Gastric Schwannoma mimicking gastrointestinal stromal tumors: a rare case with review of literature

Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST have similar radiological and endoscopic features making it extremely difficult to differentiate them preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. This case stresses on the importance of including gastric schwannomas in the differential diagnosis of a submucosal gastric mass as it has the ability to mimic a gastrointestinal stromal tumor, which is a leading differential diagnosis because of its common occurrence at this site.

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Gastric schwannoma: a benign tumor often misdiagnosed as gastrointestinal stromal tumor

Clinics and Practice ◽

10.4081/cp.2015.775 ◽

2015 ◽

Vol 5 (3) ◽

Cited By ~ 7

Author(s):

Apurva S. Shah ◽

Pravin M. Rathi ◽

Vaibhav S. Somani ◽

Astha M. Mulani

Keyword(s):

Differential Diagnosis ◽

Gastrointestinal Stromal Tumor ◽

Gastrointestinal Stromal Tumors ◽

Rare Case ◽

Benign Tumor ◽

Stromal Tumor ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Gastric Schwannoma ◽

Gastric Mass

Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.

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Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

Case Reports in Surgery ◽

10.1155/2012/280982 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

William Yoon ◽

Kari Paulson ◽

Paul Mazzara ◽

Sweety Nagori ◽

Mohammed Barawi ◽

...

Keyword(s):

Differential Diagnosis ◽

Surgical Resection ◽

Treatment Options ◽

Partial Gastrectomy ◽

Preoperative Imaging ◽

Mesenchymal Tumors ◽

Gastric Schwannoma ◽

Gastric Mass ◽

Submucosal Mass ◽

Slow Growing

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

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Gallbladder GIST: A review of literature

Polish Journal of Surgery ◽

10.5604/01.3001.0013.5550 ◽

2019 ◽

Vol 92 (1) ◽

pp. 1-5

Author(s):

Ashish Gupta

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Interstitial Cells Of Cajal ◽

Case Reports ◽

Gallbladder Wall ◽

Postoperative Adjuvant Therapy ◽

Review Of Literature ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Extensive Search ◽

Cells Of Cajal

Mesenchymal tumors of the gallbladder are rarely encountered in clinical practice. The Gastrointestinal Stromal tumors(GIST) of the gallbladder are rarely encountered. These tumors most commonly arise from the interstitial cells of cajal(ICC), the pacemakers of the intestinal system. There can be benign as well as malignant form of GIST .The literature on GIST arising from the gallbladder wall is limited to few case reports only.on extensive search of the indexed literature only 9 cases of gallbladder GIST were retrieved. Based on the available literature these tumors are commonly found in females. They usually present with hypochondrial pain with or without other features of cholangitis. These tumors are usually malignant and warrant a radical surgical excision.The data on postoperative adjuvant therapy and survival is limited. The authors are presenting a review of the available literature on this rare pathology.

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Gastrointestinal stromal tumors (gists): Definition, clinical, histological, immunohistochemical and molecular genetic features and predictors of malignant potential and differential diagnosis

Archive of oncology ◽

10.2298/aoo0204267z ◽

2002 ◽

Vol 10 (4) ◽

pp. 267-271 ◽

Cited By ~ 4

Author(s):

Vesna Zivkovic ◽

Vuka Katic ◽

Aleksandar Nagorni ◽

Ljubinka Velickovic ◽

Maja Milentijevic ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Molecular Genetic ◽

Malignant Potential ◽

Gi Tract ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Cellular Origin ◽

Genetic Features ◽

Exon 11 ◽

Malignant Gists

Gastrointestinal stromal tumors (GISTs) represent a distinct and the most important subset of mesenchymal tumors of the gastrointestinal (GI) tract GISTs occur throughout the GI tract but are usually located in the stomach and small intestine. The cellular origin, differentiation, nomenclature and prognosis of GISTs are controversial. Because GISTs, like the interstitial cells of Cajal, the GI pacemaker cells, express CD117 (c-kit protein), the origin of GISTs from the Cajal cells has recently been suggested. GISTs are also known for their wide variability in clinical behavior and for the difficulty to determine their malignant condition The most reproducible predictors of malignancy are mitotic count >1-5 per10 high-powered fields (HPF), size >5 cm, tumor necrosis, infiltration and metastasis to other sites. However, some tumors with mitotic activity <1/10 HPF may metastasize indicating some uncertainty in malignant potential of GISTs, especially those larger than 5 cm. Recently, mutations in c-kit gene (exon 11) preferentially occur in malignant GISTs and may be a clinically useful adjunct marker in evaluation of GISTs. In conclusion, the strong CD117 expression mostly defines primary GI mesenchymal tumors as GIST. Specific identification of GIST may become clinically important if therapies targeting the c-kit tyrosine kinase activation become available.

