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Hikichi T, Hashimoto M, Yanagita T, Kato T, Nakamura J. Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions. J Med Ultrason (2001) 2023:10.1007/s10396-023-01342-7. [PMID: 37490244 DOI: 10.1007/s10396-023-01342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/26/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the first-choice procedure for obtaining pathological tissue samples from gastrointestinal (GI) subepithelial lesions (SELs). However, its diagnostic accuracy is lower than that for pancreatic masses owing to puncture difficulty and the need for immunostaining for definitive diagnosis. The advent of fine-needle biopsy needles, which have become well known in recent years, improves the diagnostic accuracy of EUS-FNA for GI SELs. The forward-viewing echoendoscope and rapid on-site evaluation (ROSE) have also helped to improve diagnostic accuracy. Furthermore, in facilities where ROSE is not available, endosonographers perform a macroscopic on-site evaluation. With these procedural innovations, EUS-FNA is now performed aggressively even for SELs smaller than 20 mm. The incidence of procedure-related adverse events such as bleeding and infection is low, and thus, EUS-FNA can be safely performed to diagnose SELs.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takumi Yanagita
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Baldaque-Silva F, Moro CF, Arnelo U. A Nerve-Wracking Cyst. Gastroenterology 2021; 161:e12-e13. [PMID: 33839099 DOI: 10.1053/j.gastro.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Francisco Baldaque-Silva
- Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | - Carlos Fernández Moro
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Urban Arnelo
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Sweden
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Lauricella S, Valeri S, Mascianà G, Gallo IF, Mazzotta E, Pagnoni C, Costanza S, Falcone L, Benvenuto D, Caricato M, Capolupo GT. What About Gastric Schwannoma? A Review Article. J Gastrointest Cancer 2021; 52:57-67. [PMID: 32964322 DOI: 10.1007/s12029-020-00456-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Gastric schwannomas (GSs) are rare mesenchymal neoplasms of the gastrointestinal tract. Diagnosis is often achieved postoperatively, based on pathology reports of retrieved specimens. The aim of the present study is to follow up all patients with gastric schwannoma (Gs) undergoing endoscopic, partial, or more extended surgery and to evaluate the appearance of local or distant recurrence. METHODS A PubMed, Cochrane, and Embase systematic review of the literature has been performed. Original papers, review articles, and case reports published between 1988 and 2019 were considered eligible. All the studies who met the inclusion criteria were analyzed. Statistical analysis of data has been performed using GraphPad Prism 7 software. RESULTS Three hundred twenty-eight articles were found, and a total of 102 were included and analyzed in depth. Fifty-three papers reported the follow-up information, ranging from 1 to 417 months across different studies. Among them, 31 patients underwent endoscopic removal of the gastric lesions; 140 patients underwent local surgery, including wedge resection or partial gastrectomy; and 148 patients underwent subtotal or total gastrectomy. The median follow-up was of 27-38-33 months, respectively. No recurrence or distant metastasis was detected in the endoscopy group. Among local surgery group, liver metastasis was reported in one case; in extended surgery group, one patient died for multiple liver metastases. CONCLUSIONS Local or more extended surgery involved a larger cohort of patients and reported satisfactory long-term results compared with endoscopy group. Surgery in absence of a definite preoperative diagnosis is considered the gold standard treatment for resectable Gs.
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Affiliation(s)
- Sara Lauricella
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Sergio Valeri
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University, Rome, Italy
| | - Gianluca Mascianà
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ida Francesca Gallo
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University, Rome, Italy
| | - Erica Mazzotta
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Chiara Pagnoni
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Saponaro Costanza
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Falcone
- Department of Pathology, Campus Bio-Medico University, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Marco Caricato
- Department of Colorectal Surgery, Campus Bio-Medico University, Rome, Italy
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Li C, Guo L, Hua K. Diagnostic Dilemma of Retroperitoneal Schwannomas Encountered in a Specialized Gynecology Hospital. J INVEST SURG 2021; 35:614-619. [PMID: 34058943 DOI: 10.1080/08941939.2021.1910757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study analyzed the potential diagnosis and therapeutic challenges of retroperitoneal schwannoma (RSs) in a specialized gynecology hospital. METHODS AND MATERIALS A retrospective review was performed in our hospital from 2000 to 2018. A literature search of RSs was conducted using PubMed database. RESULTS 45 patients were identified (22 from our hospital and 23 from the literature review). The majority of patients presented asymptomatic (22/45). Among them, 25 cases were misdiagnosed as adnexal cysts, 13 uterine fibroids, 1 ovarian malignancy and 6 pelvic masses. Intraoperative exploration revealed that the masses were located in the retroperitoneal space. The median diameter was 6.2 cm (range 3.0-9.8 cm) in our hospital compared with 9.3 cm (6-15 cm) in literature review. Complete resection was performed in 37 patients and subtotal resection in 8 patients. The pathological results confirmed the diagnosis of benign schwannoma and no recurrence was found in the follow-up data. CONCLUSION The preoperative diagnosis of RSs is difficult to make because of its nonspecific characteristics. In a specialized gynecology hospital, it is more important to differentiate the benign and malignant of mass before surgery. Surgical complete resection of tumor is recommended and recurrence is unusual after complete resection.
