Two cases of benign esophageal schwannoma with positive FDG-PET findings

We report two cases of rare benign esophageal schwannoma showing high uptake of radiotracer on [¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET). Case 1 was a 78-year-old woman with a tumor (50 × 30 × 30 mm) located on the right side of the upper thoracic esophagus. Case 2 was a 70-year-old woman with a tumor (40 × 35 × 27 mm) located in the left anterior wall of the thoracic-to-cervical esophagus. Both tumors were enucleated and histologically diagnosed as benign esophageal schwannoma with nuclear palisading and lymphoid cuffing (Antoni A type). Immunohistochemical staining showed positivity for S-100 protein. There have been five reported cases of esophageal schwannoma with FDG-PET findings, including the present two cases. All five tumors were FDG-PET positive and presented histologically as benign esophageal schwannoma. There was no association between histological malignancy and FDG uptake. We therefore propose that the malignant potential of esophageal schwannomas cannot be evaluated using FDG-PET.     

Successful treatment of pancreatic schwannoma by enucleation: A case report

Rationale:Pancreatic schwannomas are extremely rare and are difficult to diagnose preoperatively. Over the past 50 years, only 96 cases of pancreatic schwannoma have been reported in English literature. Herein, we report a case of pancreatic schwannoma treated with enucleation.Patient concerns:A 66-year-old woman visited a local hospital due to ventosities. Ultrasonography and computed tomography revealed a pancreatic mass. She visited our hospital for further diagnosis and treatment.Diagnosis and interventions:Magnetic resonance imaging revealed a tumor in the pancreatic body, and a solid pseudopapillary tumor was considered preoperatively. During the surgery, a pancreatic mass was found growing in the pancreatic body and tail. A successful tumor enucleation was performed. The mass was 7 × 6 × 3 cm in size with a thin capsule. Pathological examination revealed that the tumor was mainly composed of spindle-shaped cells with a palisading arrangement and no atypia. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining showed that protein S-100 was strongly positive. The tumor was diagnosed as a benign schwannoma originating from the pancreatic body and tail.Outcomes:Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications.Lessons:Pancreatic schwannomas are extremely rare and difficult to diagnose using imaging examinations. Enucleation is a safe and efficacious treatment for exophytic pancreatic schwannomas.     

A case report of benign esophageal schwannoma with FDG uptake on PET-CT and literature review of 42 cases in Japan

We report a rare case of benign esophageal schwannoma showing [¹⁸F]-fluorodeoxyglucose (FDG) uptake on positron emission tomography computed tomography (PET-CT). A 43-year-old woman diagnosed with left breast cancer was referred to our hospital for further treatment. Preoperative PET-CT showed a significant accumulation [maximum standardized uptake value (SUV_max) 2.5] in the upper thoracic esophagus. Endoscopy revealed a submucosal tumor about 40?mm in size in the upper thoracic esophagus. Endoscopic ultrasonography-guided fine-needle aspiration biopsy did not reveal the histological diagnosis. The patient underwent thoracoscopic enucleation of the tumor. The resected tumor measured 40?×?20?mm. Microscopically, the tumor consisted of spindle cells. Immunohistochemistry was positive for S-100 and vimentin and was negative for KIT (CD117) and CD34. The final diagnosis was benign esophageal schwannoma.     

Orbital schwannoma with calcification treated by intracapsular excision: A case report

Rationale:Orbital schwannoma is a relatively rare orbital tumor, and calcification of the lesion is rarely found in the orbit. We report a case of orbital schwannoma which was characterized by calcification in the orbital muscle cone, and was cured by intracapsular excision.Patient concerns:A 54-year-old female with a complaint of a mass in the left orbit during a magnetic resonance imaging examination and symptom of dizziness 6 months before, presented with painless exophthalmos and vision decline in the left eye.Diagnoses:According to clinical manifestations, imaging examinations and postoperative immunohistochemical examinations, the diagnosis was orbital schwannoma, with calcification in the muscle cone.Interventions:The patient was treated by intracapsular excision of the left orbit. We removed the intracapsular mass and most part of the cyst wall in order to prevent orbital apex syndrome.Outcomes:The diagnosis of schwannoma with calcification was confirmed finally through histological and immunohistochemical exam. The patient was followed up for 28 months and the orbital CT scan showed that there were no significant lesions found in the orbital muscle cone.Lessons:Understanding clinical, imaging diagnostic, and histopathological features of rare orbital schwannoma with calcification will facilitate timely diagnosis and treatment of this condition. The intracapsular excision can help in avoiding complications.     

