Asian Journal of Case Reports in Surgery

Aims: Here we present a case of Gastric Outlet Obstruction (GOO) with suspected Gastrointestinal Stromal Tumor (GIST) diagnosed as Gastric Schwannoma (GS) with post-operative histopathology.

Presentation of the case: 31-year-old female presented with complaints of epigastric lump for past 2 years with symptoms of partial GOO for 2 months. Pre-operative investigations were suggestive of a Sub-Mucosal Tumor (SMT), possibly GIST. Intra-operatively an exophytic, 10x10 cm tumor was seen arising from the antrum of stomach. A Distal Gastrectomy with reconstruction in the form of Roux-en-Y Gastro-Jejunostomy was done. Post-operative histopathology was suggestive of GS. The tumor cells were negative for CD-117 and CD-34. They tested positive for S-100.

Discussion: Schwannomas are rare, benign, slow growing tumors of the Gastrointestinal Tract (GIT). In the GIT they are most commonly seen originating from the nerve plexus in the submucosa of stomach. They comprise only 0.2% of all gastric tumors with noted female preponderance. They present with non-specific complaints and lack discrete characteristics on imaging which makes it difficult to distinguish them from other SMT’s such as leiomyoma and GIST. Histopathology with IHC for S-100 protein remains the gold-standard for diagnosis.

Conclusion: Not all SMT’s arising in the stomach are GIST’s. GS although a rare entity entails a much better prognosis without need of any peri-operative adjuvant or neoadjuvant therapy.