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Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.002183 ◽

2021 ◽

pp. 10-16

Author(s):

Yana Miroshnichenko

Keyword(s):

Differential Diagnosis ◽

Tumor Cells ◽

Gastrointestinal Stromal Tumors ◽

Spindle Cell ◽

Prognostic Markers ◽

Mitotic Rate ◽

Mesenchymal Tumors ◽

Ki 67 ◽

Stromal Tumors ◽

Strong Expression

The aim. To clarify all most important immunohistochemical features of gastrointestinal stromal tumors with different histological patterns and analyze the role of expression of Ki-67, MMP-9, VEGF and p16ink4A as a predictive markers of tumor progression. Materials and methods. The study is based on analysis of 100 primary GISTs for description of their morphological features and 36 GISTs taken from this 100 for study of prognostic markers. Results. All spindle cell GISTs have shown diffuse expression of CD117 in tumor cells. The levels of CD117 expression varied from strong expression (3+) until mild expression (1+). Strong expression were seen in 75,8 % of spindle cell GISTs. Epithelioid GISTs demonstrated heterognous moderate or mild expression of CD117. All primary epithelioid GISTs from patients that had relapse of tumor in period from 1 till 3 years demonstrated focal mild expression of CD 117 in tumor cells. Expression of DOG-1 were seen in all 100 cases of GISTs, that were included in our study. The strong expression of DOG-1 (3+) were seen in all 45 GISTs that had low mitotic rate (≤5 mitoses per 50HPF) and not associated with their histological pattern. GISTs with high mitotic rate demonstrated heterogeneous expression of DOG-1 in tumors: moderate expression (2+) with patchy areas of strong expression (3+). Expression of CD56 was not found in spindle cell GISTs, but single tumor cells of epithelioid GISTs that had high mitotic rate demonstrated expression of this marker. The average expression of p16ink4A were higher in tumors that gave relapses compared with tumors without relapses (50,3 % versus 5,7 % respectively, U-test=16.5; p≤0,01).The average expression of MMP-9 also were significantly higher in GISTs that gave relapses: 63,2 % compared with 13,4 % in GISTs without relapse (U-test=16; p≤0 ,01).The strong VEGF expression was found in 66,7 % of GISTs that had relapses and only in 8,3 % of GISTs without relapses. 50 % of GISTs without relapses was negative for VEGF. Finally, the average expression of Ki-67 were 13,4 % in GISTs with relapses and 8,7 % in GISTs without them (U-test=16; p≤0,01). Conclusion. We highly recommend using DOG-1 for epithelioid GISTs. Additionally in epithelioid GISTs can be used CD56 that can give focal positive reaction in some tumour cells. The following minimal panel of markers for differential diagnosis of spindled GISTs from other mesenchymal tumors of gastrointestinal tract is proposed: CD117, DOG-1 and SMA, where the first too markers will demonstrated the moderate or strong diffuse expression and SMA can be occasionally positive in some tumor cells. p16ink4A, ki-67, VEGF and MMP-9 can be used as additional prognostic markers in GISTs.

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Gastric Schwannoma Mimicking Malignant Gastrointestinal Stromal Tumor Exhibiting Increased Fluorodeoxyglucose Uptake

Case Reports in Oncology ◽

10.1159/000445825 ◽

2016 ◽

Vol 9 (1) ◽

pp. 228-234 ◽

Cited By ~ 8

Author(s):

Sung Jin Oh ◽

Byoung Jo Suh ◽

Jong Kwon Park

Keyword(s):

Gastric Neoplasms ◽

Emission Computed Tomography ◽

Computed Tomography Imaging ◽

Mesenchymal Tumors ◽

Tomography Imaging ◽

Submucosal Tumors ◽

Stromal Tumors ◽

Gastric Schwannoma ◽

Positron Emission ◽

Fluorine 18 Fluorodeoxyglucose

A schwannoma is a kind of neurogenic tumor that rarely occurs in the gastrointestinal tract. Gastric schwannomas make up 0.2% of all gastric neoplasms. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST are similar in clinical features, so they are difficult to differentiate preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. We report a 49-year-old woman who was diagnosed after operation with a gastric schwannoma, which was suspected a malignant GIST by fluorine-18-fluorodeoxyglucose positron emission computed tomography imaging.