A case of giant esophageal epiphrenic diverticulum resected laparoscopically,followed by Heller myotomy and Dor fundoplication

A 66-year-old male patient visited our hospital with the chief complaints of difficulty in swallowing and vomiting. The upper gastrointestinal radiographic contrast study revealed a diverticulum with a diameter of about 10 cm in the diaphragm to the right of the esophagus. Upper gastrointestinal endoscopy revealed the inlet of the diverticulum on the right wall of the esophagus at a distance of 44–46 cm from the incisors. The patient was diagnosed as having a giant epiphrenic esophageal diverticulum with obstruction; dysfunction of the lower esophageal sphincter was also considered. Therefore, he was treated by laparoscopic resection of the diverticulum, followed by Heller myotomy and Dor fundoplication. The postoperative course was satisfactory, and the patient showed substantial improvement in his dysphagia. He was discharged from our hospital on the 9th postoperative day. At present, 2 years after the operation, he remains well without any recurrence of the symptoms.     

A case of primary intrapulmonary benign schwannoma

A case of primary intrapulmonary schwannoma was described. A 72-year-old man was admitted to our hospital because of dry cough. A chest radiograph showed partial atelectasis of the middle lobe, but computed tomogram of the chest revealed no tumor shadow. Bronchoscopy disclosed a pale-yellow uneven endobronchial wall of the right middle lobe bronchus. Transbronchial biopsy revealed benign schwannoma. Primary intrapulmonary schwannoma has been rarely reported.     

Primary benign schwannoma of the left ventricle coursing under the left anterior descending artery

A 57-year-old female patient with a mass adjacent to the left ventricle coursing along the left anterior descending artery has been reported. The maximum possible resection was performed at a maximum degree; however without complete removal. Histological examination revealed a benign primary schwannoma of the heart. To our knowledge, this is the first reported case of benign schwannoma of left ventricle in an adult.     

Benign pericardial schwannoma with massive pericardial effusion in a Chinese man: A case report

Primary cardiac neoplasms are rare, and the pericardial schwannoma has an even lower occurrence. We report a case of pericardial schwannoma in China, which is the eighth reported case adding to the existing literature on pericardial schwannoma, and this is the first case reported complicated with massive pericardial effusion. Pericardial schwannomas are usually benign, but they can sometimes have a malignant tendency and cause life‐threatening complications. Thus, it should be managed aggressively and completely resected.     

Multimodal ultrasound imaging of primary thyroid schwannoma: A case report

Rationale:Primary schwannoma of the thyroid gland is very rare, and its preoperative diagnosis is difficult.Patient concerns:We report the case of a thyroid nodule in an 18-year-old woman, who presented with a mass in her left neck with stiffness and normal thyroid function. However, the patient complained of numbness in her left upper extremity, and ultrasound (US) features were suspicious of malignancy.Diagnoses:Multimodal US imaging was performed using B-mode, color doppler, ultrasonic elastography (UE), and contrast-enhanced ultrasound (CEUS). CEUS revealed heterogeneous enhancement and “target sign” within the tumor. The nodule was suspicious for malignancy and classified as TI-RADS 4b, while the elasticity values measured by UE indicated a benign lesion. Fine needle aspiration (FNA) was subsequently performed in the markedly contrast-enhanced area for biopsy. Cytological results revealed a benign schwannoma.Intervention:The patient underwent left lobe resection. Postoperative pathology confirmed it to be a primary benign schwannoma of the thyroid.Outcomes:After thyroidectomy, the patient was followed-up with US. At present, all laboratory tests and thyroid imaging are normal, and the numbness of the left upper limb has disappeared.Lessons:The combination of different US modalities is useful for the diagnosis of thyroid lesions. FNA performed under CEUS guidance improves the accuracy of biopsy sampling.     

