Ann Surg Treat Res.  2014 Sep;87(3):161-165. 10.4174/astr.2014.87.3.161.

Metachronous schwannoma in the colon with vestibular schwannoma

Affiliations
  • 1Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea. hwangcrc@kuh.ac.kr
  • 2Department of Pathology, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  • 3Department of Neurosurgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Abstract

We experienced a case of vestibular schwannoma and metachronous schwannoma in the colon. A 59-year-old female presented with a 1-month history of hematochezia. She had undergone suboccipital craniectomy resulting in radical subtotal resection, followed by gamma knife radiosurgery for a large left vestibular schwannoma 4 years prior to admission. On preoperative colonoscopy, a huge mass through which the colonoscope could not be passed was detected. CT scans showed colo-colonic intussusception with a 4.8-cm-sized mass in the descending colon. PET/CT revealed hypermetabolism of the descending colon tumor and pericolic lymph nodes. We performed left hemicolectomy under the preoperative impression of colon cancer with intussusception. A pathological diagnosis of benign schwannoma of the colon was made in this patient.

Keyword

Colon neurilemmoma; Schwannoma; Craniectomy; Gamma knife radiosurgery

MeSH Terms

Colon*
Colon, Descending
Colonic Neoplasms
Colonoscopes
Colonoscopy
Diagnosis
Female
Gastrointestinal Hemorrhage
Humans
Intussusception
Lymph Nodes
Middle Aged
Neurilemmoma*
Neuroma, Acoustic*
Positron-Emission Tomography and Computed Tomography
Radiosurgery
Tomography, X-Ray Computed

Figure

  • Fig. 1 Vestibular schwannoma on brain MRI. (A) T1 weighted image of vestibular schwannoma at the cerebello-pontine angle before neurosurgery. (B) T2 weighted image of vestibular schwannoma at the cerebello-pontine angle before neurosurgery. (C) T1 weighted image of residual vestibular schwannoma before Gamma-knife surgery. (D) T1 weighted image of residual vestibular schwannoma after Gamma-knife surgery.

  • Fig. 2 Pathologic findings of brain schwannoma. (A) The tumor shows typical microscopic appearance of a schwannoma. It is composed of spindle cells arranged in interlacing fascicles (Antoni A: cellular area, H&E: ×200) showing transition with loose meshwork of delicate collagen fibers (Antoni B: acellular area). (B) The tumor cells strongly and diffusely express the S-100 protein (×200).

  • Fig. 3 Intussuscepted tumor in the descending colon on preoperative colonoscopy.

  • Fig. 4 Preoperative radiologic imaging (A-C, CT; D, PET).

  • Fig. 5 (A, B) Gross features of colonic schwannoma.

  • Fig. 6 Pathologic findings of colonic schwannoma. (A) The tumor is composed of compact spindle cells arranged in interlacing fascicles (Antoni A: H&E, ×100). (B) In the other part, more loosely arranged, delicate collagen fibers are noted (Antoni B: H&E, ×100). Ectatic vessel with surrounding hyalinization is also noted. (C) The tumor cells strongly and diffusely express the S-100 protein (×100).


Reference

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