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| Year : 2010 | Volume
: 53
| Issue : 1 | Page : 198-200 |
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| Schwannoma of the ascending colon |
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Vijaya V Mysorekar1, Saraswathi G Rao1, Umesh Jalihal2, M Sridhar3
1 Department of Pathology, M. S. Ramaiah Medical College and Hospital, Bangalore, India
2 Department of Gastroenterology, M. S. Ramaiah Medical College and Hospital, Bangalore, India
3 Department of Surgery, M. S. Ramaiah Medical College and Hospital, Bangalore, India
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| Date of Web Publication | 19-Jan-2010 |
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How to cite this article:
Mysorekar VV, Rao SG, Jalihal U, Sridhar M. Schwannoma of the ascending colon. Indian J Pathol Microbiol 2010;53:198-200 |
Sir,
According to world-wide data, schwannomas of the colon are extremely rare. To our knowledge, in Indian literature, there have been no reports of colonic schwannoma, and only a single case each, of gastric [1] and rectal schwannoma, [2] have been reported. We report the case of a patient with two discrete schwannomas in the ascending colon.
A 33-year-old male presented with abdominal pain since 3 months. There was no history of fever, vomiting, diarrhea, or rectal bleeding. On examination, there was tenderness in the right hypochondrium. Colonoscopy revealed a polyp in the ascending colon, along the medial aspect. Relevant laboratory investigations were normal. A clinical diagnosis of colonic lipoma was made. Polypectomy was done endoscopically. Three days later, the patient developed colonic perforation at the site of polypectomy, and showed signs of peritonitis. Hence, right hemicolectomy with ileo-colic anastomoses was performed.
Grossly, the endoscopically removed polyp measured 3 x 3 x 2 cm and was globular, with a short stalk. The cut surface was glistening, yellow with grayish-brown areas. In the hemicolectomy specimen, a perforation 3 mm in size, surrounded by a congested and edematous raw area, was noticed at the site of polypectomy. The specimen also showed another larger polyp on the mucosal surface, 3 cm distal to the raw area. This polyp measured 5 x 4 x 3 cm and was globular, with a cut surface similar to that of the smaller polyp [Figure 1]. On microscopy, both the polyps showed tumors composed of interlacing fascicles of spindle-shaped cells with wavy nuclei, displaying cellular and hypocellular areas. There was mild nuclear atypia, and no mitoses [Figure 2]A and B. Verocay bodies were absent. A peripheral cuff of lymphoid aggregates was observed [Figure 2]C. Immunohistochemically, the tumor cells were diffusely and strongly positive (85% positivity) for S-100 protein [Figure 3] and negative for CD117, CD34 and desmin.
In our patient, had the second larger polyp also been detected during endoscopy, an endoscopic removal of the smaller polyp would not have been attempted and a partial colectomy would have directly been performed. Nevertheless, he had an uneventful postoperative recovery and is free from complications or recurrence during the follow-up period of six months.
Gastrointestinal schwannomas occur equally in men and women, in a wide age range (18-87 years). They are more commonly located in the stomach. [3] In a review of 600 mesenchymal tumors of the colon and rectum, only 20 colorectal schwannomas were identified, the commonest location being the caecum (seven cases) and rectosigmoid colon (six cases). [4] The origin of gastrointestinal schwannomas is most likely to be from the myenteric plexus. [5] Histopathologically, the described cases have shown similar features as in our case, including the absence of Verocay bodies. Immunohistochemically, schwannomas always show S-100 positivity, and are sometimes also positive for glial fibrillary acidic protein (GFAP). They are negative for CD117, CD34, smooth muscle actin and desmin. [4] They do not show cytogenetic abnormalities.
In our case, the CD117 negativity ruled out the diagnosis of gastrointestinal stromal tumor. The other gastrointestinal spindle cell lesions considered as differential diagnoses were leiomyoma/ leiomyosarcoma, fibrous tumors/fibromatosis, and myofibroblastic tumors; however, these were ruled out by immunohistochemistry. Although neurofibroma was a very close differential diagnosis on the basis of the S-100 positivity, the histological features, including the presence of a peripheral cuff of lymphoid aggregates, favored the diagnosis of schwannoma.
Colorectal schwannomas have no connection with neurofibromatosis 1 or 2. [4] Our patient had no clinical features or family history of neurofibromatosis. Schwannomas behave in a benign fashion with no tendency for aggressive behavior. [4] Thus, complete excision of the tumor is sufficient, and extensive surgery should be avoided.
 Acknowledgment | |  |
The authors are grateful to Dr. S. Kumar, Principal, M. S. Ramaiah Medical College, for his kind support in publishing this paper.
| References | | |
| 1. | Chandra M, Mehrotra P, Mitra MK. Gastric schwannoma presenting as gastric polyp with gastrointestinal bleeding. Indian J Gastroenterol 2002;21:31.  [PUBMED] [FULLTEXT] |
| 2. | Bhardwaj K, Bal MS, Kumar P. Rectal schwannoma. Indian J Gastroenterol 2002;21:116-7. [PUBMED] |
| 3. | Goh BK, Chow PK, Kesavan S, Yap WM, Ong HS, Song IC, et al. Intraabdominal schwannomas: a single institution experience. J Gastrointest Surg 2008;12:756-60. [PUBMED] [FULLTEXT] |
| 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;25:846-55. [PUBMED] [FULLTEXT] |
| 5. | Mulchandani MH, Chattopadhyay D, Obafunwa JO, Joypaul VB. Gastrointestinal autonomic nerve tumours - report of a case and review of literature. World J Surg Oncol 2005;3:46. [PUBMED] [FULLTEXT] |
Correspondence Address:
Vijaya V Mysorekar
89, A.G.'s office colony, 5th main, 6th cross, New BEL Road, Bangalore - 560 054
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.59241
[Figure 1], [Figure 2], [Figure 3] |
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