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Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynecology, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Luopei Guo
- Department of Obstetrics and Gynecology, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Keqin Hua
- Department of Obstetrics and Gynecology, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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Takasumi M, Hikichi T, Hashimoto M, Nakamura J, Kato T, Kikuchi H, Waragai Y, Watanabe K, Takagi T, Suzuki R, Sugimoto M, Hayashi M, Sato Y, Irie H, Kobashi R, Okubo Y, Kobayakawa M, Ohira H. A Pilot Randomized Crossover Trial of Wet Suction and Conventional Techniques of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Upper Gastrointestinal Subepithelial Lesions. Gastroenterol Res Pract 2021; 2021:4913107. [PMID: 33824658 DOI: 10.1155/2021/4913107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Methods Twenty-six patients with UGI-SELs indicated for EUS-FNA were randomly assigned to the dry-first arm using the dry technique for the first two passes or the wet-first arm using the wet technique for the first two passes using a cross-over design with a ratio of 1 : 1. The primary endpoint was the cellularity score of the EUS-FNA specimens rated on a 4-point scale (0-3). The secondary endpoints were the factors influencing cellularity in each suction technique. Results The mean cellularity score was 1.65 ± 1.20 for the wet technique and 2.00 ± 0.98 for the dry technique (p = 0.068). Logistic regression analysis showed that higher cellularity may be related to the final diagnosis of gastrointestinal stromal tumors in the dry technique and the SEL location in the upper stomach in the wet technique. Conclusion The wet EUS-FNA technique failed to show a potential for improved cellularity of specimens compared to the dry technique for UGI-SELs.
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Melita G, Tortora A, Navarra G, Ieni A, Pallio S. Endoscopic Ultrasound-Guided Fine Needle Biopsy for the Diagnosis of Retroperitoneal Schwannoma. Indian J Surg 2021; 83:348-350. [DOI: 10.1007/s12262-020-02301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Yanagita T, Hikichi T, Nakamura J, Watanabe K, Kikuchi H, Takasumi M, Hashimoto M, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Hanayama H, Saze Z, Kobayakawa M, Kono K, Ohira H. Gastric carcinoma with lymphoid stroma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:471-7. [PMID: 33386563 DOI: 10.1007/s12328-020-01300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
A 78-year-old man with a subepithelial lesion (SEL) in the gastric body and two carcinomas in the gastric antrum was referred to our hospital. Following a diagnosis of SEL, the patient was followed-up by esophagogastroduodenoscopy annually for 4 years. Although the SEL had increased in size over the years, histological evaluation of the forceps biopsies did not reveal any significant findings. We detected a hypoechoic mass in the submucosa by endoscopic ultrasonography, and suspected the lesion to be an aberrant pancreas or mesenchymal tumor. The patient first underwent endoscopic submucosal dissection for the 2 gastric cancers. Histological examination of the resected specimens revealed intramucosal well-differentiated tubular adenocarcinomas. Next, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed for the gastric SEL. Aspirated specimens revealed an adenocarcinoma with lymphocyte infiltration. The lesion was diagnosed as a gastric carcinoma with lymphoid stroma (GCLS). Subsequently, he underwent distal gastrectomy, and the surgical specimen was confirmed as GCLS corresponding to preoperative diagnosis. In addition, the adenocarcinoma cells were positive for Epstein-Barr (EB) virus-encoded small RNA-1 by in situ hybridization. Finally, the lesion was diagnosed as GCLS associated with EB virus. Thus, EUS-FNA is advantageous for diagnosing GCLS associated with EB virus.
