Abstract
Introduction and importance
Gastric schwannoma is a rare and benign tumor originating from the peripheral nerves of the stomach. Despite its benign nature, this tumor typically remains asymptomatic for an extended period, and its radiological and endoscopic presentation poses challenges in distinguishing it from other gastric mesenchymal tumors.
Case presentation
Here, we present a rare case of a patient experiencing gastric pain and melena secondary to a gastric mass. The initial preoperative diagnosis indicated a gastrointestinal stromal tumor, but subsequent pathological and immunohistochemical staining of the surgical specimen confirmed the presence of gastric schwannoma.
Discussion
To gain insights into this uncommon condition, we conducted an electronic search on PubMed using the keywords “gastric schwannoma” and “gastric neurinoma.” Our focus centered on case series containing more than five cases of gastric localization, resulting in the analysis of 14 case series involving a total of 321 patients. Our review aims to comprehensively discuss the clinical, radiological, and therapeutic aspects associated with this rare disease.
Conclusion
In the absence of a definitive preoperative diagnosis, the surgical approach is considered the primary treatment for resectable gastric schwannoma, given its excellent long-term outcomes. However, further studies are imperative to better define the role of endoscopic resection in managing this condition.
Keywords: Gastric schwannoma, Neurolemmas, Schwann cell, S 100 positive, Immunochemical staining
Highlights
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Gastric schwannoma (GS) is a rare and benign tumor originating from the peripheral nerves within the stomach.
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its radiological and endoscopic presentation poses challenges in distinguishing it from other gastrointestinal stromal tumor (GIST).
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In the absence of a definitive preoperative diagnosis, the surgical approach is considered the primary treatment for resectable gastric schwannoma.
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only immunohistochemical stainning with S100 positive could distinguishes GS from GIST
1. Introduction
Schwannomas, also known as neurolemmas or neurinomas, are benign and rare tumors that develop from Schwann cells of the nerve sheath in peripheral nerves, the central nervous system, and the spinal cord [1]. Gastric localization represents 2–6 % of mesenchymal tumors [2] and 0.2 % of all gastric tumors [3]. Herein, we report a rare case of 50-year-old patient with no significant medical history. Was presented to emergency room with epigastric pain and melena for one month before admission necessitating blood transfusion. Radiological and endoscopic examinations suggested a Gastrointestinal Stromal Tumor (GIST). The patient underwent atypical stomach resection via a laparoscopic approach, with no postoperative complications and no recurrence after eight months of follow-up the pathological examination was in favor to gastric schwannoma.
We performed an electronic search on PubMed using the terms “gastric schwannoma” and “gastric neurinoma.” Our attention was directed towards case series encompassing more than five cases of gastric involvement, leading to the examination of 14 case series comprising a collective total of 321 patients. The objective of our review is to provide a comprehensive discussion of the clinical, radiological, and therapeutic facets associated with this uncommon disease.
This work has been reported following the updated SCARE guidelines [29].
2. Case information
A 50-year-old patient, with no significant medical or surgical history, surgery, is a non-smoker, does not consume alcohol or medicinal plants, and has no history of cancer in the family. He was admitted to our service for persistent postprandial gastric pain for one month, without vomiting or intestinal transit disorders. The patient had melena, which required transfusion of 2 units of blood in the emergency room a month ago for anemia with hemoglobin at 7.3 g/dl. He reported also, an altered general condition characterized by anorexia and asthenia, without significant weight loss. During the physical examination, the patient was stable in terms of hemodynamic parameters, with discolored conjunctiva and the abdomen was soft without a palpable mass. Rectal examination revealed no abnormalities. The laboratory tests showed microcytic anemia with a hemoglobin level of 9.0 g/dl, the mean corpuscular volume of 62 fl, and an average corpuscular concentration of hemoglobin at 32.9 g/l. The hematocrit was at 27 %, tumor markers, hemostasis and urinary tests were normal. Gastroscopy revealed an evolving peptic ulcer, a fundic mass with extrinsic compression, and staged duodenal and gastric biopsies suggested chronic gastritis with the presence of Helicobacter pylori and nonspecific duodenitis.
