Abstract
Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the “gold standard.” We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.
Similar content being viewed by others
References
Moriya T, Kimura W, Hirai I, et al. (2012) Pancreatic schwannoma: Case report and an updated 30-year review of the literature yielding 47 cases. World J Gastroenterol 18(13):1538–1544. doi:10.3748/wjg.v18.i13.1538
Almo KM, Traverso LW (2001) Pancreatic schwannoma: an uncommon but important entity. J Gastrointest Surg 5(4):359–363
Garcia G, Anfossi E, Prost J, et al. (2002) Benign retroperitoneal schwannoma: report of three cases. Progr Urol 12(3):450–453
Klimo P Jr, Rao G, Schmidt RH, Schmidt MH (2003) Nerve sheath tumors involving the sacrum. Case report and classification scheme. Neurosurg Focus 15(2):E12
Chetty R (2011) Reticular and microcystic schwannoma: a distinctive tumor of the gastrointestinal tract. Ann Diagn Pathol 15(3):198–201. doi:10.1016/j.anndiagpath.2010.02.011
Gupta A, Subhas G, Mittal VK, Jacobs MJ (2009) Pancreatic schwannoma: literature review. J Surg Educ 66(3):168–173. doi:10.1016/j.jsurg.2008.12.001
Ercan M, Aziret M, Bal A, et al. (2016) Pancreatic schwannoma: a rare case and a brief literature review. Int J Surg Case Rep 22:101–104. doi:10.1016/j.ijscr.2016.03.014
Suzuki K, Nakanishi A, Kurosaki Y, Nogaki J, Takaba E (2007) Adrenal schwannoma: CT and MRI findings. Radiat Med 25(6):299–302. doi:10.1007/s11604-007-0136-4
Weiss SW, Langloss JM, Enzinger FM (1983) Value of S-100 protein in the diagnosis of soft tissue tumors with particular reference to benign and malignant Schwann cell tumors. Lab Investig 49(3):299–308
Li S, Ai SZ, Owens C, Kulesza P (2009) Intrapancreatic schwannoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration cytology. Diagn Cytopathol 37(2):132–135. doi:10.1002/dc.20985
Bui TD, Nguyen T, Huerta S, Gu M, Hsiang D (2004) Pancreatic schwannoma. A case report and review of the literature. Jop 5(6):520–526
Sugiyama M, Kimura W, Kuroda A, Muto T (1995) Schwannoma arising from peripancreatic nerve plexus. AJR Am J Roentgenol 165(1):232. doi:10.2214/ajr.165.1.7785620
Novellas S, Chevallier P, Saint Paul MC, Gugenheim J, Bruneton JN (2005) MRI features of a pancreatic schwannoma. Clin Imaging 29(6):434–436. doi:10.1016/j.clinimag.2005.04.017
Hughes MJ, Thomas JM, Fisher C, Moskovic EC (2005) Imaging features of retroperitoneal and pelvic schwannomas. Clin Radiol 60(8):886–893. doi:10.1016/j.crad.2005.01.016
Kobayashi H, Kotoura Y, Sakahara H, et al. (1994) Schwannoma of the extremities: comparison of MRI and pentavalent technetium-99m-dimercaptosuccinic acid and gallium-67-citrate scintigraphy. J Nucl Med 35(7):1174–1178
Maeda N, Yoshida T, Higuchi Y (2000) A case of retroperitoneal schwannoma: diagnostic usefulness of magnetic resonance imaging. Hinyokika Kiyo 46(3):173–175
Cohen LM, Schwartz AM, Rockoff SD (1986) Benign schwannomas: pathologic basis for CT inhomogeneities. AJR Am J Roentgenol 147(1):141–143. doi:10.2214/ajr.147.1.141
Inokuchi T, Takiuchi H, Moriwaki Y, et al. (2006) Retroperitoneal ancient schwannoma presenting as an adrenal incidentaloma: CT and MR findings. Magn Reson Imaging 24(10):1389–1393. doi:10.1016/j.mri.2006.07.015
Beaulieu S, Rubin B, Djang D, et al. (2004) Positron emission tomography of schwannomas: emphasizing its potential in preoperative planning. AJR Am J Roentgenol 182(4):971–974. doi:10.2214/ajr.182.4.1820971
Hamada K, Tomita Y, Qiu Y, et al. (2009) (18)F-FDG PET analysis of schwannoma: increase of SUVmax in the delayed scan is correlated with elevated VEGF/VPF expression in the tumors. Skelet Radiol 38(3):261–266. doi:10.1007/s00256-008-0612-7
Miyake KK, Nakamoto Y, Kataoka TR, et al. (2016) Clinical, morphologic, and pathologic features associated with increased FDG uptake in schwannoma. AJR Am J Roentgenol 207(6):1288–1296. doi:10.2214/AJR.15.14964
Chen JM, Houle S, Ang LC, et al. (1998) A study of vestibular schwannomas using positron emission tomography and monoclonal antibody Ki-67. Am J Otol 19(6):840–845
