Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
BMC Surg. 2020 Nov 19;20(1):289. doi: 10.1186/s12893-020-00963-w.
Schwannomas are nerve sheath tumors that commonly originate from the stomach and small intestine. A primary schwannoma of the diaphragm is rare and does not show any symptoms until it grows to a certain size. Hence, it is extremely rare that it was found at a size that allowed resection under videoscopic surgery.
A 77-year-old woman was referred to our department for surgical treatment of a tumor located near the gastric fornix. She underwent a routine esophagogastroduodenoscopy 2 years and 7 months prior to the referral. It was suspected that she had a submucosal tumor measuring 10 mm, located in the fornix, and was then referred to her previous physician. During her follow-up, endoscopic ultrasonography (EUS) revealed that the cystic structure had continued to grow toward the gastric wall, and she was then referred to the endoscopy division of our hospital. She continued to be followed-up, and it was noted that the tumor was gradually increasing in size. Therefore, she requested surgical resection, and was finally referred to our division. Since the tumor was rather small, we planned a laparoscopic surgery. An initial examination during the operation revealed that the tumor was located on the left diaphragm. Since the tumor was relatively small and visibility was good, we decided to continue with the laparoscopic surgery. Partial diaphragmectomy with complete inclusion of the tumor was performed, and the defect of the diaphragm was directly closed by a running suture. Pathological examination revealed a benign schwannoma that had originated from the diaphragm. To support our findings, we also reviewed the scientific literature on diaphragmatic schwannoma cases reported up to April 2020.
In this extremely rare case, we successfully resected the diaphragmatic schwannoma using laparoscopic surgery.
神经鞘瘤是一种常见起源于胃和小肠的神经鞘肿瘤。膈肌的原发性神经鞘瘤很少见，直到长到一定大小时才会出现任何症状。因此，在能够通过腔镜手术切除的大小发现它是极其罕见的。
一名 77 岁女性因胃贲门附近的肿瘤被转诊至我科进行手术治疗。她在转诊前 2 年 7 个月接受了常规食管胃十二指肠镜检查。当时怀疑她患有 10mm 大小的黏膜下肿瘤，位于贲门，随后被转诊给她之前的医生。在随访过程中，内镜超声（EUS）显示囊性结构继续向胃壁生长，随后她被转诊至我院内镜科。她继续接受随访，发现肿瘤逐渐增大。因此，她要求手术切除，最终被转诊至我科。由于肿瘤较小，我们计划进行腹腔镜手术。手术过程中的初步检查发现肿瘤位于左侧膈肌。由于肿瘤相对较小且可视性良好，我们决定继续进行腹腔镜手术。进行了部分膈肌切除术，完整包含肿瘤，并通过连续缝合直接关闭膈肌缺损。病理检查显示为起源于膈肌的良性神经鞘瘤。为了支持我们的发现，我们还回顾了截至 2020 年 4 月报告的膈肌神经鞘瘤病例的科学文献。
在这个极其罕见的病例中，我们成功地通过腹腔镜手术切除了膈肌神经鞘瘤。
