|Year : 2017 | Volume
| Issue : 3 | Page : 234-236
A case report of oesophageal schwannoma with thoracoscopic surgery
Zhiliang Hu1, Zhun He1, Xianfeng Li2, Chuanliang Peng3, Zhen Li1
1 Thoracic Department, The Affiliated Hospital of Jining Medical University, Jining, China
2 Thoracic Department, Xinjiang Uygur Autonomous Region People's Hospital, Xinjiang, China
3 Thoracic Department, The Second Hospital of Shandong University, Shandong, China
|Date of Submission||31-Dec-2016|
|Date of Acceptance||12-Jan-2017|
|Date of Web Publication||12-Jun-2017|
Thoracic Department, The Affiliated Hospital of Jining Medical University, 89 Guhuai Street, Jining 272000
Source of Support: None, Conflict of Interest: None
Oesophageal schwannomas is a rare tumour and most commonly found incidentally or from diagnostic workup of dysphagia or dyspnoea. Most oesophageal schwannomas are benign and more frequently occurs in female than in the male. To date, <40 cases have been described in the English literature. In this study, we reported the case of a 57-year-old woman visited our hospital with the symptom of long-time dysphagia. A thoracic computed tomography demonstrated an upper oesophageal well marginated and homogeneous mass that adhered to the right wall of the oesophagus. Oesophageal endoscopy showed an extrinsic bulge 21 cm distal to the incisors with normal overlying mucosa. Strictly on a clinical and radiologic basis, this entity is impossible to definitively diagnose, the final diagnosis was based on histopathology and immunohistochemistry. Tumour cells stain positive for S100, a characteristic marker of Schwann cell. A minimally invasive thoracoscopic surgery was performed. The post-operative period was uneventful.
Keywords: Dysphagia, gastroscope, minimally, oesophagus, schwannomas, thoracoscopy
|How to cite this article:|
Hu Z, He Z, Li X, Peng C, Li Z. A case report of oesophageal schwannoma with thoracoscopic surgery. J Min Access Surg 2017;13:234-6
| ¤ Introduction|| |
The incidence of schwannoma is low among benign oesophageal tumours, the first case of oesophageal schwannoma was reported by Chaterlin and Fissore in 1976. Oesophageal schwannomas are difficult to definitively diagnose endoscopy and imaging, and final diagnosis was confirmed by pathological examination. Surgical resection is the main treatment for oesophageal schwannoma, usually through a thoracoscopic approach in recent years. The prognosis is generally good, and recurrence is rare.
In this present case, we report an oesophageal schwannoma with long-term dysphagia and successfully treated with minimally invasive thoracoscopic surgery.
| ¤ Case Report|| |
A 57-year-old female was admitted to hospital with the symptoms of the gradual onset of dysphagia for 2 years without significant weight loss. Her medical and family histories were unremarkable, and the physical exam was non-contributory. Thoracic computed tomography demonstrated an upper oesophageal well-defined mass that adhered to the right wall of the oesophagus [Figure 1]a. Endoscopic ultrasonography showed one well-defined hypoechoic mass in the muscularis propria layer [Figure 1]b. Oesophageal endoscopy showed an extrinsic bulge (38 mm × 30 mm) 21 cm distal to the incisors with normal overlying mucosa [Figure 1]c. From above analysis, we preoperatively diagnosed leiomyoma.
|Figure 1: (a) Computed tomography showing a large mass compressing oesophagus; (b) Endoscopic ultrasonography showing a well-defined hypoechoic mass in the muscularis propria layer; (c) Endoscopic finding showing the normal mucosa; (d) Intraoperative photograph showing a tumour adjacent to the upper oesophagus|
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Surgery was performed under general anaesthesia, a single lumen endotracheal intubation, and two-lung ventilation and then provided the thoracic cavity with carbon dioxide positive pressure using an enclosed trocar to make the lungs collapse. She was positioned to the left lateral decubitus position and was anteverted moderately. Thoracoscopy was performed with four thoracic ports. A 1 cm incision was made at the 7th intercostal space on the posterior axillary line for observation, the operational ports located at the 4th intercostal space on the anterior axillary line, 6th and 9th intercostal space on the scapular line, respectively. A tumour about 40 mm in diameter was found adjacent to the upper oesophagus [Figure 1]d. The tumour was round-shapes, solid and originating from the muscular layer of oesophagus. Whereas the tumour was slightly rich in nourishing blood vessels and there was no evident gaps with surrounding tissue. Gastroscope was used to identify oesophageal mucosa. A fast pathological examination was performed which reported leiomyomas once the tumour was resected. Air injection through the tube revealed no leakages. The muscular layer was repaired.
Immunohistochemical staining revealed the tumour to be positive for S100 protein but negative for CD117, CD34, Dog-1 and smooth muscle actin (MSA) [Figure 2]. The patient started oral feeding at post-operative day 3 after upper gastrointestinal radiography showing no iodinated contrast agent extravasation, gradually transited from a liquid diet to a normal diet and discharged at day 5.
|Figure 2: Immunohistochemical analysis demonstrating cells staining strongly positive for S100 (×400)|
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| ¤ Discussion|| |
The majority of oesophageal tumours are malignant, the most common benign submucosal oesophageal tumour is leiomyoma, which accounts for more than half of all benign tumours. Oesophageal schwannoma is rare peripheral nerve sheath tumour, and only a few cases have been reported in the English literature. Most oesophageal schwannomas are benign and more frequently occurs in female than in male. The patients reported ranged in age from 22 to 77, the size and location of tumour vary widely. Of the cases described, there is a strong pre-dominance for this disease entity in the Asian population. The clinical performance of oesophageal schwannomas is atypical and is relevant to locations, sizes and depths involved. The majority of cases present with dysphagia, as well as a wide variety of presentations have been presented including dyspnoea, chest pain, coughing, dysphonia and superior vena cava syndrome. Strictly on a clinical and radiologic basis this entity is impossible to definitively diagnose, imaging examination characteristic and pre-operative gastroscopy are non-specific. Diagnosis is made on histological and immunohistochemical results, tumour cells stain positive for S100 (a characteristic marker). In this case, the final diagnosis was based on histopathology and immunohistochemistry. Surgical resection of oesophageal submucosal tumours is dependent upon the tumour size, malignant potential and patient's symptomatic state, thoracoscopic surgery is becoming common with less invasion. We selected the minimally invasive thoracoscopic approach to improve her quality of life and performed submucosal resection.
In this case, the gastroscope was used. It is easy to identify oesophageal mucosa according to the degree of light because of close adhesion, and ensure the mucosa from damage, which is different from reported literatures.
Author Zhen Li is in charge of the operational implementation. Author Zhiliang Hu, Zhun He and Xianfeng Li are assistants during surgery. Author Chuanliang Peng is responsible for language editing and image procession.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]