Paranjape C, Johnson SR, Khwaja K, et al. (2004) Clinical characteristics, treatment, and outcome of pancreatic schwannomas. J Gastrointest Surg 8(6):706–712. doi:10.1016/j.gassur.2004.05.010
Kinhal VA, Ravishankar TH, Melapure AI, et al. (2010) Pancreatic schwannoma: report of a case and review of literature. Indian J Surg 72(Suppl 1):296–298. doi:10.1007/s12262-010-0112-6
Tofigh AM, Hashemi M, Honar BN, Solhjoo F (2008) Rare presentation of pancreatic schwannoma: a case report. J Med Case Rep 2:268. doi:10.1186/1752-1947-2-268
Eggermont A, Vuzevski V, Huisman M, De Jong K, Jeekel J (1987) Solitary malignant schwannoma of the pancreas: report of a case and ultrastructural examination. J Surg Oncol 36(1):21–25
Ferrozzi F, Bova D, Garlaschi G (1995) Pancreatic schwannoma: report of three cases. Clin Radiol 50(7):492–495
Yu RS, Sun JZ (2006) Pancreatic schwannoma: CT findings. Abdom Imaging 31(1):103–105. doi:10.1007/s00261-005-0345-1
Duma N, Ramirez DC, Young G, et al. (2015) Enlarging pancreatic schwannoma: a case report and review of the literature. Clin Pract 5(4):793. doi:10.4081/cp.2015.793
Mummadi RR, Nealon WH, Artifon EL, Fleming JB, Bhutani MS (2009) Pancreatic Schwannoma presenting as a cystic lesion. Gastrointest Endosc 69(2):341 (discussion 341). doi:10.1016/j.gie.2008.08.036
Scialpi M, Reginelli A, D’Andrea A, et al. (2016) Pancreatic tumors imaging: an update. Int J Surg 28(Suppl 1):S142–S155. doi:10.1016/j.ijsu.2015.12.053
Low G, Panu A, Millo N, Leen E (2011) Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics 31(4):993–1015. doi:10.1148/rg.314105731
Freelove R, Walling AD (2006) Pancreatic cancer: diagnosis and management. Am Fam Physician 73(3):485–492
Kuo TC, Yang CY, Wu JM, et al. (2013) Peripancreatic schwannoma. Surgery 153(4):542–548. doi:10.1016/j.surg.2012.08.066
Yu GH, Sack MJ, Baloch Z, Gupta PK (1999) Difficulties in the fine needle aspiration (FNA) diagnosis of schwannoma. Cytopathology 10(3):186–194
Hirabayashi K, Yasuda M, Umemura S, et al. (2008) Cytological features of the cystic fluid of pancreatic schwannoma with cystic degeneration. A case report. Jop 9(2):203–208
Feldman L, Philpotts LE, Reinhold C, Duguid WP, Rosenberg L (1997) Pancreatic schwannoma: report of two cases and review of the literature. Pancreas 15(1):99–105
Maneschg C, Rogatsch H, Bartsch G, Stenzl A (2001) Treatment of giant ancient pelvic schwannoma. Tech Urol 7(4):296–298
Zippi M, Pica R, Scialpi R, et al. (2013) Schwannoma of the rectum: a case report and literature review. World J Clin Cases 1(1):49–51. doi:10.12998/wjcc.v1.i1.49
Jacobson BC, Hirsch MS, Lee JH, et al. (2001) Multiple asymptomatic plexiform schwannomas of the sigmoid colon: a case report and review. Gastrointest Endosc 53(7):801–804. doi:10.1067/mge.2001.115317
Gallo SH, Sagatelian MA (1995) Benign schwannoma of the small intestine: an unusual cause of gastrointestinal bleeding. J Ky Med Assoc 93(7):291–294
Hesselfeldt-Nielsen J, Geerdsen JP, Pedersen VM (1987) Bleeding schwannoma of the small intestine: a diagnostic problem. Case report. Acta Chir Scand 153(10):623–625
Hong HS, Ha HK, Won HJ, et al. (2008) Gastric schwannomas: radiological features with endoscopic and pathological correlation. Clin Radiol 63(5):536–542. doi:10.1016/j.crad.2007.05.026
Jung MK, Jeon SW, Cho CM, et al. (2008) Gastric schwannomas: endosonographic characteristics. Abdom Imaging 33(4):388–390. doi:10.1007/s00261-007-9291-4
Levy AD, Quiles AM, Miettinen M, Sobin LH (2005) Gastrointestinal schwannomas: CT features with clinicopathologic correlation. AJR Am J Roentgenol 184(3):797–802. doi:10.2214/ajr.184.3.01840797
Choi JW, Choi D, Kim KM, et al. (2012) Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT. Korean J Radiol 13(4):425–433. doi:10.3348/kjr.2012.13.4.425
Sarlomo-Rikala M, Miettinen M (1995) Gastric schwannoma—A clinicopathological analysis of six cases. Histopathology 27(4):355–360
Patil DT, Rubin BP (2011) Gastrointestinal stromal tumor: advances in diagnosis and management. Arch Pathol Lab Med 135(10):1298–1310. doi:10.5858/arpa.2011-0022-RA