A thoracoabdominopelvic computed tomography (CT) (Fig. 1) found a fundic mass along the great curvature, with extraluminal development, an oval shape, and heterogeneous enhancement (Hounsfield Unit >20). It measures 35 ∗ 32 ∗ 31 mm at its maximum dimensions, with a very discreet peri-lesional infiltration. It has contact with the right abdominal rectus muscle, and the transverse colon, suggesting a gastrointestinal stromal tumor (GIST).
Fig. 1.
CT scan shows a fundic mass (A), with extraluminal development (B), an oval shape and heterogeneous enhancement (C) with discreet peri-lesional infiltration (D).
According to the preoperative explorations findings, and after the eradication of Helicobacter pylori, an open coelioscopy exploration was conducted (placement of the trocars under direct vision). After obtaining the patient's consent, supervised by our professor with 15 years of experience in a university hospital, the exploration of the abdominal cavity revealed a protruding mass on the posterior face of the stomach (fundus) without clear evidence of peritoneal carcinosis or hepatic metastases. An atypical resection was performed (Fig. 2), and the pathological examination confirmed gastric schwannoma with positive staining for the S100 protein and negative staining for antibody anti-CD 117, anti-dog 1 (Discovered on GIST-1), anti-desmin, and anti-AML in immunohistochemistry (Fig. 3). The postoperative follow-up was simple, and the patient was discharged on the 4th postoperative day. Follow-up at 3 months, 6 months, and after 8 months of follow-up, with no signs of recurrence or gastric symptoms observed.
Fig. 2.
Resected specimen photography of the mass.
Fig. 3.
Pathological with immunohistochemical staining photography shows, A: CD 117 negative, B: S100 positive, C: fusiforme cells, D: schwann cells.
3. Discussion
Submucosal tumors of the stomach are categorized into three subgroups: myogenic (leiomyomas and leiomyosarcomas), neurogenic (schwannomas, neurofibromatosis, and granulomatous cells), and gastrointestinal stromal tumors (GIST) [2]. The association of schwannomas and Recklinghausen neurofibromatosis was reported in 5 to 18 % of cases [3].
Schwannomas have a benign nature, with a low risk of malignant. The only reported cases of malignant transformation are by Jian-song et al. [21], developing from Schwann cells of the myelin sheaths of the nerves, typically localized in the peripheral and spinal nerves of the head and neck [4]. These tumors are observed in young adults aged 27 to 50 years, with a peak in frequency in the fifth decade, and a female predominance [5].
Gastric schwannomas account for 40 to 70 % of schwannomas in the digestive tract, 2–6 % of mesenchymal tumors in the gastrointestinal tract, and 0.2 % of all gastric tumors, representing 4 % of benign stomach tumors [5]. They pose a diagnostic challenge in the preoperative stage, resembling gastrointestinal stromal tumors (GISTs) in their clinical, radiological, and endoscopic aspects. Despite these similarities, only immunohistochemistry can confirm the diagnosis. Voltaggio et al. estimated a ratio of 45 GISTs to 1 GS. [7].
We conducted an electronic search on PubMed using the keywords “gastric schwannoma” and “gastric neurinoma.” We focused on case series with over than five cases, specifically addressing gastric localization. Our analysis included 14 case series, with the results summarized in Table 1. Among 321 cases, the average age was 55.5 years, and the sex ratio was five women to two men.
Table 1.
