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EndoTODAY ³»½Ã°æ ±³½Ç


[Schwannoma. ½Å°æÃÊÁ¾] - ðû

1. Introduction

2. Endoluminal type

3. Intramural type

4. Extraluminal type

5. More cases of gastric schwannoma

6. CT findings of schwannnoma

7. Esophageal schwannoma

8. Colonic schwannoma

9. References


1. Introduction to schwannoma

Primary gastrontestinal neurogenic tumors are rare. They fall into two major groups: Those of peripheral nerve sheath origin (schwannomas, neurofibromas, ganglioneuromas, neuromas, and perineuromas) and those arising from sympathetic or chromaffin system (neuroblastomas, ganglioneuromas, and paragangliomas). Most schwannomas arise from the myenteric plexus.

Schwannoma (½Å°æÃÊÁ¾)´Â Schwann ¼¼Æ÷ ±â¿øÇÏ´Â ¾ç¼º Á¾¾çÀ¸·Î È£¹ßºÎÀ§´Â vestibular area (cerebellopontine angle)ÀÌ°í neurofibromatosis type 2¿Í ¿¬°üµÇ¾î ÀÖ½À´Ï´Ù. À§ schwannoma´Â schwannomaÀÇ À§Àå°ü ħ¹ü Áß¿¡´Â °¡Àå ÈçÇÏ¸ç ¹«Áõ»ó ȤÀº ÃâÇ÷À̳ª º¹ÅëÀ¸·Î ¹ß°ßµÇ±âµµ ÇÕ´Ï´Ù.


Stomach, mid body, anterior wall, wedge resection : Schwannoma
Actin (Smooth muscle) : Negative in tumor cells
Desmin : Negative in tumor cells
DOG-1 : Negative in tumor cells
S-100 : Positive in tumor cells
Ki-67 : Positive in 5-10% of tumor cells
C-KIT (CD 117) : Negative in tumor cells

GI tractÀÇ ½Å°æÃÊÁ¾Àº prominent lymphocytic rimÀ» º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù.

S-100

¶Ç ´Ù¸¥ Áõ·ÊÀÔ´Ï´Ù.

Benign schwannomas consist almost entirely of woven nests of compact bundles of slender, wavy S100-positive tumor cells with a loose myxoid stroma. The tumor cells may also form compact fascicles, occasionally aligning in rows or vague palisades (Verocay bodies). Antoni A area: interlacing bundles of spindle cells with wavy or oval nuclei eosinophilic cytoplasm, indistinct cytoplasmic borders. Antoni B area: hypocellular area

S-100

È£¹ß¿¬·ÉÀº 30-50¼¼À̸ç È£¹ßºÎÀ§´Â ÀÌ»óÇÏ°Ôµµ lesser curvatureÂÊÀ̶ó°í ÇÕ´Ï´Ù. Intramural typeÀÌ °¡Àå ÈçÇÏÁö¸¸ extraluminal type ȤÀº endoluminal typeµµ °¡´ÉÇÕ´Ï´Ù. ÀüÇüÀûÀÎ ÇüÅ´ ±Ë¾çÀ» µ¿¹ÝÇÑ Á¡¸·ÇÏ Á¾¾çÀÌ¸ç ¾Ç¼ºº¯È­´Â ¸Å¿ì µå¹°´Ù°í ÇÕ´Ï´Ù. º´¼Ò ÁÖº¯¿¡ lymph node°¡ Ä¿Áø °æ¿ì°¡ ¸¹Àº °ÍÀÌ Æ¯Â¡ÀÔ´Ï´Ù. µû¶ó¼­ benignÀε¥µµ ¼ö¼ú·Î ¿¬°áµÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ±¹¼Ò ÀýÁ¦¼ú·Î Ä¡·áÇÕ´Ï´Ù.

¾Æ·¡´Â gastric schwannoma Áõ·Ê ¸ðÀ½ÀÔ´Ï´Ù. ´Ù¾çÇÑ ¼Ò°ßÀ» º¸½Ç ¼ö ÀÖ½À´Ï´Ù.


2. Endoluminal type

50´ë ¿©¼º¿¡¼­ ¹ß°ßµÈ À§ SMT·Î ¼ö¼úÀ» ½ÃÇàÇÏ¿´°í ÃÖÁ¾ º´¸®°á°ú´Â Schwannoma, 4.7 x 4.3 cm, negative resection margins, S-100: Positive¿´½À´Ï´Ù.

