Unconvincing Diagnosis of a Rare Subtype of Primary Gastric Lymphoma with Incongruent Endoscopic Presentation: A Case of Gastric Schwannoma

Seung Soo Lee; In Ho Kim

doi:10.4166/kjg.2013.62.6.359

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Lee and Kim: Unconvincing Diagnosis of a Rare Subtype of Primary Gastric Lymphoma with Incongruent Endoscopic Presentation: A Case of Gastric Schwannoma

Case Report

Korean J Gastroenterol 2013;62(6):359-364.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.6.359

Unconvincing Diagnosis of a Rare Subtype of Primary Gastric Lymphoma with Incongruent Endoscopic Presentation: A Case of Gastric Schwannoma

Seung Soo Lee, In Ho Kim¹

Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea

¹Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea

Correspondence to: In Ho Kim, Department of Surgery, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-3206, Fax: +82-53-624-7185, E-mail: ihkim@cu.ac.kr

Received 3 April 2013 Revised 8 May 2013 Accepted 17 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary gastric lymphoma is a rare gastric malignancy. Its diagnostic process is complex. Clinician may find initial diagnosis of primary gastric lymphoma unreliable, especially when it indicates the rarest subtype of gastric lymphoma, while its initial endoscopic presentation fails to raise the slightest suspicion of primary gastric lymphoma. A 53-year-old Korean man was diagnosed, by endoscopic examination, with a round submucosal tumor of the stomach. Deep endoscopic biopsy, however, confirmed CD5 positive gastric lymphoma. Surgical treatment was performed for diagnosis and treatment. Postoperative histological examination confirmed gastric schwannoma. Gastric schwannoma is a spindle cell tumor, characterized by a peripheral cuff-like lymphocytic infiltration. Deep endoscopic biopsy may have been misdirected to the peripheral lymphoid cuff, failing to acquire spindle cells. The literature has been reviewed, and options for diagnostic accuracy have been suggested.

Keywords: Lymphoma, B-cell, marginal zone, Neurilemmoma, Stomach neoplasms

References

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Fig. 1.

Endoscopic and EUS images taken in its initial presentation. (A) A 2.5 cm sized round mass was located at the greater curvature of the gastric antrum. (B) On EUS, the homogenous hypoechoic mass originated from the fourth layer.

Fig. 2.

Histopathological and immunohistochemical findings of specimen from deep endoscopic biopsy. (A) Multiple pieces of gastric mucosa show heavy infiltration of lymphoid tissue, without normal gastric mucosa structure (H&E, ×40). (B) Small round lymphoid tissue infiltrates in the gastric mucosa, and entraps a few small vessels (H&E, ×200). (C) Immunohistochemical stains show positive reaction for CD5 and CD20(×100), but no reaction for CD23 and cyclin D1 (×200), in crushed lymphoid lesion.

Fig. 3.

Abdominal computed tomographic scan. A round exophytic submucosal mass was located in the gastric antrum (arrow). Effervescent granules were used for gastric distension.

Fig. 4.

Cross-section of the tumor, showing a white firm mass below the intact mucosal layer. The mass originated from the muscularis propria, occupying the submucosal and subserosal layers, as well.

Fig. 5.

Postoperative histopathological findings of surgically removed specimen (H&E). (A) The tumor was a well-circumscribed ovoid in shape (×10). (B) Infiltration of lymphoid tissue was shown in the peripheral area of the tumor (single arrow), not as in the central area of the tumor (double arrow) (×40). (C) Lymphoid cuffing was present in the peripheral area of the tumor (×200). (D) The central area of the tumor consisted of wavy spindle cells (×200).

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