Reported case series for gastric schwannoma.
| Author | Jin Wook Choi | Shinichi Fujiwara | Lysandra Voltaggio | Lijun Zheng | Bin Li | Hyung-Chul Park | Jian-song | Kaixiong Tao | Jong Min Yoon | Jianli Liu | Jinlong Hu | Wei Wang | Jian Wang | Zhihan Zhong | Total | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reference | [21] | [8] | [9] | [22] | [5] | [23] | [10] | [14] | [24] | [25] | [19] | [26] | [27] | [28] | – | |
| N | 16 | 14 | 51 | 29 | 6 | 31 | 8 | 30 | 27 | 12 | 14 | 19 | 38 | 26 | 321 | |
| Year | 2012 | 2013 | 2013 | 2014 | 2014 | 2015 | 2015 | 2015 | 2016 | 2017 | 2017 | 2019 | 2019 | 2022 | – | |
| Epidemiological characteristics | ||||||||||||||||
| Mean age | 58.7 | 49 | 56 | 63.5 | 61,3 | 58 | 54,4 | 56.9 | 53 | 47 | 52.6 | 53.42 | 54,5 | 59 | 55,53 | |
| Male | 4 | 6 | 11 | 11 | 4 | 9 | 1 | 11 | 11 | 3 | 6 | 6 | 6 | 9 | 98 | |
| Female | 12 | 8 | 40 | 18 | 2 | 22 | 7 | 19 | 16 | 9 | 8 | 13 | 32 | 17 | 223 | |
| History of neurofibromatosis | – | – | 0 | 0 | – | – | 0 | – | 0 | – | – | 0 | – | 0 | ||
| Clinical findings | ||||||||||||||||
| Asymptomatic | 11 | 13 | 15 | 5 | – | 26 | 3 | 9 | 23 | – | 5 | 6 | 13 | 7 | 44,9 % | |
| Epigastric pain/abdominal pain | 2 | 1 | 12 | 20 | – | 5 | 3 | 14 | 4 | – | 9 | 3 | 18 | 15 | 34 % | |
| Gastrointestinal bleeding | 0 | 0 | 7 | 4 | – | 0 | – | 3 | 0 | – | 1 | 6 | 1 | 7 % | ||
| Endoscopic findings | ||||||||||||||||
| Mass location | Body | 3 | – | – | 1 | 28 | – | 12 | 17 | – | – | – | – | – | 61/106 (57 %) |
|
| Antrum | 6 | – | – | 1 | 2 | – | 10 | 2 | – | – | – | – | – | 21/106 (20 %) |
||
| Fundus | 5 | – | – | 3 | 1 | – | 7 | 8 | – | – | – | – | – | 24/106 (23 %) |
||
| Ulcer | Yes | 4 | – | – | 0 | 2 | – | – | 3 | – | – | 11 | – | 8 | 28/92 (30 %) |
|
| No | 8 | – | – | 5 | – | – | 24 | – | – | 8 | – | 19 | 64/92 (70 %) |
|||
| CT characteristics/endoscopic ultrasound characteristics | ||||||||||||||||
| Mass | Endoluminal | 4 | – | 1 | – | – | 5 | – | 15 | – | – | 0 | 3 | 8 | 9 | 45/152 (30 %) |
| Exophytic | 4 | – | 4 | – | – | – | – | 12 | – | – | 16 | 7 | 16 | 6 | 65/(43 %) | |
| Mixte | 6 | – | 3 | – | – | – | – | 0 | – | – | 9 | 13 | 11 | 42 (27 %) | ||
| Mean size on CT (cm) | 3.2 | 4 | 4.5 | 5,2 | 2,1 | 2,6 | 4,8 | 3 | 3.2 | 3,75 | 1.7 | 4,5 | 3,4 | 3.14 | 3,5 | |
| Mass location | Body | 3 | – | 5 | – | – | 17 | – | – | 6 | 4 | – | 14 | 27 | 19 | 95/160 (60 %) |
| Antrum | 6 | – | 3 | – | – | 8 | – | – | 5 | 8 | – | 3 | 5 | 4 | 42 (27 %) |
|
| Fundus | 5 | – | 0 | – | – | 5 | – | – | 1 | 2 | – | 2 | 4 | 4 | 23 (13 %) |
|
| Homogeneous mass | 15 | 12 | – | – | 17 | 7 | 12 | 3 | 9 | – | 18 | 32 | – | 125/177 (70 %) | ||
| Heterogeneous mass | 1 | 2 | – | – | 14 | 1 | – | 24 | 3 | – | 1 | 6 | – | 52 (30 %) | ||
| Necrosis | – | – | – | – | 1 | – | 0 | 0 | – | 1 | 4 | – | ||||
