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Case Reports
. 2021 Jul 7;27(25):3940-3947.
doi: 10.3748/wjg.v27.i25.3940.

Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture: A case report

Zhi-Yu Lu  1 , Dun-Yong Zhao  2
Affiliations
Case Reports

Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture: A case report

Zhi-Yu Lu et al. World J Gastroenterol. .

Abstract

Background: Schwannomas, also known as neurinomas, are tumors that derive from Schwann cells. Gastrointestinal schwannomas are extremely rare, but the stomach is the most common site. Gastric schwannomas are usually asymptomatic. Endoscopy and imaging modalities might offer useful preliminary diagnostic information. However, to diagnose schwannoma, the immunohistochemical positivity for S-100 protein is essential, whereas CD117, CD34, SMA, desmin, and DOG-1 are negative.

Case summary: A 45-year-old female was found to have a gastric mass during a medical examination, which was diagnosed as a gastric schwannoma. We performed endoscopic full-thickness resection and endoscopic purse-string suture. Pathology and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 protein. Furthermore, to exclude the misdiagnosis of gastrointestinal stromal tumor, we performed a mutational detection of the c-Kit and PDGFRA genes. Postoperative follow-up revealed that the patient recovered well.

Conclusion: Immunohistochemical staining is essential for the diagnosis of schwannoma. Endoscopic full-thickness resection is an effective treatment method for gastric schwannoma.

Keywords: Case report; Endoscopic full-thickness resection; Endoscopic purse-string suture; Gastric schwannoma; Gene mutational analysis; Immunohistochemical staining.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Abdominal computed tomography scanning. A: Computed tomography scan revealed a rounded mass arising from the greater curvature of the gastric body; B: The gastric mass exhibited slight internal contrast enhancement.
Figure 2
Figure 2
Gastroscopy and endoscopic ultrasonography. A: Gastroscopy demonstrated a hemispherical protrusion lesion of the gastric body; B: Endoscopic ultrasonography showed that the lesion arose from the muscularis propria.
Figure 3
Figure 3
Pathological analysis and immunohistochemical staining. A: Hematoxylin and eosin staining revealed spindle cell tumors with mild cells, mitotic figures 1-2/50 high-power field, local inflammatory cell infiltration, and no necrosis. Combined with immunohistochemistry and gene detection results, the results were consistent with schwannoma; B-G: Immunohistochemical staining of the gastric mass confirmed a gastric schwannoma through positive staining for S-100 protein (B), whereas CD117 (C), CD34 (D), α-smooth muscle actin (E), desmin (F), and DOG1 (G) were negative.
Figure 4
Figure 4
c-Kit and PDGFRA gene mutational analysis. DNA sequencing electropherograms revealed an absence of mutations in exons 9, 11, 13, and 17 of the c-Kit gene and exons 12 and 18 of the PDGFRA gene.
Figure 5
Figure 5
Endoscopic full-thickness resection operative process. A: Marked the lesion with argon plasma coagulation; B and C: Application of the insulated-tip knife to isolate the stromal tumor along its periphery; D and E: An “artificial perforation” observed after stromal tumor resection and sealed the perforation by endoscopic purse-string suture; F: The resected tumor.
Figure 6
Figure 6
Gastroscopy at 16 mo after the operation revealed that the incision recovered well and that there was no recurrence.
See this image and copyright information in PMC

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