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CASE REPORT
Year : 2019  |  Volume : 22  |  Issue : 5  |  Page : 731-733

Benign esophageal schwannoma: A case report and review of literature


Department of Thoracic Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Jiefang Road, Hangzhou, China

Date of Acceptance13-Dec-2018
Date of Web Publication15-May-2019

Correspondence Address:
Prof. Y Chai
Department of Thoracic Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_142_18

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   Abstract 


Esophageal schwannoma was extremely rare and difficult to differentiate from other submucosal tumors. We present a case of a 55-year-old woman who suffered from dysphagia and retrosternal pain for a month. Endoscopic ultrasonography revealed a submucosal tumor, located 23–25cm from the incisors arising from the esophagus. The patient underwent subtotal esophagectomy. The histopathological finding confirmed the diagnosis of esophageal schwannoma. Her postoperative course was uneventful and free of recurrence 2 years after the operation.

Keywords: Dysphagia, endoscopic ultrasonography, esophageal schwannoma, subtotal esophagectomy


How to cite this article:
Zhu L, Li W, Zhu Z, Chai Y. Benign esophageal schwannoma: A case report and review of literature. Niger J Clin Pract 2019;22:731-3

How to cite this URL:
Zhu L, Li W, Zhu Z, Chai Y. Benign esophageal schwannoma: A case report and review of literature. Niger J Clin Pract [serial online] 2019 [cited 2019 May 23];22:731-3. Available from: http://www.njcponline.com/text.asp?2019/22/5/731/258264




   Introduction Top


The incidence of benign primary tumors of the esophagus is low and accounting for ~2% of all esophageal tumors. More than 80% of benign esophageal tumors are leiomyomas and schwannomas and are extremely rare.[1] We report a case of a 55-year-old woman with benign esophageal schwannoma successfully treated with subtotal esophagectomy.


   Case Presentation Top


A 55-year-old woman was referred to our hospital with 1-month history of dysphagia and retrosternal pain. Physical examination revealed no abnormal findings. Barium esophagogram demonstrated a protruding lesion with a smooth surface in the upper thoracic esophagus [Figure 1]. Enhanced computed tomography (CT) demonstrated a well-demarcated and slightly enhanced homogeneous mass. Esophagoscopy showed a submucosal tumor bulging on the posterior esophageal wall and located 23–25 cm from the incisors without mucosal ulceration [Figure 2]a. Furthermore, endoscopic ultrasonography examination indicated that the tumor was located within the muscular layer [Figure 2]b.
Figure 1: The barium esophagogram showing a tumor in the upper thoracic esophagus

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Figure 2: Esophagoscopy showings a submucosal tumor without mucosal ulceration (a). Endoscopic ultrasonography showing a well-demarcated, slightly heterogeneous solid lesion (b)

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A left thoracotomy with subtotal esophagectomy was performed. The tumor was arising from the muscular layer of the esophagus and infiltrating the mucosa. The tumor was 2.5 × 2.5 × 2.0 cm in size, which was elastic firm. The cut surface was yellowish-white, with no evidence of hemorrhage or necrosis. Histological examination revealed that the tumor was composed of compact bundles of spindle-shaped cells [Figure 3]a. Immunohistochemical examination indicated that the tumor cells were diffusely positive for S-100 protein [Figure 3]b and negative for alpha-smooth muscle actin, desmin, CD34, and CD117, establishing the diagnosis of benign schwannoma.
Figure 3: Histological examination of the tumor demonstrates proliferation of spindle-shaped cells. H and E ×400 (a). Immunohistochemically, the tumor cells are positive for S-100 protein. ×200 (b)

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The postoperative recovery was uneventful. She was discharged in good condition on the sixth day after the operation. Two years after the operation, she remains in good health and shows no evidence of recurrence to date.