| Preoperative diagnosis | ||||||||||||||||
| GS | 14 | 1 | – | – | 6 | 31 | – | 1 | – | – | 14 | 0 | 7 | – | 74/163 (44,5) |
|
| GIST | – | 12 | – | – | 0 | 0 | – | 21 | – | – | 0 | 13 | 29 | – | 75 (45,6) |
|
| Tumor (SM) | – | 0 | – | – | 0 | 0 | – | 4 | – | – | 0 | 5 | 1 | – | 10 (16,3) |
|
| Leiomyoma | – | 1 | – | – | 0 | 0 | – | 1 | – | – | 0 | 1 | 1 | – | 4 (6,4) |
|
| Treatment | ||||||||||||||||
| Surgery | Yes | 14 | 51 | 8 | 1 | – | 30 | – | 27 | 12 | 0 | 16 | 19 | 38 | 23 | 268 |
| Wedge | 0 | 18 | 3 | 0 | – | 5 | – | 24 | 5 | 0 | – | – | – | 0 | 63 | |
| Gastrectomy | 14 | 21 | 5 | 1 | – | 17 | – | 3 | 7 | 0 | – | – | – | 23 | 112 | |
| Endoscopic locale resection | 0 | 0 | 0 | 0 | 5 | 0 | – | 0 | 0 | 14 | 0 | 0 | 3 | 30 | ||
| Histological finding | ||||||||||||||||
| Diagnosis | GS | 14 | 51 | 8 | 5 | – | 30 | 25 | 27 | 12 | 14 | – | 19 | 38 | – | 243 |
| Other | 0 | 0 | 0 | 1 | – | 0 | 4 Malignant Schwanoma | 0 | 0 | 0 | – | 0 | 0 | – | 5 | |
| Mean mass size (cm) | – | – | 5.1 | 5,2 | – | – | 4,13 | 3,2 | – | 4,5 | – | 4426 | ||||
| Immunochemical staining | ||||||||||||||||
| S100 positive | – | 14/14 | 43/43 | 29/29 | 6/6 | – | 8/8 | 30/30 | 27/27 | – | 14/14 | 19/19 | – | 26/26 | 100 % | |
| CD34 negative | – | 14/14 | 26/29 | 25/29 | – | – | 8/8 | 27/30 | 26/27 | – | 12/14 | 4/14 | – | 19/26 | 92 % | |
| CD 117 negative | – | – | – | – | – | – | 8/8 | 30/30 | – | – | 14/14 | 19/19 | – | 26/26 | 100 % | |
| DOG1 Negative | – | – | 22/32 | – | – | – | – | 30/30 | – | – | 14/14 | 14/14 | – | 26/26 | 92 % | |
| Desmin negative | – | 14/14 | – | – | – | 8/8 | 30/30 | 27/27 | – | – | – | – | 26/26 | 100 % | ||
| Ki67 < 10 % | – | – | – | 16/29 | 6/6 | – | – | 30/30 | 27/27 | – | 14/14 | 12/12 | – | 23/26 | 91 % | |
The slow growth of gastric schwannoma often results in it being asymptomatic for a long time. It may be incidentally discovered during abdominal surgery (such as cholecystectomy or cancer procedures) or imaging for another disease [22]. Symptoms, when present, include dyspepsia, and digestive bleeding. These nonspecific symptoms are primarily associated with the tumor's location and size [6,7]. In the analyzed series, 40 % of cases were asymptomatic, 34 % experienced epigastric or abdominal pain, and only 7 % had digestive bleeding.
On computed tomography, gastric schwannomas appear as an endoluminal mass with exophytic development or mixed parietal growth. Schwannomas do not exhibit intralesional hemorrhagic signs, necrosis, cystic changes, or calcification [[8], [9], [10]]. In contrast to Gastrointestinal Stromal Tumors (GISTs), which appear on CTas a heterogeneous mass with endoluminal development, moderate enhancement, peri gastric infiltration, and peri-lesional adenopathy.
