ABSTRACT
When a gastric mass is encountered, the surgeon must make the decision to resect the lesion or stop the surgery (for less morbidity) and discuss the best treatment. it’s rare to find mesenchymal gastric tumors during bariatric procedures, specially gastric schwannomas (GS). 57-year-old woman with hypertension and diabetes under treatment, body mass index (BMI) of 36 kg/m2, referring difficulties to lose weight with diet and physical activity. The patient underwent a Roux-en-Y gastric bypass (RYBG) with a wedge resection of a gastric nodule in the anterior wall of the incisura angularis. The immunohistochemistry (IHC) staining was strongly positive for S100, whereas c-kit (CD117), CD45, smooth muscle action (SMA), AE1/AE3 were negative. Hence, a final diagnosis of gastric schwannoma was made. GS should be included in the differential diagnosis of gastric nodules. We also present a surgical option to treat obese patients with gastric nodules during the bariatric procedure.
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A and B) shows microscopic examination with fusocellular stromal tumor with mild atypias associated with lymphoid component. No mitotic activity and no necrosis were identified; C) IHC staining and CD45 negative; D) strongly positive for S100; E) SMA negative; F) Ki-67 of 5%.IHC: immunohistochemistry; SMA: smooth muscle actin.
A) ectopic gastric mucosa in the distal part esophagus; B and C) elevated and covered with normal mucosa with 20 mm in the anterior wall of the incisura angularis suggesting subepithelial lesion; mild antral gastritis.