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Wang H, Zhang BB, Wang SF, Zhong JJ, Zheng JM, Han H. Pancreatic schwannoma: Imaging features and pathological findings. Hepatobiliary Pancreat Dis Int 2020; 19:200-202. [PMID: 31378472 DOI: 10.1016/j.hbpd.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Han Wang
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Bing-Bing Zhang
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Shen-Fan Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jing-Jiao Zhong
- Department of Imaging, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jian-Ming Zheng
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Huan Han
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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Azami T, Takano Y, Niiya F, Kobayashi T, Yamamura E, Maruoka N, Norose T, Ohike N, Nagahama M. A case of primary pancreatic schwannoma diagnosed by endoscopic ultrasound-fine needle aspiration. Clin J Gastroenterol 2020; 13:585-590. [PMID: 31983049 DOI: 10.1007/s12328-020-01095-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/10/2020] [Indexed: 01/27/2023]
Abstract
Pancreatic schwannoma is difficult to diagnose preoperatively. A 79-year-old man was found to have a 9-mm pancreatic mass on abdominal ultrasonography. On EUS, there was a 9-mm, clearly demarcated, round, solid, hypo-echoic mass in the pancreatic body. The differential diagnosis included a pancreatic neuroendocrine tumor, a solid-pseudopapillary neoplasm, and an atypical pancreatic cancer. EUS-FNA was performed with a 22G needle. On pathology examination, spindle-shaped tumor cells were seen proliferating in bundles. On immunostaining, the lesion was negative for c-kit, CD34, and α-SMA but positive for S-100 protein. The MIB-1 index was < 2%. Based on the above findings, the lesion was diagnosed as a benign pancreatic schwannoma. We, therefore, decided to follow the patient with careful observation rather than resecting the lesion surgically. The tumor has not changed significantly after 3 years of follow-up. EUS-FNA is useful for the diagnosis of pancreatic schwannoma. If the tumor can be determined to be benign preoperatively, unnecessary surgery can be avoided. EUS-FNA should be actively implemented for pancreatic tumors that are difficult to diagnose definitively on imaging.
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Affiliation(s)
- Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan.
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
| | - Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
| | - Takahiro Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
| | - Eiichi Yamamura
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
| | - Naotaka Maruoka
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
| | - Tomoko Norose
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama-shi, Kanagawa, Japan
| | - Nobuyuki Ohike
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama-shi, Kanagawa, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
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Morales-Maza J, Pastor-Sifuentes FU, Sánchez-Morales GE, Ramos ESG, Santes O, Clemente-Gutiérrez U, Pimienta-Ibarra AS, Medina-Franco H. Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review. World J Gastrointest Oncol 2019; 11:750-760. [PMID: 31558979 PMCID: PMC6755107 DOI: 10.4251/wjgo.v11.i9.750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/29/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach´s plexus or less frequently from Meissner´s plexus. The main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors (GISTs), which are classified by their immunohistochemistry. The treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important role. Wedge resection, subtotal or total gastrectomy can be done. In its counterpart, esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2% of all esophageal tumors. The main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor, followed by GIST. The treatment consists on tumoral enucleation or esophagectomy.
AIM To review the available literature about gastrointestinal schwannomas; especially lesions from de stomach and esophagus, including diagnosis, treatment, and follow up, as well as, reporting our institutional experience.
METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. The following databases were used for reviewing process: PubMed, Ovid, MEDLINE, and Scopus. Only English language manuscripts were included. All gastrointestinal schwannomas specifically located in the esophagus and stomach were included. Cases that did not report long-term follow-up were excluded.
RESULTS Gastric localization showed a higher prevalence in both, the literature review and our institution: 94.95% (n = 317) and 83% (n = 5) respectively. With a follow-up with disease-free survival greater than 36 mo in most cases: 62.01% (n = 80) vs 66.66% (n = 4). In both groups, the median size was > 4.1 cm. Surgical treatment is curative in most cases
CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal tumors. It has a good prognosis, and most are benign. A disease-free survival of more than 36 mo can be achieved by surgery.
