Case report Gastric schwannoma: MRI findings N KARABULUT, MD, D R MARTIN, MD, PhD and M YANG, MD Department of Radiology, West Virginia University Hospitals, Morgantown, WV, USA Abstract. MRI features are described in a case of gastric schwannoma. A large, discretely marginated, multilobular mass was seen adjacent to the gastric antrum with the epicentre of the mass in the gastrocolic ligament. The overall signal pattern was low on T 1 weighted images and moderate to markedly elevated on T 2 weighted images. Post-gadolinium sequences demonstrate slow but fairly uniform enhancement throughout the mass. Schwannomas are rare among the spindle cell mesenchymal tumours of the digestive tract, arising from the Schwann cells of the neural plexus of the gastrointestinal wall. Gastric schwannomas, most commonly sited in the stomach, account for only 0.2% of all gastric tumours [1] and have received little attention in radiological literature. These tumours are usually asymptomatic or may present as upper gastro- intestinal bleeding or as mass lesions [1–7]. Upper endoscopy is important in the initial evaluation of these patients, but it may not be helpful in the diagnosis of submucosal tumours growing exophytically. Cross-sectional imaging findings may be useful in the detection and character- ization of the tumour and its relation with surrounding organs. We describe here the MRI features of gastric schwannoma in a 46-year-old patient. To our knowledge, this case is the first to be reported with MRI documentation. Case report A 46-year-old White male was seen in surgery clinic with the complaint of inguinal hernia. On physical examination the patient was found to have a large abdominal mass in his right upper quadrant. The patient denied any complaints or any symptoms related to the mass. Laboratory findings were within normal limits. Upper endos- copy showed large extrinsic bulges from both the anterior and posterior walls in the gastric antrum. Multiple biopsies taken from the site of extrinsic mass revealed marked chronic active gastritis without evidence of a malignancy. The patient subsequently underwent abdominal MRI in order to evaluate the mass, which showed a large, discretely marginated mass with innumerable lobulations centered in the region of the gastro- colic ligament (Figure 1). The overall signal pattern was low on T 1 weighted images and moderate to markedly elevated on T 2 weighted images (Figure 1a, b). Each of these lobulations appeared to be encapsulated with moderately well defined borders, which were seen as markedly hypointense on T 1 weighted images and hypo- intense, isointense and hyperintense on T 2 weighted images. Post-gadolinium sequences demonstrate slow but fairly uniform marked enhancement throughout the internal aspect of each of the lobules (Figure 1c, d). However, the hypointense borders around the lobulations remained unen- hanced. There was no evidence of necrosis within the tumour mass. The inferior aspect of the mass was pushing on the transverse colon with the transverse colon draped around the mass. The superior aspect of the mass was seen extending over the anterior aspect of the gastric antrum, pylorus, duodenal cap and proximal part of the second segment of the duodenum towards the gall bladder fossa and porta hepatis. The distal stomach appeared to be squeezed by the mass (Figure 1a, b, d). The pancreas was pushed posteriorly and inferiorly but was clearly separate from the mass. The remainder of the abdomen was unremarkable without evidence of direct organ invasion, lymphadenopathy or solid organ metastases. The celiac artery and major branches, as well as the superior mesenteric artery and major branches, were clearly identified but a vascular supply to the mass was not well demonstrated. At exploratory laparatomy, the abdominal mass was found to be adhered to the greater curvature in the anterior wall of the distal stomach. Since the mass was arising from the distal portion of the stomach, a partial gastrec- tomy with Billroth I gastroduodenostomy was Received 24 January 2002 and accepted 19 March 2002. Address correspondence to N Karabulut, MD, Hastane Cad. Umut Apt 5/3, 20010, Denizli, Turkey. The British Journal of Radiology, 75 (2002), 624–626 E 2002 The British Institute of Radiology 624 The British Journal of Radiology, July 2002
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