4.5 x 4 x 3 cm schwanomma


3. Intramural type


4. Extraluminal type

°Ç°­°ËÁø¿¡¼­ ¿ì¿¬È÷ ¹ß°ßµÈ SMT°¡ Á¡Â÷ Ä¿Áø´Ù°í ÀÇ·ÚµÈ ºÐÀ¸·Î ¼ö¼ú·Î ÀýÁ¦ÇÏ¿´½À´Ï´Ù.


[2014-11-2. Ãß°¡] Clinical Endoscopy 2013³â 5¿ùÈ£¿¡ gastric schwannoma Áõ·Ê°¡ ½Ç·È½À´Ï´Ù (link). EUS-guided trucut biopsy·Î ¼ö¼úÀü Áø´ÜÀ» ÇÒ ¼ö ÀÖ¾ú´ø Áõ·ÊÀÔ´Ï´Ù.

ÀÌ Á¤µµ Å©±âÀÇ SMT¶ó¸é ¾îÂ¥ÇÇ wedge resection¸¦ ÇØ¾ß ÇÕ´Ï´Ù. ¼ö¼ú Àü¿¡ EUS-guided trucut biopsy°¡ ²À ÇÊ¿äÇß´ÂÁö ¾à°£ ÀǽÉÀÔ´Ï´Ù.


5. More cases of gastric schwannoma


Schwannoma (5.5 x 5 cm)


Schwannoma (2 x 1.3 cm), C-kit: Negative, S-100: Positive in tumor, SMA: Focal positive, in probably entrapped smooth muscle, CD34: Negative


Schwannoma (3.3 x 2.8 x 2.7 cm)


Schwannoma (2.3 x 1.5 cm)


Schwannoma (2.9 x 1.8 cm)


6. CT findings of schwannnoma

CT¿¡¼­ schwannoma¿Í GIST¸¦ °¨º°Çϱâ´Â ½±Áö ¾Ê½À´Ï´Ù. ÃÖ±Ù »ï¼º¼­¿ïº´¿ø ¿µ»óÀÇÇаú¿¡¼­ ÀǹÌÀÖ´Â ºÐ¼®À» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Choi. Korean J Radiol. 2012;13:425-433). ½Å°æÃÊÁ¾Àº GIST¿¡ ºñÇÏ¿© homogeneous enhancement, exophytic or mixed growth pattern, perilesional LN°¡ Ư¡À̾ú°í tumor volume doubling timeÀº GIST¿¡¼­ 377ÀÏ, ½Å°æÃÊÁ¾Àº 1685ÀÏÀ̾ú½À´Ï´Ù.

º´¼Ò ÁÖº¯¿¡ lymph node°¡ Ä¿Áø °æ¿ì°¡ ¸¹Àº °ÍÀÌ SchwannomaÀÇ Æ¯Â¡ÀÔ´Ï´Ù. µû¶ó¼­ benignÀε¥µµ ¼ö¼ú·Î ¿¬°áµÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ¸²ÇÁÀýÀÌ Ä¿Á®ÀÖÀ¸´Ï "Ȥ½Ã³ª?" ÇÏ´Â »ý°¢ÀÌ µé±â ¸¶·ÃÀÔ´Ï´Ù.

Conclusion of the study: Although small gastric schwannomas (GSs) and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.


SchwannomaÀε¥ ¸²ÇÁÀýÀÌ ¶Ñ·ÈÀÌ Ä¿Á³´ø Áõ·Ê¸¦ ¼Ò°³ÇÕ´Ï´Ù.


7. Esophageal schwannoma. ½Äµµ ½Å°æÃÊÁ¾

38´ë ³²ÀÚ·Î 2ÁÖÀüºÎÅÍ ¿¬ÇÏ°ï¶õ, À̹°°¨À¸·Î ³»½Ã°æÀ» ½ÃÇàÇÏ¿© ½Äµµ Á¾±«°¡ ¹ß°ßµÇ¾ú°í chest X-ray¿¡¼­ mediastinal mass·Î °üÂûµÇ¾ú½À´Ï´Ù. VATS·Î mass enucleationÀ» ½ÃÇàÇÏ¿´°í Á¶Á÷°Ë»ç¿¡¼­ Schwannoma, 5 x 3.5 cm, mitosis: up to 2/10 HPF, no necrosisÀÇ ¼Ò°ßÀ̾ú½À´Ï´Ù. Âü°í¹®ÇåÀ» ÀοëÇÕ´Ï´Ù.

