Benign esophageal schwannoma

Rationale: Schwannoma is a tumor of the peripheral nervous system that originated in the Schwann cells of the neural sheath. Esophageal schwannomas are rare esophageal submucosal tumors, comprising approximately 2% of esophageal tumors. Since the symptoms, signs, and images of esophageal schwannoma are not specific, its preoperative diagnosis remains challenging. Patient concerns: A 67-year-old woman visited our department with complaints of gradually developed dysphagia and dyspnea for 4 years. A chest computed tomography scan showed a well-demarcated, enhancing homogeneous tumor measuring 61 × 46 × 60 mm in the upper third of the esophagus. Upper gastrointestinal endoscopy revealed a smooth elevated lesion located 19 to 24 cm from the incisor teeth. An endoscopic ultrasound-guided fine-needle aspiration demonstrated the presence of benign spindle cells. Diagnoses: Histopathologic examination revealed spindle-shaped cells in a fasciculated and disarrayed architecture. The immunohistochemical study showed positivity for S-100 protein antibody and absence of staining for CD117, CD34, smooth muscle actin, and Desmin. These findings confirmed the diagnosis of benign esophageal schwannoma. Interventions: The tumor was considered to be difficult to repair the esophagus by direct anastomosis after tumor resection. Therefore, subtotal esophagectomy and esophagogastrostomy in the right thorax were performed. Outcomes: The patient has been doing well with no recurrence at 36 months after the operation. Lessons: The symptoms and surgical procedures for benign esophageal schwannoma depend on the size and location of the tumor, proper and timely treatment is essential. A definitive diagnosis is confirmed by histology, and complete excision should yield good results.