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Gastric Schwannoma: A Case Report and Review of the Literature for Gastric Submucosal Masses Distinction

Case Reports in Medicine ◽

10.1155/2018/1230285 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Behnam Sanei ◽

Amirhosein Kefayat ◽

Melika Samadi ◽

Parvin Goli ◽

Mohammad Hossein Sanei ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Rare Case ◽

Outlet Obstruction ◽

Accurate Diagnosis ◽

Review Of The Literature ◽

Stromal Tumors ◽

Gastric Schwannoma ◽

Frequent Vomiting ◽

Submucosal Mass ◽

Slow Growing

Schwannomas origin from Schwann cells sheath and generally are benign, slow-growing, and asymptomatic neoplasms which frequently appear in the head and neck. Although gastrointestinal schwannoma is really rare, the most affected organ in GI system is the stomach. Gastric schwannoma forms 0.2% of all gastric tumors. This neoplasm is always detected as a submucosal mass, the same as other gastrointestinal stromal tumors. Although these tumors have almost the same presentations, they are completely different at therapeutic options and prognoses. Hence, it is important to distinguish them apart and make an accurate diagnosis to optimize treatment outcomes. Herein, we report a case of 28-year-old woman with frequent vomiting and abdominal pain caused by 5 × 6 cm schwannoma in the antrum of the stomach. This is a rare case of gastric outlet obstruction due to a massive schwannoma. In addition, all other probable submucosal masses will be discussed at different aspects.

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Multislice imaging of gastrointestinal stromal tumors

10.32512/jmr.1.1.2018/3.14 ◽

2018 ◽

pp. 3-14

Keyword(s):

Computed Tomography ◽

Key Words ◽

Gold Standard ◽

Gastrointestinal Stromal Tumors ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Preferential Localization ◽

Multislice Imaging ◽

Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

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Gastrointestinal Stromal Tumors (GISTs): Novel Therapeutic Strategies with Immunotherapy and Small Molecules

International Journal of Molecular Sciences ◽

10.3390/ijms22020493 ◽

2021 ◽

Vol 22 (2) ◽

pp. 493

Author(s):

Christos Vallilas ◽

Panagiotis Sarantis ◽

Anastasios Kyriazoglou ◽

Evangelos Koustas ◽

Stamatios Theocharis ◽

...

Keyword(s):

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitors ◽

Gastrointestinal Stromal Tumors ◽

Kinase Inhibitors ◽

Checkpoint Inhibitors ◽

Survival Rates ◽

Cancer Therapeutics ◽

Gastrointestinal Neoplasms ◽

Mesenchymal Tumors ◽

Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common types of malignant mesenchymal tumors in the gastrointestinal tract, with an estimated incidence of 1.5/100.000 per year and 1–2% of gastrointestinal neoplasms. About 75–80% of patients have mutations in the KIT gene in exons 9, 11, 13, 14, 17, and 5–10% of patients have mutations in the platelet-derived growth factor receptor a (PDGFRA) gene in exons 12, 14, 18. Moreover, 10–15% of patients have no mutations and are classified as wild type GIST. The treatment for metastatic or unresectable GISTs includes imatinib, sunitinib, and regorafenib. So far, GIST therapies have raised great expectations and offered patients a better quality of life, but increased pharmacological resistance to tyrosine kinase inhibitors is often observed. New treatment options have emerged, with ripretinib, avapritinib, and cabozantinib getting approvals for these tumors. Nowadays, immune checkpoint inhibitors form a new landscape in cancer therapeutics and have already shown remarkable responses in various tumors. Studies in melanoma, non-small-cell lung cancer, and renal cell carcinoma are very encouraging as these inhibitors have increased survival rates. The purpose of this review is to present alternative approaches for the treatment of the GIST patients, such as combinations of immunotherapy and novel inhibitors with traditional therapies (tyrosine kinase inhibitors).

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