½ÄµµÀÇ ½Å°æÃÊÁ¾Àº ¹ÌÁֽŰ濡¼­ ¹ß»ýÇÑ °æ¿ì¿Í, ½ÄµµÁ¡¸·ÇÏÀÇ ½Å°æÃÑ¿¡¼­ ¹ß»ýÇÑ °æ¿ì·Î ºÐ·ùµÉ ¼ö ÀÖÀ¸¸ç ÀüÀÚÀÇ °æ¿ì, ¹ÌÁֽŰ濡¼­ ¹ß»ýÇÏ¿© ½Äµµº®À¸·Î È®ÀåµÇ´Â ¾ç»óÀ» º¸À̸ç, ÈÄÀÚÀÇ °æ¿ì´Â ´ë°³ ½ÄµµÁ¡¸·ÇÏÀÇ ½Å°æÃÑ¿¡¼­ À¯·¡ÇÏ¿©, ½Äµµ ±ÙÀ°Ãþ ³»ÀÇ Á¾¾çÀ¸·Î ³ªÅ¸³­´Ù. ½Äµµ¿¡ ¹ß»ýÇÏ´Â ½Å°æÃÊÁ¾Àº ½Äµµ Á¶¿µ¼ú¿¡¼­ ºÎµå·¯¿î Æú¸³°°Àº Ã游 °á¼ÕÀ» º¸ÀÌ¸ç ½Äµµ ³»½Ã°æ¿¡¼­´Â µ¹ÃâÇü Á¡¸·ÇÏ Á¾¾çÀ¸·Î º¸ÀδÙ. ±×·¯³ª ÀÌ°ÍÀº ´Ù¸¥ ½Äµµ Á¡¸·ÇÏ Á¾¾ç°ú ±¸º°À» ÇÒ ¼ö Àִ Ưº°ÇÑ ¼Ò°ßÀÌ ¾Æ´Ï¹Ç·Î ¼ö¼ú Àü¿¡´Â ½Äµµ ÆòÈ°±ÙÁ¾À̳ª ³¶Á¾, ¶Ç´Â Áö¹æÁ¾ µîÀ¸·Î Áø´ÜµÇ´Â °æ¿ì°¡ ´ëºÎºÐÀÌ´Ù. Áø´Ü¿¡ À־ Á¾¾çÀÇ ÇüŸ¦ ½±°í Á¤È®ÇÏ°Ô ÃøÁ¤ÇÒ ¼ö ÀÖ´Â ¹æ¹ýÀº ³»½Ã°æ ÃÊÀ½ÆÄÀ̸ç, ÈäºÎ Àü»êÈ­ ´ÜÃþÃÔ¿µÀ» ÇÔ²² ÀÌ¿ëÇÏ¸é ¼ö¼ú¿¡ ´ëÇÑ Á¤º¸¸¦ ´õ ¾òÀ» ¼ö ÀÖ´Ù. ÀϹÝÀûÀ¸·Î ¹æ»ç¼±ÇÐÀû¼Ò°ß¿¡ ÀÇÇØ ³¶Á¾À̳ª Áö¹æÁ¾°úÀÇ ±¸ºÐÀº ½±°Ô ÀÌ·ç¾îÁú¼ö ÀÖ´Ù. ½Å°æÃÊÁ¾Àº ³»½Ã°æÀû ÃÊÀ½ÆÄ»ó °æ°è°¡ ºÐ¸íÇÏ°í Àú¿¡ÄÚ¼Ò°ßÀ» º¸À̸ç, °íÀ¯ ±ÙÀ°Ãþ¿¡¼­ ¹ß»ýÇÏ¿© Á¡¸· ÇÏ¿¡ À§Ä¡ÇÏ°í, ÈäºÎ Àü»êÈ­ ´ÜÃþ ÃÔ¿µ»ó ¿¬ºÎÁ¶Á÷Á¾¾çÀÇ ÇüÅ·Πº¸À̸ç, Á¶¿µÁõ°­ÀÌ ÀßµÇÁö ¾Ê´Â´Ù. (´ëÈä¿ÜÁö 2005;38:589-593)


8. Colonic schwannoma. ´ëÀå ½Å°æÃÊÁ¾

Hematochezia

°ËÁø ³»½Ã°æ ¹ß°ß RS junction SMT·Î low anterior resection ½ÃÇàÇÔ.
Schwannoma, plexiform type
2.3x2cm
12 reactive regional lymph nodes


[References]

1) EndoTODAY Á¡¸·ÇÏÁ¾¾ç

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endscopy Learning Center. Lee Jun Haeng.