Rare but Revealing: Divergent Diagnostic and Management Pathways in Gastric Schwannoma - A Case Series
Abstract:
Gastric schwannomas are uncommon mesenchymal tumours of the gastrointestinal tract. They are frequently mistaken for other subepithelial gastric lesions, particularly gastrointestinal stromal tumours (GISTs), due to overlapping clinical, endoscopic, and radiological features. This diagnostic overlap creates uncertainty in preoperative decision making and management. In contrast to the extensive literature on GISTs, gastric schwannomas remain poorly characterised owing to their rarity. We describe two patients with gastric schwannoma who presented with markedly different clinical scenarios, including an infrequent diagnosis during pregnancy. A retrospective review of clinical presentation, imaging findings, operative strategies, histopathological characteristics, and postoperative outcomes was performed. Surgical management was individualised based on tumour characteristics and patient-specific considerations. In both cases, histopathology demonstrated spindle cell tumours with diffuse S-100 positivity and absence of CD117 and DOG-1 expression, confirming the diagnosis of gastric schwannoma. Postoperative recovery was uneventful, and no recurrence was observed during six-monthly follow-up. This case series underscores the importance of including gastric schwannoma in the differential diagnosis of gastric subepithelial tumours and highlights the need for tailored surgical strategies, particularly in complex contexts such as pregnancy.
