Lobulated esophageal schwannoma resected with concurrent approach from the thorax and cervix
© The Author(s). 2018
Received: 30 July 2017
Accepted: 5 February 2018
Published: 13 February 2018
Esophageal schwannomas are rare esophageal submucosal tumors. We herein report a case of a lobulated esophageal schwannoma resected with concurrent approach from the thorax and cervix.
A 74-year-old woman visited our hospital with complaint of loss of consciousness, and a lobulated mediastinal tumor was discovered by chance in computed tomography. Upper gastrointestinal endoscopy showed a smooth elevated lesion at a position of 23–28 cm from the incisor teeth. A hypermetabolic appearance was noted on positron emission tomography. Based on these data, a gastrointestinal stromal tumor was suspected. The tumor was enucleated at the thoracic cavity while being pushed from the cervical incision. Pathological examination showed an esophageal schwannoma.
We experienced a case of lobulated esophageal schwannoma with fluorodeoxyglucose accumulation. We resected the tumor with concurrent approach from the thorax and cervix.
Most esophageal tumors are cancer including squamous cell carcinoma and adenocarcinoma, and benign tumors are less than 1% of all esophageal tumors . Leiomyoma is more than half of all benign esophageal tumors, and schwannoma is rare [1, 2]. The most common treatment for esophageal submucosal tumor is enucleation by surgery or endoscopy . Recently, the cases of esophageal submucosal tumor resected by thoracoscopy have increased . But the most important point in surgery is safety and curability, so we have to select which approach is better thoracoscopy surgery or thoracotomy by size of the tumor. We herein experienced a case of esophageal schwannoma resected with concurrent approach from the thorax and cervix.
Most esophageal tumors are cancer including squamous cell carcinoma and adenocarcinoma, and benign tumors are less than 1% of all esophageal tumors . Leiomyoma is more than half of all benign esophageal tumors, and schwannoma is rare [1, 2]. Esophageal schwannoma more frequently develops in women than in men, and these tumors are often located in the upper and mid-esophagus in the mediastinum . Some patients with esophageal schwannoma complain a variety of symptoms including dysphagia, dyspnea, chest pain, and coughing [6, 7]; others complain no symptom until the tumors grow larger.
Fluorodeoxyglucose (FDG)-PET as well as CT and MRI are reportedly useful for the confirmation of mediastinal tumors. FDG-PET is usually used to predict the malignancy potential of the tumor or to confirm the recurrence site of the cancer. Many cases of esophageal gastrointestinal stromal tumor with FDG accumulation are reported [8, 9]. In our case, we diagnosed esophageal gastrointestinal stromal tumor for the reason of esophageal submucosal tumor with FDG accumulation. Meanwhile, some esophageal schwannomas with FDG accumulation are reported [10–12]. Schwannomas originate from nerve cells that express glucose transporter type 3, and FDG uptake is considered to be increased for this reason . Preoperative diagnosis of esophageal submucosal tumor is difficult with only imaging findings. On the other hand, EUS-FNA might be able to provide a diagnosis. In general, histological features of schwannoma include spindle-shaped tumor cells arranged in a palisading pattern or with loose cellularity in a reticular array. Immunohistochemical stainings are also useful as schwannoma shows S-100 protein positivity . Although we thought we should undergo EUS-FNA because the huge mediastinal tumor with high FDG uptake had malignancy potential, the patient desired preserving esophagus regardless of the result of the EUS-FNA.
We experienced a case of lobulated esophageal schwannoma with FDG accumulation. We resected the tumor with concurrent approach from the thorax and cervix.
The authors have no conflicts of relevant financial interests.
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YI wrote the paper. CT and NN studied the concept and patient care. MK, KK, and KY studied the concept of the study. All authors read and approved the final manuscript.
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