The analysis of the selected series confirmed the CTcriteria for gastric schwannomas. In most cases (60 %), these masses are typically f localized mass in gastric body and in 65 % of cases, they develop in an exophytic mode. The average size is 3.5 cm, and they often have a homogeneous appearance (70 %), devoid of necrosis, calcification, or intralesional hemorrhage.
Endoscopy reveals a submucosal elevation lined with normal mucosa. In 25 to 50 % of cases, a central ulcer may be observed because of ischemic phenomena affecting the covering mucosa. Diagnosing gastric schwannomas based solely on classical superficial endoscopy biopsy is challenging, as it frequently returns to normal mucosa [11].
The diagnostic features of endoscopic and CT are not entirely reliable, and gastric GISTs may present a very high risk of local and distant recurrence when resected with incomplete surgical margins. Thus, preoperative pathological diagnosis seems mandatory for proper management. Both endoscopic and CT diagnostic features are not entirely reliable. In fact, preoperative diagnosis accuracy, according to Kaixiong Tao et al.'s series, was only 3.3 %, despite adhering to standard endoscopy and CT procedures.
Eosophago-gastroduodenal endoscopic ultrasound (EGD EUS) with biopsy emerges as a valuable tool for preoperative diagnosis, demonstrating a predictive value of 83.9 % [12]. However, it's essential to note that the positivity of the results is predominantly influenced by tumor size. When gastric stromal lesions are detected, endoscopic ultrasound alone is useful in delineating the risk characteristics of GIST and to identify cases that may benefit from neo-adjuvant therapy [13].
Macroscopically, schwannomas manifest as a nodular mass, well-circumscribed and encapsulated at the periphery of a nerve. Histologically, they are fusiform cell neoplasms typically comprising two components: compact fusiform Schwann cells (Antoni A area), occasionally exhibiting a palisade layout (Verocay bodies), alternating with hypocellular zones (Antoni B zones) [14]. Focal nuclear atypia and mitotic activity may be present, and thick-walled, hyaline blood vessels are commonly observed. In immunohistochemical examination, tumor cells show strong and uniform positivity staining for protein S100 and positive staining for glial components like fibrillary acid protein (GFAP). Positivity for epithelial membrane antigen (EMA) may be encountered in sub-capsular areas. Schwannomas are negative for CD117, DOG1, CD34, SMA, and desmin, allowing for clear differentiation from Gastrointestinal Stromal Tumors (GISTs), which are positive for CD117 and DOG-1, or leiomyomas, which are positive for smooth muscle alpha-actin (SMA) and desmin [15].
Given the low probability of malignant transformation that is typically observed with this specific type of mesenchymal tumor, the consensus among experts is to recommend a surgical approach as the primary course of treatment for GS [2]. Only a few cases of recurrence after surgery have been previously documented in the literature (Table 1). Today, surgical resection is considered the standard and reference treatment.
For the preoperative evaluation of gastric lesions, essential considerations include location, origin layer, size, and growth pattern. This assessment is crucial for determining the feasibility of endoscopic resection. Tumors that are larger than 5 cm in size, exhibit extraluminal growth, have central ulceration, or are localized in challenging areas such as the gastric incisure or upper part of the gastric body of the small curvature, are unfavorable factors for endoscopic treatment. These findings justify surgery. According to the literature, endoscopic resections were performed in cases of small tumors (<2 cm) (refer to Table 1), with a predominant location in the gastric body [[16], [17], [18]].
Gastric schwannomas (GSMs) are primarily developed from the deep layer of submucosa and muscularis propria. Caution should be exercised in performing full thickness endoscopic resection (EFTR) to prevent the tumor from falling into the peritoneal cavity [20]. Therefore, all endoscopic procedures should be undertaken in qualified centers by experienced operators and in carefully selected patients.
Despite the lower number of patients included in the endoscopic resection group, no mortality or recurrence of the disease was observed. However, additional studies supporting the use of endoscopic resection for GS and reporting a follow-up period are needed.