Komatsu D, Koide N, Hiraga R, et al. (2009) Gastric schwannoma exhibiting increased fluorodeoxyglucose uptake. Gastric Cancer 12(4):225–228. doi:10.1007/s10120-009-0526-7
Fujiwara S, Nakajima K, Nishida T, et al. (2013) Gastric schwannomas revisited: has precise preoperative diagnosis become feasible? Gastric Cancer 16(3):318–323. doi:10.1007/s10120-012-0186-x
Yap J, Huang YT, Lin M (2015) Detection of synchronous gastric schwannoma on FDG PET/CT aided by discordant metabolic response. Clin Nucl Med 40(5):e287–e289. doi:10.1097/RLU.0000000000000724
Gossios K, Katsimbri P, Tsianos E (2000) CT features of gastric lymphoma. Eur Radiol 10(3):425–430. doi:10.1007/s003300050069
Wani HU, Al Omair A, Al Shakweer W, Ahmed B (2010) Schwannoma of the ascending colon with ileocolic intussusception. Trop Gastroenterol 31(4):337–339
Catania G, Puleo C, Cardi F, et al. (2001) Malignant schwannoma of the rectum: a clinical and pathological contribution. Chir Ital 53(6):873–877
Genna M, Leopardi F, Fambri P, Postorino A (1997) Neurogenic tumors of the ano-rectal region. Ann Ital Chir 68(3):351–353 (discussion 353–354)
Kasperlik-Zaluska AA, Roslonowska E, Slowinska-Srzednicka J, et al. (2006) 1,111 patients with adrenal incidentalomas observed at a single endocrinological center: incidence of chromaffin tumors. Ann N Y Acad Sci 1073:38–46. doi:10.1196/annals.1353.004
Zhang YM, Lei PF, Chen MN, et al. (2016) CT findings of adrenal schwannoma. Clin Radiol 71(5):464–470. doi:10.1016/j.crad.2016.01.010
Liu QY, Gao M, Li HG, et al. (2012) Juxta-adrenal schwannoma: dynamic multi-slice CT and MRI findings. Eur J Radiol 81(4):794–799. doi:10.1016/j.ejrad.2011.01.082
Kim SH, Choi BI, Han MC, Kim YI (1992) Retroperitoneal neurilemoma: CT and MR findings. AJR Am J Roentgenol 159(5):1023–1026. doi:10.2214/ajr.159.5.1414767
Kinoshita T, Naganuma H, Ishii K, Itoh H (1998) CT features of retroperitoneal neurilemmoma. Eur J Radiol 27(1):67–71
Mohiuddin Y, Gilliland MG (2013) Adrenal schwannoma: a rare type of adrenal incidentaloma. Arch Pathol Lab Med 137(7):1009–1014. doi:10.5858/arpa.2012-0291-RS
Rha SE, Byun JY, Jung SE, et al. (2003) Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics 23(1):29–43. doi:10.1148/rg.231025050
Adas M, Ozulker F, Adas G, et al. (2013) A rare adrenal incidentaloma: adrenal schwannoma. Case Rep Gastroenterol 7(3):420–427. doi:10.1159/000355871
Richter KK, Premkumar R, Yoon HS, Mercer P (2011) Laparoscopic adrenalectomy for a rare 14-cm adrenal schwannoma. Surg Laparosc Endosc Percutan Tech 21(6):e339–e343. doi:10.1097/SLE.0b013e31823ac4d4
Xiao C, Xu B, Ye H, et al. (2011) Experience with adrenal schwannoma in a Chinese population of six patients. J Endocrinol Invest 34(6):417–421. doi:10.1007/BF03346705
Fu H, Lu B (2015) Giant retroperitoneal schwannoma: a case report. Int J Clin Exp Med 8(7):11598–11601
Gu L, Liu W, Xu Q, Wu ZY (2008) Retroperitoneal schwannoma mimicking hepatic tumor. Chin Med J (Engl) 121(17):1751–1752
Jakowski JD, Wakely PE Jr, Jimenez RE (2008) An uncommon type of adrenal incidentaloma: a case report of a schwannoma of the adrenal medulla with cytological, histological, and ultrastructural correlation. Ann Diagn Pathol 12(5):356–361. doi:10.1016/j.anndiagpath.2008.06.003
Shoji F, Maruyama R, Okamoto T, et al. (2005) Malignant schwannoma of the upper mediastinum originating from the vagus nerve. World J Surg Oncol 3:65. doi:10.1186/1477-7819-3-65
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Statement of informed consent was not applicable since the manuscript does not contain any patient data.
Additional information
This article is based on poster presentation at ARRS annual meeting April 30–May 5, 2017, New Orleans, LA, USA.
Rights and permissions
About this article
Cite this article
Lee, N.J., Hruban, R.H. & Fishman, E.K. Abdominal schwannomas: review of imaging findings and pathology. Abdom Radiol 42, 1864–1870 (2017). https://doi.org/10.1007/s00261-017-1088-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-017-1088-5