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Affiliation(s)
- Jesús Morales-Maza
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | | | - Germán E Sánchez-Morales
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | - Emilio Sanchez-Garcia Ramos
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | - Oscar Santes
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | - Uriel Clemente-Gutiérrez
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
| | | | - Heriberto Medina-Franco
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City14080, Mexico
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Chen W, Cai G. Endoscopic ultrasound-guided fine-needle aspiration biopsy of gastric schwannoma: Cytomorphologic features and diagnostic pitfalls. Diagn Cytopathol 2019; 47:1218-1222. [PMID: 31343112 DOI: 10.1002/dc.24289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
Schwannoma rarely occurs in the stomach. We present a case of gastric schwannoma, which was initially evaluated by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy and confirmed by surgical resection. The patient was a 57-years-old woman with history of dyspepsia, who was found to have a large submucosal mass in the stomach. EUS-FNA showed scant spindle cells with abundant lymphocytes. The spindle cells were immunoreactive with S100, while negative for CD117, desmin, and CD34. The lymphocytes were mixed B-cells and T-cells. Immunostaining, flow cytometry, and molecular testing showed no evidence of B-cell lymphoma. The diagnosis of gastric schwannoma was confirmed by histopathological evaluation of the resected tumor. Gastric schwannoma has unique features of mixed spindle cells and lymphocytes. The tumor should be differentiated from other gastric mesenchymal tumors, and lymphoproliferative disorder is a pitfall.
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Affiliation(s)
- Wanwan Chen
- Department of Pathology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Sugiyama T, Ebi M, Ochiai T, Kurahashi S, Saito T, Onishi K, Yamamoto K, Inoue S, Adachi K, Yoshimine T, Yamaguchi Y, Tamura Y, Izawa S, Hijikata Y, Funaki Y, Ogasawara N, Sasaki M, Kasugai K. Gastric schwannoma with high accumulation on fluorodeoxyglucose-positron emission tomography resected by non-exposed endoscopic wall-inversion surgery. Clin J Gastroenterol 2019; 13:50-54. [PMID: 31270750 DOI: 10.1007/s12328-019-01014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
Gastric schwannoma is a relatively rare tumor arising from Auerbach plexus in the muscle layer of the gastric wall, and constitutes 0.1% to 0.2% of all gastric tumors and 5% of benign non-epithelium-related gastric tumors. We report the case of a 49-year-old woman in whom upper gastrointestinal endoscopy revealed an approximately 2-cm submucosal tumor on the anterior wall of the fornix of the stomach. Contrast-enhanced computed tomography revealed a homogeneously enhanced lesion (~ 17 mm) in the upper third of the stomach as well as a lesion (~ 25 mm) on the left kidney that was strongly enhanced in the early phase. An 18F-fluorodeoxyglucose positron emission tomography scan revealed high accumulation that is characteristic of gastric tumors. The possibility of malignancy was not completely excluded, and the gastric tumor was resected by non-exposed endoscopic wall-inversion surgery. The patient was discharged with a good prognosis 5 days after surgery. In conclusion, non-exposed endoscopic wall-inversion surgery is a minimally invasive and effective method for resecting small gastric submucosal tumors (diameters < 3 cm) for which preoperative diagnosis is difficult.
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Affiliation(s)
- Tomoya Sugiyama
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tomoko Ochiai
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kentaro Onishi
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kazuhiro Yamamoto
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Satoshi Inoue
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kazunori Adachi
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Yoshimine
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuhiro Tamura
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shinya Izawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasutaka Hijikata
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Miyake M, Fukui S, Gotoh D, Matsumura Y, Samma S, Matsumoto Y, Momose H, Hori S, Watanabe S, Owari T, Morizawa Y, Itami Y, Nakai Y, Inoue T, Anai S, Torimoto K, Aoki K, Tanaka N, Fujimoto K. The diagnostic utility of retroperitoneoscopic tissue biopsy for unresectable retroperitoneal lesions excluding urogenital cancers. World J Surg Oncol 2019; 17:35. [PMID: 30777073 DOI: 10.1186/s12957-019-1581-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. Treatment of unresectable retroperitoneal lesions requires pathological diagnosis. Here, we report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers. Methods We analyzed 47 patients consisting of 23 (49%) and 24 (51%) cases that underwent retroperitoneoscopic tissue biopsy and open biopsy, respectively. The clinicopathological features, including postoperative complications, were compared between the two groups. Results Tumor pathology was diagnosed successfully with a single operation in all patients. Malignant pathology (68%) was more common than benign pathology (32%). The most common pathology was malignant lymphoma, which accounted for about 50% of all cases. There was no significant difference with respect to the age, sex, tumor size, presence of tumor-related symptom, histopathology, operative time, and complications. Three (13%) of 23 patients in the retroperitoneoscopic biopsy group received percutaneous needle biopsy before laparoscopic excisional biopsy because the evaluation of needle cores failed to confirm subclasses of diagnosed pathologies. One patient was converted to open surgery just after the initiation of operation due to severe adhesion of adjacent structures. We had two cases with iatrogenic urinoma due to ureteral injury after retroperitoneoscopic biopsy. Conclusions We conclude that retroperitoneoscopic biopsy is a safe and useful tool for benign and malignant retroperitoneal lesions, in comparison to open biopsy. It is critical to carefully examine the preoperative imaging for the location of tumors, especially those close to the renal pelvis and ureter.