4. Conclusion
The surgical approach, in the absence of a definitive preoperative diagnosis, is regarded as the reference treatment for resectable GS, given its excellent long-term outcomes. Additional studies are required to further define the role of endoscopic resection.
References
- 1.Gubbay A.D., Moschilla G., Gray B.N., Thompson I. Retroperitoneal schwannoma: a case series and review. Aust. N. Z. J. Surg. 1995;65(3):197–200. doi: 10.1111/j.1445-2197.1995.tb00607.x. [DOI] [PubMed] [Google Scholar]
- 2.Daimaru Y., Kido H., Hashimoto H., Enjoji M. Benign schwannoma of the gastrointestinal tract: a clinicopathologic and immunohistochemical study. Hum. Pathol. 1988;19(3):257–264. doi: 10.1016/s0046-8177(88)80518-5. [DOI] [PubMed] [Google Scholar]
- 3.Wang G., Liu X., Zhou J. Differentiating gastric schwannoma from gastric stromal tumor (≤5 cm) by histogram analysis based on iodine-based material decomposition images: a preliminary study. Front. Oncol. 2023;13 doi: 10.3389/fonc.2023.1243300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Daneshmand S., Youssefzadeh D., Chamie K., et al. Benign retroperitoneal schwannoma: a case series and review of the literature. Urology. 2003;62(6):993–997. doi: 10.1016/s0090-4295(03)00792-1. [DOI] [PubMed] [Google Scholar]
- 5.Li B., Liang T., Wei L., et al. Endoscopic interventional treatment for gastric schwannoma: a single-center experience. Int. J. Clin. Exp. Pathol. 2014;7(10):6616–6625. (Published 2014 Sep 15) [PMC free article] [PubMed] [Google Scholar]
- 6.Nishida T., Hirota S. Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol. Histopathol. 2000;15(4):1293–1301. doi: 10.14670/HH-15.1293. [DOI] [PubMed] [Google Scholar]
- 7.Lauricella S., Valeri S., Mascianà G., et al. What about gastric schwannoma? A review article. J Gastrointest Cancer. 2021;52(1):57–67. doi: 10.1007/s12029-020-00456-2. [DOI] [PubMed] [Google Scholar]
- 8.Fujiwara S., Nakajima K., Nishida T., et al. Gastric schwannomas revisited: has precise preoperative diagnosis become feasible? Gastric Cancer. 2013;16(3):318–323. doi: 10.1007/s10120-012-0186-x. [DOI] [PubMed] [Google Scholar]
- 9.Voltaggio L., Murray R., Lasota J., Miettinen M. Gastric schwannoma: a clinicopathologic study of 51 cases and critical review of the literature. Hum. Pathol. 2012;43(5):650–659. doi: 10.1016/j.humpath.2011.07.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Ji J.S., Lu C.Y., Mao W.B., Wang Z.F., Xu M. Gastric schwannoma: CT findings and clinicopathologic correlation. Abdom. Imaging. 2015;40(5):1164–1169. doi: 10.1007/s00261-014-0260-4. [DOI] [PubMed] [Google Scholar]
- 11.Singh A., Mittal A., Garg B., Sood N. Schwannoma of the stomach: a case report. J. Med. Case Rep. 2016;10:4. doi: 10.1186/s13256-015-0788-0. . Published 2016 Jan 15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Williamson J.M., Wadley M.S., Shepherd N.A., Dwerryhouse S. Gastric schwannoma: a benign tumour often mistaken clinically, radiologically and histopathologically for a gastrointestinal stromal tumour—a case series. Ann. R. Coll. Surg. Engl. 2012;94(4):245–249. doi: 10.1308/003588412X13171221590935. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Takemura M., Yoshida K., Takii M., Sakurai K., Kanazawa A. Gastric malignant schwannoma presenting with upper gastrointestinal bleeding: a case report. J. Med. Case Rep. 2012;6:37. doi: 10.1186/1752-1947-6-37. (Published 2012 Jan 25) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Tao K., Chang W., Zhao E., et al. Clinicopathologic features of gastric schwannoma: 8-year experience at a single institution in China. Medicine (Baltimore) 2015;94(45) doi: 10.1097/MD.0000000000001970. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Hoda K.M., Rodriguez S.A., Faigel D.O. EUS-guided sampling of suspected GI stromal tumors. Gastrointest. Endosc. 2009;69(7):1218–1223. doi: 10.1016/j.gie.2008.09.045. [DOI] [PubMed] [Google Scholar]
