Gastric Schwannoma: A Rare Cause of Gastric Bleeding

Abstract

Gastric schwannomas and gastrointestinal stromal tumors (GISTs) are two types of mesenchymal tumors, which represent a group of rare tumors of the gastrointestinal tract. The differential diagnosis between these two tumors is difficult given their very similar appearance and clinical features. The authors present a case of a 63-year-old man with melena and epigastric pain. An upper digestive endoscopy was performed, revealing an ulcerated gastric subepithelial lesion suspected to be a GIST. Further imaging with a computed tomography (CT) scan revealed a well-defined hypodense solid nodular mass, with homogeneous enhancement, measuring 22 × 18 mm, on the anterior wall of the transition between the body and gastric antrum, situated within the submucosal layer. The patient subsequently underwent a laparoscopic atypical gastrectomy, which proceeded without complications. The pathological examination of the excised lesion confirmed it to be a gastric schwannoma, with complete excision. This case report illustrates a rare cause of gastrointestinal bleeding, that requires immediate action, and en bloc resection is usually curative. Given the excellent prognosis after complete resection, a correct diagnosis is essential.

Keywords: Abdominal pain; Gastric lesion; Gastrointestinal oncology; Laparoscopic surgery; Schwannoma.

Figure 1

Upper gastrointestinal endoscopy showing subepithelial lesion located on the anterior surface/greater curvature of the middle/distal body, ulcerated.

Figure 2

Abdominal and pelvic tomography scan. In a submucosal position, on the anterior wall of the transition between the body and the gastric antrum, a well-defined hypodense solid nodularity, with homogeneous and frank enhancement, measuring 22 × 18 mm (red arrow) was observed.

Figure 3

Microscopic analysis. The lesion developed in dependence on the gastric wall.

Figure 4

Microscopic analysis showing proliferation of spindle cells on a background with a myxoid appearance.

Figure 5

Immunohistochemical analysis showing SOX10 immunoreactive cells.