Gastric schwannomas revisited: Has precise preoperative diagnosis become feasible?

Shinichi Fujiwara, Kiyokazu Nakajima, Toshirou Nishida, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Hiroshi Miyata, Shuji Takiguchi, Masaki Mori, Yuichiro Doki

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Gastric schwannomas are not common but are clinically important in terms of differential diagnosis from other submucosal lesions. The precise preoperative diagnosis, however, has been challenging mainly owing to the lack of specific findings in conventional imaging studies. The aim of this study was to revisit the possibilities and limitations of modern preoperative diagnostic modalities for gastric schwannomas. Methods: Fourteen consecutive patients with a final pathological diagnosis of gastric schwannoma were retrospectively analyzed. Data included demographics, preoperative imaging studies/diagnosis, surgery, histopathology, and follow-up results. Results: The series included 6 males and 8 females, with a median age of 49 years (range 26-68 years). No symptoms were presented, except for 1 patient with epigastric pain. The tumors were located in the upper (n = 5), middle (3), and lower stomach (6), with a median size of 41 mm (range 20-75 mm). Twelve schwannomas (86 %) showed homogeneous enhancement on computed tomography. Ulceration was seen on endoscopy in 4 of 12 available cases (33 %). Positron emission tomography was performed in the last 4 patients, showing fluorodeoxy-glucose uptake in all cases (100 %). A preoperative diagnosis of schwannoma was not obtained in the majority of cases (13/14, 93 %); only 1 case was correctly diagnosed, by endoscopic aspiration cytology. Laparoscopic partial gastrectomy was attempted and completed in 13 cases. The patients have been followed up for 4.7 years (range 2.1-20.3 years), with no recurrencesor metastases and acceptable gastrointestinal function. Conclusions: The precise preoperative diagnosis of gastric schwannomas remains difficult even with modern imaging studies. Surgery, therefore, should be positively considered for patients without a conclusive preoperative diagnosis.

Original languageEnglish
Pages (from-to)318-323
Number of pages6
JournalGastric Cancer
Volume16
Issue number3
DOIs
Publication statusPublished - Jul 1 2013

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Neurilemmoma
Stomach
Gastrectomy
Positron-Emission Tomography
Endoscopy
Cell Biology
Differential Diagnosis
Tomography
Demography
Neoplasm Metastasis
Glucose
Pain
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Fujiwara, S., Nakajima, K., Nishida, T., Takahashi, T., Kurokawa, Y., Yamasaki, M., ... Doki, Y. (2013). Gastric schwannomas revisited: Has precise preoperative diagnosis become feasible? Gastric Cancer, 16(3), 318-323. https://doi.org/10.1007/s10120-012-0186-x

Gastric schwannomas revisited : Has precise preoperative diagnosis become feasible? / Fujiwara, Shinichi; Nakajima, Kiyokazu; Nishida, Toshirou; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro.

In: Gastric Cancer, Vol. 16, No. 3, 01.07.2013, p. 318-323.

Research output: Contribution to journalArticle

Fujiwara, S, Nakajima, K, Nishida, T, Takahashi, T, Kurokawa, Y, Yamasaki, M, Miyata, H, Takiguchi, S, Mori, M & Doki, Y 2013, 'Gastric schwannomas revisited: Has precise preoperative diagnosis become feasible?', Gastric Cancer, vol. 16, no. 3, pp. 318-323. https://doi.org/10.1007/s10120-012-0186-x
Fujiwara S, Nakajima K, Nishida T, Takahashi T, Kurokawa Y, Yamasaki M et al. Gastric schwannomas revisited: Has precise preoperative diagnosis become feasible? Gastric Cancer. 2013 Jul 1;16(3):318-323. https://doi.org/10.1007/s10120-012-0186-x
Fujiwara, Shinichi ; Nakajima, Kiyokazu ; Nishida, Toshirou ; Takahashi, Tsuyoshi ; Kurokawa, Yukinori ; Yamasaki, Makoto ; Miyata, Hiroshi ; Takiguchi, Shuji ; Mori, Masaki ; Doki, Yuichiro. / Gastric schwannomas revisited : Has precise preoperative diagnosis become feasible?. In: Gastric Cancer. 2013 ; Vol. 16, No. 3. pp. 318-323.
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abstract = "Background: Gastric schwannomas are not common but are clinically important in terms of differential diagnosis from other submucosal lesions. The precise preoperative diagnosis, however, has been challenging mainly owing to the lack of specific findings in conventional imaging studies. The aim of this study was to revisit the possibilities and limitations of modern preoperative diagnostic modalities for gastric schwannomas. Methods: Fourteen consecutive patients with a final pathological diagnosis of gastric schwannoma were retrospectively analyzed. Data included demographics, preoperative imaging studies/diagnosis, surgery, histopathology, and follow-up results. Results: The series included 6 males and 8 females, with a median age of 49 years (range 26-68 years). No symptoms were presented, except for 1 patient with epigastric pain. The tumors were located in the upper (n = 5), middle (3), and lower stomach (6), with a median size of 41 mm (range 20-75 mm). Twelve schwannomas (86 {\%}) showed homogeneous enhancement on computed tomography. Ulceration was seen on endoscopy in 4 of 12 available cases (33 {\%}). Positron emission tomography was performed in the last 4 patients, showing fluorodeoxy-glucose uptake in all cases (100 {\%}). A preoperative diagnosis of schwannoma was not obtained in the majority of cases (13/14, 93 {\%}); only 1 case was correctly diagnosed, by endoscopic aspiration cytology. Laparoscopic partial gastrectomy was attempted and completed in 13 cases. The patients have been followed up for 4.7 years (range 2.1-20.3 years), with no recurrencesor metastases and acceptable gastrointestinal function. Conclusions: The precise preoperative diagnosis of gastric schwannomas remains difficult even with modern imaging studies. Surgery, therefore, should be positively considered for patients without a conclusive preoperative diagnosis.",
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AB - Background: Gastric schwannomas are not common but are clinically important in terms of differential diagnosis from other submucosal lesions. The precise preoperative diagnosis, however, has been challenging mainly owing to the lack of specific findings in conventional imaging studies. The aim of this study was to revisit the possibilities and limitations of modern preoperative diagnostic modalities for gastric schwannomas. Methods: Fourteen consecutive patients with a final pathological diagnosis of gastric schwannoma were retrospectively analyzed. Data included demographics, preoperative imaging studies/diagnosis, surgery, histopathology, and follow-up results. Results: The series included 6 males and 8 females, with a median age of 49 years (range 26-68 years). No symptoms were presented, except for 1 patient with epigastric pain. The tumors were located in the upper (n = 5), middle (3), and lower stomach (6), with a median size of 41 mm (range 20-75 mm). Twelve schwannomas (86 %) showed homogeneous enhancement on computed tomography. Ulceration was seen on endoscopy in 4 of 12 available cases (33 %). Positron emission tomography was performed in the last 4 patients, showing fluorodeoxy-glucose uptake in all cases (100 %). A preoperative diagnosis of schwannoma was not obtained in the majority of cases (13/14, 93 %); only 1 case was correctly diagnosed, by endoscopic aspiration cytology. Laparoscopic partial gastrectomy was attempted and completed in 13 cases. The patients have been followed up for 4.7 years (range 2.1-20.3 years), with no recurrencesor metastases and acceptable gastrointestinal function. Conclusions: The precise preoperative diagnosis of gastric schwannomas remains difficult even with modern imaging studies. Surgery, therefore, should be positively considered for patients without a conclusive preoperative diagnosis.

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