Menzie Jack, Eldredge Thomas, Low Liang
Department of General Surgery, Monash Health, Melbourne, AUS.
Department of Upper Gastrointestinal and Hepatobiliary Surgery, Monash Health, Melbourne, AUS.
Cureus. 2024 Nov 27;16(11):e74589. doi: 10.7759/cureus.74589. eCollection 2024 Nov.
Schwannomas are rare, benign tumours arising from Schwann cells, with oesophageal cases representing a small fraction. Their variety of symptoms and nonspecific imaging features often make preoperative diagnosis challenging, frequently requiring immunohistochemical staining for confirmation. We describe the case of a 62-year-old woman with progressive dysphagia, found to have a subepithelial mass at the gastroesophageal junction (GOJ). Imaging and endoscopic ultrasound-guided biopsy confirmed an oesophageal schwannoma. The patient underwent robotic-assisted thoracoscopic excision, which allowed for precise tumour removal while avoiding a more extensive oesophagectomy. Intraoperatively, two distinct lobular tumours were identified and successfully excised without compromising the oesophageal mucosa. Postoperatively, the patient recovered well with resolution of symptoms and no evidence of residual tumour on follow-up imaging. This case highlights the potential of robotic-assisted approaches for treating oesophageal schwannomas, which can offer advantages in complex resections by improving surgical precision and reducing morbidity. Despite promising outcomes, robotic-assisted enucleation of oesophageal schwannomas remains rare, with few cases documented. This case supports robotic resection of oesophageal schwannomas as a feasible option in specialized settings, but further studies are needed to establish its role and develop recommendations.
施万细胞瘤是一种罕见的起源于施万细胞的良性肿瘤,食管病例占比很小。其多样的症状和非特异性影像学特征常常使术前诊断具有挑战性,通常需要免疫组化染色来确诊。我们描述了一名62岁进行性吞咽困难女性的病例,该患者在胃食管交界处(GOJ)发现有一个上皮下肿物。影像学检查和内镜超声引导下活检确诊为食管施万细胞瘤。患者接受了机器人辅助胸腔镜切除术,该手术在避免更广泛食管切除术的同时实现了肿瘤的精确切除。术中,发现了两个不同的小叶状肿瘤并成功切除,未损伤食管黏膜。术后,患者恢复良好,症状缓解,随访影像学检查未发现残留肿瘤迹象。该病例突出了机器人辅助手术治疗食管施万细胞瘤的潜力,通过提高手术精度和降低发病率,在复杂切除术中具有优势。尽管结果令人鼓舞,但机器人辅助摘除食管施万细胞瘤仍然罕见,仅有少数病例记录。该病例支持在专业环境中机器人切除食管施万细胞瘤是一种可行的选择,但需要进一步研究来确定其作用并制定相关建议。