Esophageal melanotic schwannoma presenting with superior vena caval obstruction

Esophageal schwannoma: Case report and epidemiological, clinical, surgical and immunopathological analysis

INTRODUCTION

Schwannoma is a tumor of the peripheral nervous system originated in the Schwann cells of the neural sheath.

PRESENTATION OF CASE

A 43-years-old male complained of odynophagia, dysphagia and hemoptysis. The upper gastrointestinal endoscopy showed a smooth elevated lesion, 20 cm from the incisor teeth, occupying the entire lumen of the esophagus. The chest computed tomography (CT) scan showed a lesion of 7 cm and superior mediastinal, lower paraesophageal and cardiac enlarged lymph nodes. A posterolateral thoracotomy was performed with total esophagectomy without intraoperative complications. The anatomopathological analysis revealed fusocellular mesenchymal neoplasia of low malignancy potential. The immunohistochemical study showed positivity for S-100 protein and KI67 antibodies and absence of staining for CD117, CD34, ALK protein, SMA and Desmin. Thus, the morphological and immunohistochemical findings pointed to the diagnosis of esophageal Schwannoma.

DISCUSSION

Although rare and indolent, Schwannoma occurs in the peripheral nervous system, being uncommon in the esophagus.

CONCLUSION

The immunohistochemical study is essential for the diagnosis, which is based on the positivity for S-100 protein and absence of staining for CD34 and CD117.

Dumbbell-shaped C-2 psammomatous melanotic malignant schwannoma. Case report and review of the literature

The authors present the case of a dumbbell-shaped malignant psammomatous melanotic schwannoma of the upper cervical spine involving the C-2 sensory root. The family of the patient had a history of other malignant stromal tumors, without the Carney complex genetic pattern. The 30-year-old female patient complained of experiencing cervical pain and cervical muscle contractions for 6 months, and was admitted to the hospital. The cervical T1-weighted magnetic resonance (MR) images revealed the presence of a slightly hyperintense C2-3 intra-extradural lesion, moderately enhancing, which had eroded and enlarged the intervertebral foramen. The patient workup also included computed tomography scans and angiography. A posterior approach was used to perform a C2-3 hemilaminectomy, including opening of the dura mater and gross-total removal of the lesion. Histopathological examination of the lesion revealed it to be a malignant psammomatous melanotic schwannoma. The cerebrospinal MR image of the patient obtained at the 12-month follow-up examination demonstrated the presence of tumor progression into the subarachnoid space at the C-3 level. The strong malignancy potential of the lesion must be considered in the future management of the patient, especially due to the presence in the family of other stromal tumors such as gastrointestinal-stromal tumors and malignant melanomas. The authors review all the literature concerning melanotic schwannomas and report 105 cases of melanotic schwannoma that were not related to the Carney complex. The particular focus of their review is on the characteristics of the malignant progression of melanotic schwannoma, such as local recurrences, metastasis, and survival rate.

Solitary gastric melanotic schwannoma: sonographic findings

Solitary gastric schwannoma is rare, and solitary melanotic schwannoma is even rarer, posing a dilemma in diagnosis and treatment. We report the case of a 69-year-old woman with gastric melanotic schwannoma who presented with nausea, vomiting, and abdominal pain. Abdominal sonographic examination revealed a 5-cm hypoechoic mass in the epigastric area that was confirmed to be a gastric submucosal tumor on endoscopic examination. The diagnosis of melanotic schwannoma was confirmed via sonographically guided percutaneous core biopsy. The tumor was resected, and no recurrence has occurred in a 3-year follow-up.

Schwannoma in the inguinal canal masquerading an inguinal hernia

Benign neoplasms originating from the neuronal sheath are usually found along the distribution of the cranial nerves and in the flexor surfaces of the upper and lower extremities. We herein present a case of a 65-year-old man with a schwannoma located in the inguinal canal, which presented as an irreducible hernia. This is the first reported case in the English literature of a schwannoma with such a presentation.