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Mekras A, Krenn V, Perrakis A, Croner RS, Kalles V, Atamer C, Grützmann R, Vassos N. Gastrointestinal schwannomas: a rare but important differential diagnosis of mesenchymal tumors of gastrointestinal tract. BMC Surg 2018; 18:47. [PMID: 30045739 PMCID: PMC6060462 DOI: 10.1186/s12893-018-0379-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Schwannomas of gastrointestinal tract are rare, mostly benign and notably different neoplasms from conventional schwannomas that arise in soft tissue or the central nervous system. These tumors are of clinical importance since they should always be considered in the differential diagnosis of submucosal lesions of gastrointestinal tract. METHODS Seven patients with a pathologically proven gastrointestinal schwannoma were identified in our series of mesenchymal tumors and reviewed retrospectively. Clinicopathological and immunohistochemical parameters along with the follow-up results were analysed. RESULTS The series included two males and five females, with a mean age 69 years (range, 39-81). Most patients were asymptomatic on presentation, except for two patients with abdominal pain. In the other cases (n = 5), the tumor was an incidental finding during other medical, imaging or surgical procedures. The tumors were located in the stomach (n = 4) and in the small intestine (n = 3) with an average size of 29 mm (range, 12-70). A preoperative diagnosis was achieved only in one case with a CT-guided core biopsy. Otherwise the clinical, intraoperative, endoscopic or radiological findings were unspecific. Patients with gastric tumor underwent either laparoscopic (n = 2) or open (n = 2) gastric wedge resection of the tumor; in the cases of intestinal tumor (n = 3) a segmentectomy was performed. Pathological examination revealed solid homogenous tumors, which were highly cellular and composed of spindle cells with positive staining for S100 protein, and confirmed the diagnosis of schwannoma. All tumors were negative for c-Kit, smooth muscle actin, desmin and DOG-1 and showed very low proliferation index. There were negative resection margins and no malignant variants were recognized. At an average follow-up of 60 months (range, 24-185) all patients were free of disease with no signs of recurrence or metastases and acceptable gastrointestinal function. CONCLUSIONS Schwannomas are rare, slow-growing and mostly asymptomatic gastrointestinal mesenchymal tumors. They are difficult to be diagnosed preoperatively as endoscopic and radiological findings are nonspecific but histological and immunohistochemical features are of paramount importance to differentiate between benign and malignant schwannomas, or other spindle cell sarcomas. The treatment of choice is complete surgical excision without a conclusive preoperative diagnosis, and the long-term outcome is excellent as these lesions are mostly benign.
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Affiliation(s)
- Alexandros Mekras
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Vasileios Kalles
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Cem Atamer
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
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Rohit M, Bhatt A, Cruise M, Wearsch PA, Goldblum JR, Sturgis CD. Endoscopic ultrasound FNA: An illustrated review of spindle cell neoplasms of the upper gastrointestinal tract including a novel case of gastric plexiform fibromyxoma. Diagn Cytopathol 2018; 46:730-738. [PMID: 30043412 DOI: 10.1002/dc.24040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
Abstract
Plexiform fibromyxoma (PF) is a recently-described and rare mesenchymal neoplasm of the gastric wall. A few small case series reports of this spindle cell entity exist in the surgical pathology literature, but to our knowledge no prior endoscopic ultrasound guided fine needle aspiration cytology examples have been reported. In clinical practice, mural gastrointestinal (GI) lesions are often initially evaluated by endoscopic ultrasound guided (EUS) fine needle aspiration (FNA). In addition, newer EUS fine needle biopsy techniques also allow for reliable retrieval of core tissue samples with intact cellular architecture, making EUS histopathologic analyses possible. We report a combined EUS FNA and core biopsy case of PF and correlate the findings with imaging results. The cytomorphology of PF is described and illustrated, and important entities in the differential diagnosis of upper GI spindle cell lesions (including GI stromal tumor, leiomyoma, schwannoma, carcinoid tumor, desmoid-type fibromatosis, and inflammatory fibroid polyp) are reviewed. Illustrated examples of relevant cytomorphologic, cell block histomorphologic and immunohistochemical characteristics are emphasized.
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Affiliation(s)
- Maitreyi Rohit
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
| | - Amit Bhatt
- Department of Gastrointestinal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael Cruise
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Pamela A Wearsch
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
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