Gastric Schwannoma: A Rare Find

Excerpt

A 57-year-old Indian immigrant male presented for evaluation of a longstanding right back mass and a several-month history of nonspecific epigastric abdominal pain. The patient's medical history was notable for tuberculosis (TB) requiring excision of a left foot lesion and poorly controlled diabetes. A contrast-enhanced computed tomographic (CT) scan was obtained which demonstrated the back mass to be a lipoma. Additionally, there was an incidental finding of a 4-cm enhancing heterogeneous mass along the lesser curvature of the stomach. (Fig. 1). Further evaluation with endoscopic ultrasound (EUS) and esophagogastroduodenoscopy (EGD) revealed smooth normal gastric mucosa overlying a subepithelial (intramural) lesion arising from the incisura suggestive of a gastrointestinal stromal tumor (GIST). Fine needle aspirate (FNA) of the mass was negative for malignant cells. The patient was taken to the operating room for a laparoscopic resection. A large gastric mass measuring 5 × 6 cm was noted along the lesser curvature of the stomach (Fig. 2). The mass was evaluated during partial gastrectomy with wedge resection, however, due to the concern for luminal narrowing, a subtotal gastrectomy with Roux-en-Y reconstruction was performed. Based on surgical pathology with immunohistochemical staining, the mass was found to be a gastric schwannoma (Fig. 3).

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