Ann Surg Treat Res.  2014 Sep;87(3):161-165. 10.4174/astr.2014.87.3.161.

Metachronous schwannoma in the colon with vestibular schwannoma

• Jung EJ
• Han HS
• Koh YC
• Cho J
• Ryu CG
• Paik JH
• Hwang DY

• KMID: 1908488
• DOI: http://doi.org/10.4174/astr.2014.87.3.161

Abstract

We experienced a case of vestibular schwannoma and metachronous schwannoma in the colon. A 59-year-old female presented with a 1-month history of hematochezia. She had undergone suboccipital craniectomy resulting in radical subtotal resection, followed by gamma knife radiosurgery for a large left vestibular schwannoma 4 years prior to admission. On preoperative colonoscopy, a huge mass through which the colonoscope could not be passed was detected. CT scans showed colo-colonic intussusception with a 4.8-cm-sized mass in the descending colon. PET/CT revealed hypermetabolism of the descending colon tumor and pericolic lymph nodes. We performed left hemicolectomy under the preoperative impression of colon cancer with intussusception. A pathological diagnosis of benign schwannoma of the colon was made in this patient.

Keyword

Colon neurilemmoma; Schwannoma; Craniectomy; Gamma knife radiosurgery

MeSH Terms

Colon*
Colon, Descending
Colonic Neoplasms
Colonoscopes
Colonoscopy
Diagnosis
Female
Gastrointestinal Hemorrhage
Humans
Intussusception
Lymph Nodes
Middle Aged
Neurilemmoma*
Neuroma, Acoustic*
Positron-Emission Tomography and Computed Tomography
Radiosurgery
Tomography, X-Ray Computed

Figure

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  Fig. 1 Vestibular schwannoma on brain MRI. (A) T1 weighted image of vestibular schwannoma at the cerebello-pontine angle before neurosurgery. (B) T2 weighted image of vestibular schwannoma at the cerebello-pontine angle before neurosurgery. (C) T1 weighted image of residual vestibular schwannoma before Gamma-knife surgery. (D) T1 weighted image of residual vestibular schwannoma after Gamma-knife surgery.

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  Fig. 2 Pathologic findings of brain schwannoma. (A) The tumor shows typical microscopic appearance of a schwannoma. It is composed of spindle cells arranged in interlacing fascicles (Antoni A: cellular area, H&E: ×200) showing transition with loose meshwork of delicate collagen fibers (Antoni B: acellular area). (B) The tumor cells strongly and diffusely express the S-100 protein (×200).

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  Fig. 3 Intussuscepted tumor in the descending colon on preoperative colonoscopy.

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  Fig. 4 Preoperative radiologic imaging (A-C, CT; D, PET).

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  Fig. 5 (A, B) Gross features of colonic schwannoma.

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  Fig. 6 Pathologic findings of colonic schwannoma. (A) The tumor is composed of compact spindle cells arranged in interlacing fascicles (Antoni A: H&E, ×100). (B) In the other part, more loosely arranged, delicate collagen fibers are noted (Antoni B: H&E, ×100). Ectatic vessel with surrounding hyalinization is also noted. (C) The tumor cells strongly and diffusely express the S-100 protein (×100).

Reference

1. Di Cataldo A, Trombatore C, Cocuzza A, Latino R, Li Destri G, Petrillo G. Synchronous occurrence of colon adenocarcinoma and gastric schwannoma case report and review of the literature. Ann Ital Chir. 2013; 07. 2. 84:[Epub].

2. Braumann C, Guenther N, Menenakos C, Junghans T. Schwannoma of the colon mimicking carcinoma: a case report and literature review. Int J Colorectal Dis. 2007; 22:1547–1548.

3. Fotiadis CI, Kouerinis IA, Papandreou I, Zografos GC, Agapitos G. Sigmoid schwannoma: a rare case. World J Gastroenterol. 2005; 11:5079–5081.

4. Miettinen M, Shekitka KM, Sobin LH. Schwannomas in the colon and rectum: a clinicopathologic and immunohistochemical study of 20 cases. Am J Surg Pathol. 2001; 25:846–855.

5. Nonose R, Lahan AY, Santos Valenciano J, Martinez CA. Schwannoma of the colon. Case Rep Gastroenterol. 2009; 3:293–299.

6. Park KJ, Kim KH, Roh YH, Kim SH, Lee JH, Rha SH, et al. Isolated primary schwannoma arising on the colon: report of two cases and review of the literature. J Korean Surg Soc. 2011; 80:367–372.

7. Sanmillan JL, Plans G, Vidal N, Acebes JJ. Supratentorial brain schwannomas: an uncommon location for a common tumour. Br J Neurosurg. 2014; 28:25–28.