Our Summary

Schwannomas are rare tumors that sometimes develop in the digestive system, most commonly in the small and large intestines. This study involves an 87-year-old woman who was experiencing stomach pain and indigestion. Scans and a colonoscopy revealed a tumor in her sigmoid colon, the part of the large intestine closest to the rectum and anus. The doctors removed the tumor using a procedure called a laparoscopic sigmoidectomy, which is a minimally invasive surgery.

The challenge in diagnosing this type of tumor is that it grows beneath the lining of the intestines, meaning it can’t be detected by a simple biopsy. This makes it harder to distinguish from other types of tumors like GIST (gastrointestinal stromal tumors) or leiomyoma (smooth muscle tumors).

By using a test called immunohistochemistry, which looks at how certain proteins react in the tumor cells, the doctors can confirm the diagnosis. If the tumor is positive for a protein called S-100 and negative for several other proteins, it’s likely a schwannoma.

In conclusion, diagnosing schwannomas is a complex process. These tumors often don’t cause any symptoms and don’t show up clearly on scans. The key to confirming a diagnosis is a positive S-100 result on an immunohistochemistry test.

FAQs

  1. What is a schwannoma tumour and where is it commonly developed?
  2. How is a schwannoma diagnosed from other mesenchymal tumors?
  3. What is the role of an S-100 positive immunohistochemistry in diagnosing a schwannoma?

Doctor’s Tip

A helpful tip a doctor might give a patient about sigmoidectomy for a schwannoma in the sigmoid colon is to follow all post-operative care instructions carefully to ensure proper healing and recovery. This may include taking prescribed medications, following a specific diet, and avoiding strenuous activities. It is also important to attend follow-up appointments with your healthcare provider to monitor your progress and address any concerns.

Suitable For

Patients who are typically recommended sigmoidectomy for schwannomas in the sigmoid colon are those who present with symptoms such as epigastric pain and dyspepsia, as well as those with radiological findings suggestive of a neoplastic process in the sigmoid colon. Additionally, patients who have undergone colonoscopy and have a confirmed diagnosis of schwannoma based on histological and immunohistochemistry studies may also be recommended for sigmoidectomy. It is important to differentiate schwannomas from other mesenchymal tumors such as GIST or leiomyoma in order to determine the appropriate treatment approach.

Timeline

  • The patient experiences epigastric pain and dyspepsia, leading to a CT scan and colonoscopy which reveal a neoplastic process in the sigmoid colon.
  • Oncologic laparoscopic sigmoidectomy is performed to remove the tumor.
  • Histological study confirms the presence of a schwannoma, with positive immunohistochemistry to S-100.
  • The diagnostic challenge lies in differentiating schwannoma from other mesenchymal tumors like GIST or leiomyoma, as endoscopy biopsies only reach the mucosa.
  • Immunohistochemistry plays a crucial role in confirming the diagnosis, with positive S-100 and negative C-KIT, CD-34, actine, and desmin markers helping distinguish schwannoma.
  • Schwannomas are typically asymptomatic with nonspecific radiological findings, making diagnosis difficult without histological confirmation.

What to Ask Your Doctor

  1. What is a sigmoidectomy and why is it being recommended for me?
  2. What are the potential risks and complications associated with a sigmoidectomy?
  3. How long is the recovery process after a sigmoidectomy and what can I expect during this time?
  4. Will I need any follow-up appointments or tests after the surgery?
  5. Are there any dietary or lifestyle changes I should make before or after the surgery?
  6. What is the likelihood of the tumour being malignant or recurring after the surgery?
  7. How will the schwannoma diagnosis affect my long-term health and well-being?
  8. Are there any alternative treatment options for schwannoma besides surgery?
  9. Can you explain the results of the histological study and what they mean for my condition?
  10. Is there anything else I should know about my condition or the treatment plan moving forward?

Reference

Authors: de Armas Conde M, Soto Sánchez A, Hernández Barroso M, Díaz Jiménez N, Pérez Sánchez LE, Hernández Hernández G, Barrera Gómez MÁ. Journal: Rev Esp Enferm Dig. 2022 Aug;114(8):499-500. doi: 10.17235/reed.2022.8684/2022. PMID: 35285666