An Incidentally Diagnosed Gastric Schwannoma During Treatment of Acute Cholecystitis: A Case Report

A 67-year-old female presented with right upper quadrant abdominal pain. Physical examination showed a temperature of 38.2℃ and tenderness on palpation in the right upper quadrant. WBC count, C-reactive protein, AST, ALT, and total bilirubin were elevated. An abdominal CT scan was consistent with ac...

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Published inNihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 38; no. 6; pp. 1081 - 1084
Main Authors Aoki, Yuichi, Sekiguchi, Chuji, Naoi, Daishi, Rifu, Kazuma
Format Journal Article
LanguageJapanese
Published Japanese Society for Abdominal Emergency Medicine 30.09.2018
日本腹部救急医学会
Subjects
急性胆囊炎
粘膜下腫瘍
胃神経鞘腫
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ISSN1340-2242
1882-4781
DOI10.11231/jaem.38.1081

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Abstract A 67-year-old female presented with right upper quadrant abdominal pain. Physical examination showed a temperature of 38.2℃ and tenderness on palpation in the right upper quadrant. WBC count, C-reactive protein, AST, ALT, and total bilirubin were elevated. An abdominal CT scan was consistent with acute cholecystitis. Incidentally, a 70-mm submucosal tumor was seen in the gastric wall. The acute cholecystitis was treated with percutaneous transhepatic gallbladder drainage. Esophagogastroduodenoscopy (EGD) showed a submucosal tumor with an ulcer in the gastric body. Biopsy of the ulcer bed showed tangled spindle tumor cells, and immunohistochemical staining revealed S100+, desmin-, CD34-, c-kit-. And an MIB-1 index of 5～10%. The lesion was diagnosed as a gastric schwannoma. We performed partial gastrectomy, and open cholecystectomy. The patient’s post-operative course was uneventful.
AbstractList A 67-year-old female presented with right upper quadrant abdominal pain. Physical examination showed a temperature of 38.2℃ and tenderness on palpation in the right upper quadrant. WBC count, C-reactive protein, AST, ALT, and total bilirubin were elevated. An abdominal CT scan was consistent with acute cholecystitis. Incidentally, a 70-mm submucosal tumor was seen in the gastric wall. The acute cholecystitis was treated with percutaneous transhepatic gallbladder drainage. Esophagogastroduodenoscopy (EGD) showed a submucosal tumor with an ulcer in the gastric body. Biopsy of the ulcer bed showed tangled spindle tumor cells, and immunohistochemical staining revealed S100+, desmin-, CD34-, c-kit-. And an MIB-1 index of 5～10%. The lesion was diagnosed as a gastric schwannoma. We performed partial gastrectomy, and open cholecystectomy. The patient’s post-operative course was uneventful. 症例は67歳女性。主訴は右上腹部痛。血液検査では炎症反応の上昇および肝胆道系酵素の上昇を認めた。CTでは急性胆囊炎の所見があり，胃壁には70mm大の壁外発育性の腫瘤を認めた。急性胆囊炎に対して経皮経肝的胆囊ドレナージを施行し，症状は軽快した。上部消化管内視鏡検査で，胃体下部大弯に大きな潰瘍を伴った粘膜下腫瘍を認め，ボーリング生検を施行した。生検の結果，錯綜する紡錘形の腫瘍細胞を認め，免疫染色ではS100陽性，desmin陰性，CD34陰性，c-kit陰性，MIB-1 index 5～10％であり胃神経鞘腫と診断した。待機的に開腹胃部分切除術，胆囊摘出術を施行した。術後経過良好で第12病日に退院した。今回われわれは急性胆囊炎を契機に発見された胃神経鞘腫を，経皮経肝的胆囊ドレナージを行い，十分な術前診断の後に，治癒切除できた症例を経験したため，若干の文献的考察を加えて報告する。
