Gastric Schwannoma – A Rare Cause of Dyspepsia

Shadi Al-Bahri, MD1, Esther Cha, MD2, Patrick Domkowski, MD, PhD, FACS3, Jason Radecke, MD, FACS, FAMBS3. 1University of South Florida, 2MedStar Union Memorial Hospital, 3Riverside Surgical and Weight Loss Center

Introduction: Gastrointestinal schwannomas are rare benign neoplasms that are distinctively unique when compared to soft-tissue and central nervous system mesenchymal neoplasms. We present a case of a gastric schwannoma causing severe reflux treated successfully by a laparoscopic wedge gastrectomy.

Case presentation: 42 year old male with long standing reflux was found to have a 5 cm mass along the lesser curvature of the stomach.  A laparoscopic wedge resection was performed. Pathology showed a gastric schwannoma. He was discharged home after an uncomplicated hospital course.

Discussion: Schwannomas are rare tumors arising from Schwann cells that cover peripheral nerves. Rarely, schwannomas can present in the gastrointestinal tract with the stomach as the most commonly affected organ. Gastric schwannoma represent only 0.2% of all gastric tumors and 4% of all benign gastric neoplasms. Colonic and retroperitoneal schwannomas are extremely rare. Schwannomas are slow growing and usually asymptomatic but can present with a variety of symptoms, such as abdominal pain, dyspepsia, gastrointestinal bleeding, and an abdominal mass. They can also present as a gastroduodenal intussusception, perforation leading to abscess formation or a unilateral pleural effusion. Accurate pre-operative diagnosis of gastrointestinal schwannomas is often difficult due to the rarity of this condition. Computed tomography (CT) scanning typically demonstrate well-demarcated and homogenous enhancement features. Endoscopic ultrasound (EUS) can be helpful for EUS guided fine-needle aspiration or biopsy of submucosal tumors. Gastric schwannomas are often misdiagnosed as malignant gastrointestinal stromal tumors (GIST) following EGD, EUS and PET/CT (Positron emission tomographic/computed tomographic) imaging. Definitive diagnosis can only be made by surgical resection followed by immuno-histochemical staining.

Conclusion: Schwannomas are rarely found in the gastrointestinal tract and can present wtih a variety of symptoms such as dyspepsia or abdominal pain. Preoperative diagnosis is often difficult and challenging to distinguish from other mesenchymal tumors. Definitive treatment includes complete surgical excision with negative margins. The outcome after surgery is excellent as these neoplasms are generally benign in nature.

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