Kojima Yohei, Yamaguchi Takashi, Taguchi Satoshi, Kondo Eri, Yokoyama Masaaki, Shirayama Saito, Nikaido Takashi, Yanagida Osamu
Department of Surgery, Kosei Hospital, Tokyo, Japan.
Department of Surgery, Kyorin University Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2020 Oct 15;14(3):483-490. doi: 10.1159/000509542. eCollection 2020 Sep-Dec.
Colorectal schwannomas are rare and usually benign gastrointestinal mesenchymal tumors. However, these tumors are often overtreated, possibly owing to misleading malignant potential. To our knowledge, there have been no previous reports of ascending colon schwannoma preoperatively diagnosed as benign schwannoma. Herein, we report a case of ascending colon schwannoma accurately diagnosed by endoscopic biopsy and successfully treated by wedge resection. The patient was a 76-year-old woman with complaints of bloody stool. She had no relevant past medical history. Radiological findings revealed a protruded mass in the ascending colon, and colonoscopy revealed a submucosal tumor measuring approximately 3 cm in diameter with a reddish and uneven surface. Histological and immunohistochemical analysis for vimentin and S100 protein of the specimen obtained by endoscopic biopsy confirmed the diagnosis of schwannoma. Thus, we performed laparoscopy-assisted endoscopic full-thickness resection of the ascending colon wall, as appropriate for a benign soft tissue tumor. The postoperative course has been uneventful for 2 years. This case demonstrates that colonic schwannoma can be successfully treated with adequate resection if an accurate preoperative diagnosis is made, thereby avoiding overtreatment, such as surgery for colorectal tumor including lymph node dissection. Preoperatively diagnosed schwannomas should be treated by wedge resection, with postoperative pathological findings confirming the presence or absence of malignancy. Additional resection should be considered for very rare cases of coexisting malignant tissue.
结直肠神经鞘瘤是罕见的、通常为良性的胃肠道间充质肿瘤。然而，这些肿瘤常常受到过度治疗，这可能是由于对其恶性潜能的误导。据我们所知，此前尚无升结肠神经鞘瘤术前被诊断为良性神经鞘瘤的报道。在此，我们报告一例经内镜活检准确诊断并通过楔形切除术成功治疗的升结肠神经鞘瘤病例。患者为一名76岁女性，主诉便血。她既往无相关病史。影像学检查发现升结肠有一突出肿物，结肠镜检查发现一个直径约3 cm的黏膜下肿瘤，表面呈红色且不平整。对经内镜活检获取的标本进行波形蛋白和S100蛋白的组织学及免疫组化分析，确诊为神经鞘瘤。因此，我们对升结肠壁进行了腹腔镜辅助内镜全层切除术，这适用于良性软组织肿瘤。术后2年病程平稳。该病例表明，如果能做出准确的术前诊断，结肠神经鞘瘤通过充分切除可成功治疗，从而避免过度治疗，如对结直肠肿瘤进行包括淋巴结清扫在内的手术。术前诊断为神经鞘瘤的患者应采用楔形切除术治疗，术后病理结果确定有无恶性病变。对于非常罕见的并存恶性组织的病例，应考虑进一步切除。