Two resected cases of esophageal leiomyoma diagnosed with preoperative endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB)

Leiomyoma is the most common submucosal tumor of the esophagus, and accurate preoperative diagnosis is difficult. We report herein on two resected cases of esophageal leiomyoma preoperatively diagnosed accurately with endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB). The first patient, a 34-year-old man, had complained of dysphagia. Following EUS-FNAB, the pathological diagnosis was leiomyoma. Esophagectomy and reconstruction with a gastric tube were performed because the tumor had almost completely encircled the esophageal wall. The second patient, a 60-year-old woman, had complained of dysphagia. Following EUS-FNAB, the pathological diagnosis was leiomyoma. Enucleation of the tumor was performed because the tumor was not located in the entire circumference of the esophageal wall. The postoperative course of both patients was uneventful, and the final pathological diagnosis of each case was leiomyoma. We conclude that EUS-FNAB is a useful method for diagnosing esophageal submucosal tumors and for selecting an appropriate surgical procedure.     

Primary intrapulmonary benign schwannoma. A case with ultrastructural and immunohistochemical confirmation

Neurogenic pulmonary tumours are rare. Neurofibromas are the most common variety and tend to occur in patients with generalized neurofibromatosis, whereas schwannomas arise sporadically in patients who have no evidence of this disorder. A case of solitary benign schwannoma arising in a segmental bronchus is presented, and the published cases reviewed. Microscopically, the tumour had a spindle-shaped cell proliferation with palisade formation in several fields and low cellularity in other areas. The diagnosis was supported by positive immunostaining for S-100 protein and by ultrastructural examination which showed elongated cells surrounded by well-preserved basal lamina and numerous cytoplasmic processes also possessing a basal lamina.     

A case of benign schwannoma in the ascending colon]

Schwannomas are rare tumors derived from the cells of Schwann which form the neural sheath. Some patients with gastrointestinal schwannoma have been previously reported in the literature. However, schwannomas of the colon are extremely rare. We herein describe a case of schwannoma of the colon. A 49-year-old woman was admitted with complaint of abdominal pain and investigations revealed the presence of a 4 cm sized mass in the ascending colon. Following right hemicolectomy, histopathology and immunohistochemistry confirmed the colonic lesion to be a benign schwannoma. There was no evidence of specific complication or recurrence until now.     

A case of benign schwannoma in the porta hepatis]

Schwannomas or neurilemmomas are uncommon tumors arising from schwann cells of neural sheath, which most frequently affect the extremities, trunk, head and neck area. Moreover, benign schwannoma in the porta hepatis is extremely rare. Approximately, 2 cases of benign schwannoma in the porta hepatis have been reported in the literatures. We report a case of benign schwannoma in the porta hepatis occurring in a 53-year-old woman who was asymptomatic and incidentally found to have a mass. Abdominal CT scan showed a 4.5 cm-sized low attenuating mass with septum-like enhancing solid portion at porta hepatis. Abdominal exploration revealed a yellowish, cystic and encapsulated mass attached to portal vein, common bile duct, liver and duodenal wall above the hepatoduodenal ligament. There has been no evidence of recurrence during 11 months of follow-up.     

Rare cause of dysphagia after esophageal variceal banding: A case report

BACKGROUND Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus nonselective beta blockers depending on the size of varices, ability to tolerate medications and history of variceal bleeding. Band ligation is an effective intervention with rare but serious complications including bleeding, ulcers and rarely obstruction. Few cases of esophageal obstruction and necrosis caused by banding have been reported, each with varied management from conservative treatment to band removal.CASE SUMMARY An 89 years old woman with a past medical history of nonalcoholic steatohepatitis cirrhosis presented to the hospital with an inability to swallow one day after screening esophagogastroduodenoscopy where band ligation of esophageal varices was performed for primary prophylaxis. The patient was not able to tolerate her oral secretions. Initial blood work revealed a Model of End Organ Liver Disease score of 7. She was treated with sublingual nitroglycerin for esophageal spasm, a known complication after esophageal banding. When she failed to improve, esophagogastroduodenoscopy was performed and revealed the mucosa surrounding the banded varix was necrosed and blocking the lumen of the esophagus. The band was purposefully dislodged, revealing distal ulceration and stricturing. Within 72 h after band removal, she was tolerating an oral diet. Endoscopy performed 2 wk later revealed an intrinsic stenosis,measuring 8 mm in diameter by 1 cm in length, which was dilated.CONCLUSION Esophageal obstruction is a complication of variceal banding that should be considered in patients with inability to tolerate oral diet after banding.     

