S tromal tumors of gastrointestinal tract include a variety of primary mesenchymal tumors of the gastrointestinal tract, such as leiomyoma, leiomyo- sarcoma, leiomyoblastoma, and schwannoma. 1 Schwannomas are rare tumors derived from Sch- wann cells, which form the neural sheath. Gastro- intesinal schwannomas are rare and most of them originate in the stomach or the small intestine. Sch- wannomas of the colon are extremely rare. Few case reports have described the occurrence of schwan- nomas in the colon. 1-4 Case Report Our patient was a 45-year-old woman whose gen- eral health condition was good before the appearance of symptoms. She visited our gastrointestinal clinic in June 2005 complaining of bloody stool with blood clots and mucus content for 1 week, with several epi- sodes of mild diarrhea. She denied any abdominal pain, body weight loss, or recent change in bowel habit. She also denied any medical or operative his- tory or family history of cancer. Her vital signs were normal and physical examination were unremarkable. Flexible sigmoidoscopy revealed a huge yellow bulg- ing intra-luminal tumor obstructing the lumen at 50 cm above the anal verge (Fig. 1). A biopsy of the tu- mor was obtained and pathology showed inflamma- tory exudates, necrotic debris, acute and chronic in- flammation, and granulation tissue formation. Though no malignancy was found in the biopsy specimen, en- doscopic findings indicated colon cancer, so the pa- tient was referred to a proctologist for operation. Lab- oratory tests and other examinations demonstrated only mild anemia (hemoglobin, 10.0 g/dL). Dou- J Soc Colon Rectal Surgeon (Taiwan) December 2008 Case Report Schwannoma of the Colon: Report of a Case and Review of the Literature Hsin-Yuan Hung 1 Jy-Ming Chiang 1 Jinn-Shiun Chen 1 Reiping Tang 1 Tse-Ching Chen 2 1 Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan 2 Department of Pathology, Chang Gung Memorial Hospital, Lin-Kou, Taiwan Key Words Gastrointestinal schwannoma; Colon; Immunohistochemistry Schwannomas of the colon are extremely rare, and it is necessary to treat them by radial excision with a wide margin because of their tendency to recur locally and become malignant if inadequately treated. In the present study, we report a rare case of a colonic schwannoma that was success- fully treated by surgical resection in our department. Immunohistochemi- stry revealed that the tumor was positive for S-100 and negative for C-KIT, smooth muscle actin, CD21, CD34, and CD35. The patient was therefore diagnosed with a schwannoma, not a gastrointestinal stromal tu- mor(GIST). We report the findings of endoscopy, radiology, and pathol- ogy in a patient with colonic schwannoma. The literature on colonic schwannomas has been reviewed. [J Soc Colon Rectal Surgeon (Taiwan) 2008;19:128-132] Received: September 25, 2008. Accepted: December 31, 2008. Correspondence to: Dr. Jinn-Shiun Chen, M.D. Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital 199, Tung Hwa North Road, Taipei, Taiwan. Tel: +886-3-3281200 ext. 2101; Fax: +886-3-3278355. 128
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Case Report Schwannoma of the Colon: Report of a Case and ... · Case and Review of the Literature Hsin-Yuan Hung1 Jy-Ming Chiang1 Jinn-Shiun Chen1 Reiping Tang1 Tse-Ching Chen2 1Division
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Stromal tumors of gastrointestinal tract include a
variety of primary mesenchymal tumors of the
gastrointestinal tract, such as leiomyoma, leiomyo-
sarcoma, leiomyoblastoma, and schwannoma.1
Schwannomas are rare tumors derived from Sch-
wann cells, which form the neural sheath. Gastro-
intesinal schwannomas are rare and most of them
originate in the stomach or the small intestine. Sch-
wannomas of the colon are extremely rare. Few case
reports have described the occurrence of schwan-
nomas in the colon.1-4
Case Report
Our patient was a 45-year-old woman whose gen-
eral health condition was good before the appearance
of symptoms. She visited our gastrointestinal clinic in
June 2005 complaining of bloody stool with blood
clots and mucus content for 1 week, with several epi-
sodes of mild diarrhea. She denied any abdominal
pain, body weight loss, or recent change in bowel
habit. She also denied any medical or operative his-
tory or family history of cancer. Her vital signs were
normal and physical examination were unremarkable.
Flexible sigmoidoscopy revealed a huge yellow bulg-
ing intra-luminal tumor obstructing the lumen at 50
cm above the anal verge (Fig. 1). A biopsy of the tu-
mor was obtained and pathology showed inflamma-
tory exudates, necrotic debris, acute and chronic in-
flammation, and granulation tissue formation. Though
no malignancy was found in the biopsy specimen, en-
doscopic findings indicated colon cancer, so the pa-
tient was referred to a proctologist for operation. Lab-
oratory tests and other examinations demonstrated
only mild anemia (hemoglobin, 10.0 g/dL). Dou-
J Soc Colon Rectal Surgeon (Taiwan) December 2008
Case Report
Schwannoma of the Colon: Report of a
Case and Review of the Literature
Hsin-Yuan Hung1
Jy-Ming Chiang1
Jinn-Shiun Chen1
Reiping Tang1
Tse-Ching Chen2
1Division of Colon and Rectal Surgery,
Chang Gung Memorial Hospital, Lin-Kou,
Taiwan2Department of Pathology, Chang Gung
Memorial Hospital, Lin-Kou, Taiwan
Key Words
Gastrointestinal schwannoma;
Colon;
Immunohistochemistry
Schwannomas of the colon are extremely rare, and it is necessary to treatthem by radial excision with a wide margin because of their tendency torecur locally and become malignant if inadequately treated. In the presentstudy, we report a rare case of a colonic schwannoma that was success-fully treated by surgical resection in our department. Immunohistochemi-stry revealed that the tumor was positive for S-100 and negative forC-KIT, smooth muscle actin, CD21, CD34, and CD35. The patient wastherefore diagnosed with a schwannoma, not a gastrointestinal stromal tu-mor(GIST). We report the findings of endoscopy, radiology, and pathol-ogy in a patient with colonic schwannoma. The literature on colonicschwannomas has been reviewed.[J Soc Colon Rectal Surgeon (Taiwan) 2008;19:128-132]
Received: September 25, 2008. Accepted: December 31, 2008.
Correspondence to: Dr. Jinn-Shiun Chen, M.D. Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital 199, Tung