Harada Takuya, Takemoto Konomi, Okada Naoki, Minagawa Nozomi, Matsuno Yoshihiro, Maeda Yoshiaki
Department of Gastroenterological Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan.
Department of Pathology, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0179. Epub 2025 Jun 24.
Esophageal schwannomas are rare benign tumors arising from Schwann cells and are among the least common mesenchymal neoplasms of the gastrointestinal tract. While fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in the preoperative assessment of submucosal tumors, schwannomas are known to exhibit unexpectedly high FDG uptake, often mimicking malignant lesions. Dual-time-point FDG-PET, which evaluates both early and delayed FDG accumulation, has been employed to improve diagnostic specificity in various malignancies, including esophageal cancer. However, to date, no cases of esophageal schwannomas showing a malignant FDG uptake pattern on dual-time-point FDG-PET and resected thoracoscopically have been reported. We present a rare case of esophageal schwannoma demonstrating increased delayed FDG uptake, initially suggestive of malignancy that was successfully treated with thoracoscopic surgery following preoperative diagnosis via EUS-FNA.
A 55-year-old woman was referred to our hospital for evaluation of an esophageal submucosal tumor detected during health screening. FDG-PET demonstrated a high uptake pattern (SUVmax; early; 9.4, delayed; 11.8) suggestive of malignancy. However, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed histopathological features consistent with a benign schwannoma. The patient underwent thoracoscopic enucleation, and the intraoperative findings confirmed a well-circumscribed tumor without invasion of the surrounding tissues. The procedure was completed within 2 h and 5 min with minimal blood loss. The final pathological diagnosis confirmed esophageal schwannoma. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. At the 6-month follow-up, no recurrence was observed.
This case highlights that even when dual-time-point FDG-PET suggests malignancy, thoracoscopic resection may be a viable treatment option for esophageal schwannoma if a benign diagnosis is supported by preoperative EUS-FNA. This underscores the importance of integrating metabolic imaging with histopathological assessment in surgical planning.
食管神经鞘瘤是起源于施万细胞的罕见良性肿瘤，是胃肠道最不常见的间叶性肿瘤之一。虽然氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）广泛用于黏膜下肿瘤的术前评估，但已知神经鞘瘤会出现意外的高FDG摄取，常类似恶性病变。双时相FDG-PET可评估早期和延迟的FDG积聚，已被用于提高包括食管癌在内的各种恶性肿瘤的诊断特异性。然而，迄今为止，尚无经双时相FDG-PET显示恶性FDG摄取模式且经胸腔镜切除的食管神经鞘瘤病例报道。我们报告1例罕见的食管神经鞘瘤，其延迟FDG摄取增加，最初提示为恶性肿瘤，经术前EUS-FNA诊断后通过胸腔镜手术成功治疗。
一名55岁女性因健康筛查时发现食管黏膜下肿瘤转诊至我院。FDG-PET显示高摄取模式（SUVmax；早期，9.4；延迟，11.8），提示为恶性肿瘤。然而，内镜超声引导下细针穿刺活检（EUS-FNA）显示组织病理学特征符合良性神经鞘瘤。患者接受了胸腔镜摘除术，术中发现肿瘤边界清晰，未侵犯周围组织。手术在2小时5分钟内完成，出血量极少。最终病理诊断为食管神经鞘瘤。术后过程顺利，患者于术后第14天出院。在6个月的随访中，未观察到复发。
本病例强调，即使双时相FDG-PET提示为恶性肿瘤，但如果术前EUS-FNA支持良性诊断，胸腔镜切除可能是食管神经鞘瘤的可行治疗选择。这突出了在手术规划中将代谢成像与组织病理学评估相结合的重要性。