   Discussion Top


Most of the submucosal tumors of the esophagus are benign leiomyomas, whereras esophageal schwannomas are extremely rare.[1] It is often found in middle-aged women in the proximal esophagus, with dimensions of the lesions varying from 1 to 15cm.[2],[3],[4] The main symptom was dysphasia. Other symptoms, such as dyspnea, epigastria pain, chest pain, and cough may also be found.[5]

The differentiation of schwannoma from other tumors, such as leiomyoma, leiomyosarcoma, and mediasinal tumors, is very difficult preoperatively, and the definitive diagnosis is often established after resection.[2] Fluorodeoxyglucose positron emission as well as CT and magnetic resonance imaging are not very helpful for a definite diagnosis. Endoscopic ultrasound has been suggested to predict malignancy. Endoscopic ultrasonography and fine-needle guided aspiration cytology with immunohistochemical analysis can be useful for both diagnosis and management. It could provide abundant information on immunohistochemical subtyping and the capacity of the tumor for cellular progression.[6]

The diagnosis of esophageal schwannoma can be made on histological and immunohistochemical grounds.[7] On gross inspection, they may appear to be well encapsulated. Microscopically, the tumor is composed of compact bundles of spindle-shaped cells, which are classically identified as having both cellular areas (Antonio A) and myxoid areas (Antonio B). Electron microscopic examination has shown a well-developed external lamina, which is characteristic of schwannomas. Furthermore, immunohistochemical studies revealed that the tumor to be positive for the S100 protein, confirming nerve sheath origin, and negative for CD34, CD117, desmin, c-kit, and smooth muscle actin. It reveals the nature of esophageal schwannoma.[8]

Complete resection is the treatment of choice for esophageal schwannoma. The majority of patients are generally treated by enucleation, but for large tumors (≧8 cm) with broad areas adjacent to the esophageal muscular layer or considered to be malignant, the mucosal defect becomes extensive, and esophagectomy and esophagogastrostomy are, thus, usually performed.[9] In our present case as well, enucleation may carry an increased risk for complications including iatrogenic esophageal perforation and esophageal stricture, therefore; subtotal esophagectomy was performed.

Prognosis for benign esophageal schwannoma is excellent, and there is no need for adjuvant chemotherapy or radiation therapy.


   Conclusions Top


We present a relatively rare case of schwannoma of the esophagus. Although it is rare, it should be on the differential for unexplained retrosternal pain and dysphagia in any age group when endoscopic ultrasonography or CT reveals a large mediastinal mass. Surgical excision is the best treatment option, the clinical outcome is relatively good, and subtotal esophagectomy is an effective and safe method to complete resection of esophageal schwannoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Makino T, Yamasaki M, Takeno A, Kurokawa Y, Miyata H, Takiquchi S, et al. Thoracoscopic enucleation of esophageal schwannoma exhibiting (18) F-fluorodeoxyglucose uptake on positron emission tomography. Dis Esophagus 2013;26:331-2.  Back to cited text no. 1
    
2.
Wang S, Zheng J, Ruan Z, Huang H, Yang Z, Zheng J, et al. Long-term survival in a rare case of malignant esophageal schwannoma cured by surgical excision. Ann Thorac Surg 2011;92:357-8.  Back to cited text no. 2
    
3.
Choo SS, Smith M, Cimino-Mathews A, Yang SC. An early presenting esophageal schwannoma. Gastroenterol Res Pract 2011;2011:165120.  Back to cited text no. 3
    
4.
Dutta R, Kumar A, Jindal T, Tanveer N. Concurrent benign schwannoma of oesophagus and posterior mediastinum. Interact Cardiovasc Thorac Surg 2009;9:1032-4.  Back to cited text no. 4
    
5.
Kassis ES, Bansal S, Perrino C, Walker JP, Hitchcock C, RossPJR, et al. Giant asymptomatic primary esophageal schwannoma. Ann Thorac Surg 2012;93:e81-3.  Back to cited text no. 5
    
6.
Yang H, Zhao H, Garfield DH, Teng J, Han B, Sun J. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of non-lymph node thoracic lesions. Ann Thorac Med 2013;8:14-21.  Back to cited text no. 6
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7.
Kitada M, Matsuda Y, Hayashi S, Ishibashi K, Oikawa K, Miyokawa N. Esophageal schwannoma: A case report. World J Surg Oncol 2013;11:253.  Back to cited text no. 7
    
8.
Park BJ, Carrasquillo J, Bains MS, Flores RM. Giant benign esophageal schwannoma requiring esophagectomy. Ann Thorac Surg 2006;82:340-2.  Back to cited text no. 8
    
9.
Liu T, Liu H, Yang C, Zhang X, Xu S, Liu B. Benign esophageal schwannoma compressing the trachea requiring esophagectomy: A case report. Thorac Cardiovasc Surg 2013;61:505-6.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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