- 16.Moon J.S. Endoscopic ultrasound-guided fine needle aspiration in submucosal lesion. Clin Endosc. 2012;45(2):117–123. doi: 10.5946/ce.2012.45.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Wang G., Chen P., Zong L., Shi L., Zhao W. Cellular schwannoma arising from the gastric wall misdiagnosed as a gastric stromal tumor: a case report. Oncol. Lett. 2014;7(2):415–418. doi: 10.3892/ol.2013.1752. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Yang J.H., Zhang M., Zhao Z.H., Shu Y., Hong J., Cao Y.J. Gastroduodenal intussusception due to gastric schwannoma treated by Billroth II distal gastrectomy: one case report. World J. Gastroenterol. 2015;21(7):2225–2228. doi: 10.3748/wjg.v21.i7.2225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Hu J., Liu X., Ge N., et al. Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. Medicine (Baltimore) 2017;96(25) doi: 10.1097/MD.0000000000007175. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Cai M.Y., Xu J.X., Zhou P.H., et al. Endoscopic resection for gastric schwannoma with long-term outcomes. Surg. Endosc. 2016;30(9):3994–4000. doi: 10.1007/s00464-015-4711-y. [DOI] [PubMed] [Google Scholar]
- 21.Choi J.W., Choi D., Kim K.M., et al. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT. Korean J. Radiol. 2012;13(4):425–433. doi: 10.3348/kjr.2012.13.4.425. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Zheng L., Wu X., Kreis M.E., et al. Clinicopathological and immunohistochemical characterisation of gastric schwannomas in 29 cases. Gastroenterol. Res. Pract. 2014;2014 doi: 10.1155/2014/202960. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Park H.C., Son D.J., Oh H.H., et al. Endoscopic ultrasonographic characteristics of gastric schwannoma distinguished from gastrointestinal stromal tumor. Korean J. Gastroenterol. 2015;65(1):21–26. doi: 10.4166/kjg.2015.65.1.21. [DOI] [PubMed] [Google Scholar]
- 24.Yoon J.M., Kim G.H., Park D.Y., et al. Endosonographic features of gastric schwannoma: a single center experience. Clin Endosc. 2016;49(6):548–554. doi: 10.5946/ce.2015.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Liu J., Chai Y., Zhou J., Dong C., Zhang W., Liu B. Spectral computed tomography imaging of gastric schwannoma and gastric stromal tumor. J. Comput. Assist. Tomogr. 2017;41(3):417–421. doi: 10.1097/RCT.0000000000000548. [DOI] [PubMed] [Google Scholar]
- 26.Wang W., Cao K., Han Y., Zhu X., Ding J., Peng W. Computed tomographic characteristics of gastric schwannoma. J. Int. Med. Res. 2019;47(5):1975–1986. doi: 10.1177/0300060519833539. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Wang J., Zhang W., Zhou X., Xu J., Hu H.J. Simple analysis of the computed tomography features of gastric schwannoma. Can. Assoc. Radiol. J. 2019;70(3):246–253. doi: 10.1016/j.carj.2018.09.002. [DOI] [PubMed] [Google Scholar]
- 28.Zhong Z., Xu Y., Liu J., et al. Clinicopathological study of gastric schwannoma and review of related literature. BMC Surg. 2022;22(1):159. doi: 10.1186/s12893-022-01613-z. (Published 2022 May 10) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Sohrabi C., Mathew G., Maria N., Kerwan A., Franchi T., Agha R.A. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg Lond Engl. 2023;109(5):1136. doi: 10.1097/JS9.0000000000000373. [DOI] [PMC free article] [PubMed] [Google Scholar]