被膜食管支架治疗食管贲门良性狭窄32例

目的:评价被膜食管支架治疗食管贲门良性狭窄的疗效和安全性.方法:选择食管贲门良性狭窄患者32例,根据不同患者选择合适的被膜食管支架置入狭窄段.观察操作成功率、吞咽困难改善情况、术中术后并发症的发生及其处理等.结果:32例均一次性成功置入支架,支架置入后吞咽困难症状均得到持续改善.所有患者未出现食管穿孔、出血等严重并发症,但均出现不同程度的胸骨后闷胀隐痛不适,其中4例患者胸痛较明显,肌注止痛荆后缓解:3例出现支架脱落:1例出现支架近端肉芽组织增生.支架置入后可有效封闭食管气管瘘、食管纵隔瘘等.术后6 mo可经内镜成功取出支架.结论:内镜下置入被膜食管支架是治疗食管贲门良性狭窄的一种安全、有效的方法.     

A case of esophageal schwannoma and literature analysis of 18 cases

An extremely rare case of esophageal schwannoma in a 40-year-old woman is reported. She presented with a history of dysphagia persisting for a few years. After close examination the patient underwent surgery under a diagnosis of leiomyoma of the esophagus. The tumor was found in the muscle layers of the esophageal wall, and was enucleated with part of the esophageal mucosa. Histological examination of the tumor demonstrated proliferation of spindle-shaped cells. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein. The pathological diagnosis of this tumor was esophageal schwannoma. To date, only 18 cases of esophageal schwannoma, including our case, have been reported in Japan. This rare case is reported here, together with a review of the literature.     

A case of esophageal complication in epidermolysis bulhosa simplex

It is well known the involvement of the gastrointestinal tract in Epidermolysis Bulhosa (EB) and its consequences on both nutrition and growth. We present a case of a young girl with EB diagnosed soon after birth, admitted to our emergency room with food impactation. The endoscopy revealed a double barrel esophagus. No medical or surgical therapy was started and after 2 months of enteric feeding, spontaneous resolution was observed at endoscopy. Skin biopsy was compatible with EB Simplex. According to the literature EB Simplex is the subtype the least associated with GI tract involvement, presenting with dysphagia in only 2% of the patients, and with the lowest cumulative risk of esophageal stricturing.     

内镜下扩张联合黏膜下注射曲安奈德在食管良性狭窄治疗中的应用价值研究

目的探讨内镜下扩张联合黏膜下注射曲安奈德治疗食管良性狭窄的安全性及其应用价值。方法69例患者随机分为3组,分别接受单纯内镜下扩张治疗（A组）、内镜下扩张联合单次注射注射曲安奈德治疗（B组）和内镜下扩张联合多频次注射注射曲安奈德治疗（C组）。比较3组并发症发生情况、治愈率、持续症状缓解时间、再次行内镜下扩张治疗的间隔时间、内镜治疗结束后Stooler分级评分。结果术后部分患者出现胸痛及反流症状,均经对症治疗后症状改善,未出现严重出血、感染、穿孔及局部组织萎缩坏死等并发症。内镜治疗结束后3组Stooler分级评分均较术前有明显改善（P〈0．05）,各组间比较差异无统计学意义（P〉0．05）。随访至52周,A组平均持续症状缓解时间及再次行内镜下扩张治疗的间隔时间分别为（14．4±3．2）周和（18．2±3．7）周,B组分别为（19．3±3．9）周和（24．6±4．2）周,C组分别为（20．2±4．2）周和（26．1±4．5）周,B组和C组均明显长于A组（P〈0．05）,B、C组问差异无统计学意义（P〉0．05）;A组治愈率为29．2％（7／24）,B组为27．3％（6／22）,C组为43．5％（10／23）,C组明显高于A组和B组（P〈0．05）,A、B组间差异无统计学意义（P〉0．05）。结论食管良性狭窄采取内镜下扩张联合黏膜下注射曲安奈德治疗是安全的,多频次注射可明显提高治愈率。