A 67-year-old female presented with right upper quadrant abdominal pain. Physical examination showed a temperature of 38.2℃ and tenderness on palpation in the right upper quadrant. WBC count, C-reactive protein, AST, ALT, and total bilirubin were elevated. An abdominal CT scan was consistent with acute cholecystitis. Incidentally, a 70-mm submucosal tumor was seen in the gastric wall. The acute cholecystitis was treated with percutaneous transhepatic gallbladder drainage. Esophagogastroduodenoscopy (EGD) showed a submucosal tumor with an ulcer in the gastric body. Biopsy of the ulcer bed showed tangled spindle tumor cells, and immunohistochemical staining revealed S100+, desmin-, CD34-, c-kit-. And an MIB-1 index of 5～10%. The lesion was diagnosed as a gastric schwannoma. We performed partial gastrectomy, and open cholecystectomy. The patient’s post-operative course was uneventful.
Author Aoki, Yuichi
Rifu, Kazuma
Sekiguchi, Chuji
Naoi, Daishi
Author_FL 関口 忠司
利府 数馬
青木 裕一
直井 大志
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  fullname: Aoki, Yuichi
  organization: Nasuminami Hospital
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  fullname: Sekiguchi, Chuji
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  fullname: Naoi, Daishi
  organization: Nasuminami Hospital
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  fullname: Rifu, Kazuma
  organization: Nasuminami Hospital
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Journal of Abdominal Emergency Medicine
Nihon Fukubu Kyukyu Igakkai Zasshi
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日本腹部救急医学会
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1) Palmer ED: Benign intramural tumors of the stomach: a review with special reference to gross pathology. Medicine (Baltimore) 1951; 30: 81-181.
11) 急性胆管炎・胆嚢炎診療ガイドライン改訂出版委員会編：―TG13新基準掲載―急性胆管炎・胆嚢炎診療ガイドライン2013．第2版，東京，医学図書出版，2013
4) 下田忠和，佐野量造，尾崎　徳，ほか：消化管における非上皮性腫瘍の病理．胃と腸1975；10：877-887
8) Cai MY, Xu JX, Zhou PH, et al: Endoscopic resection for gastric schwannoma with long-term outcomes. Surg Endosc 2016; 30: 3994-4000.
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References_xml – reference: 9) Hu J, Liu X, Ge N, et al: Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. Medicine (Baltimore) 2017; 96: e7175.
– reference: 10) 石橋雄次，真崎純一，斉藤洋之，ほか：腹腔鏡内視鏡合同手術で胃局所切除を施行した胃神経鞘腫の1例．日臨外会誌2015；76：43-46．
– reference: 12) 俊山礼志，横山茂和，橋本和彦，ほか：十二指腸乳頭部内分泌癌の1切除例．癌と化学療法2013；40：1762-1764．
– reference: 8) Cai MY, Xu JX, Zhou PH, et al: Endoscopic resection for gastric schwannoma with long-term outcomes. Surg Endosc 2016; 30: 3994-4000.
– reference: 7) 亀山　亨，田内克典，岸本浩史，ほか：術前診断し腹腔鏡下胃局所切除を施行した胃神経鞘腫の1例．日臨外会誌2016；77：2212-2218．
– reference: 6) 日本癌治療学会，日本医学会，GIST研究会編：GIST診療ガイドライン．第3版，東京，金原出版，2014．
– reference: 13) 岡崎太郎，味木徹夫，篠崎健太，ほか：肝外胆管原発印環細胞癌に対して胆管切除術を施行した1例．日消外会誌2013；46：840-846．
– reference: 2) 牧野知紀，平尾素宏，藤谷和正，ほか：胃神経鞘腫の1例―自験例を含む本邦報告287例の検討―．日臨外会誌2004；65：1813-1817．
– reference: 3) 引地拓人，菊地　眸，中村　純，ほか：胃粘膜下腫瘍の組織生検法．胃と腸2017；52：1301-1315．
– reference: 4) 下田忠和，佐野量造，尾崎　徳，ほか：消化管における非上皮性腫瘍の病理．胃と腸1975；10：877-887．
– reference: 5) 川村弘之，片岡　誠，桑原義之，ほか：胃神経鞘腫の2例―自験例を含む236例の検討―．日臨外会誌1994；55：2037-2041．
– reference: 1) Palmer ED: Benign intramural tumors of the stomach: a review with special reference to gross pathology. Medicine (Baltimore) 1951; 30: 81-181.
– reference: 11) 急性胆管炎・胆嚢炎診療ガイドライン改訂出版委員会編：―TG13新基準掲載―急性胆管炎・胆嚢炎診療ガイドライン2013．第2版，東京，医学図書出版，2013．
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Snippet A 67-year-old female presented with right upper quadrant abdominal pain. Physical examination showed a temperature of 38.2℃ and tenderness on palpation in the...
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SubjectTerms 急性胆囊炎
粘膜下腫瘍
胃神経鞘腫
Title An Incidentally Diagnosed Gastric Schwannoma During Treatment of Acute Cholecystitis: A Case Report
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