox10, vimentin, and TLE1, but negativity for CD34, desmin, CD117, actin, GFAP, h-caldesmon, STAT6, DOG-1, CD21 and SMA	32 to 38 cm	53 mm × 39 mm × 50 mm	Benign	Video-assisted thoracoscopic partial esophagectomy	No
13	Brown et al[22]	76/Female	Dysphagia, weight loss	Positive for S100, HMB45, and Melan A and negative for CD34, epithelial membrane antigen, smooth muscle antigen, and desmin	In the lower third of the esophagus	50 mm × 40 mm × 20 mm	Benign	Subtotal esophagectomy	No