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Published on : Jul 28, 2021 | Views : 2702 | Downloads : 2

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Slide 1-

Radiological Imaging of Gastrointestinal tract Schwannoma Dr/ ABD ALLAH NAZEER.MD.
Slide 2-

Schwannoma represents 1% of tumors of the gastrointestinal tract and parts 2-8% mesenchymal tumors of the gastrointestinal. In patients with neurofibromatosis type 1 there gastrointestinal involvement in 10-25% of cases including: neurofibroma solitary leiomyoma and rarely plexiform neurofibroma. More and more frequently diagnosed by immunohistochemical stains. The average lesion size is 6-7 cm (range, 0.5 to 14 cm). They occur most often in the stomach (60-70% of cases), followed by colorectal, being exceptional in the small intestine and esophagus
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Gastric Represent 0.2% of gastric tumors, 4% of all benign gastric tumors with peak incidence between the fourth and fifth decade of life. It is usually asymptomatic, with incidental finding, although they are sometimes shaped symptomatic gastrointestinal ulceration and bleeding. Gastrointestinal schwannomas are distinctly different neoplasms from conventional soft-tissue and central nervous system schwannomas, some of which may be associated with neurofibromatosis 2. Most injuries TC are hypodense, well defined and standardized with homogeneous enhancement contrast, endoscopy can be checked exophytic nature of the injury. For RM, most of the lesions are iso/ hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences. The discrepancy in signal intensity between our T2-weight-ed images and those described in literature might be caused by the presence of melanin in the schwannoma.
Slide 4-

A 41-year-old female with a Schwannoma of the stomach. A. Unenhanced CT shows a well-defined extraluminal soft tissue mass with homogeneous density; B. Enhanced CT shows the neoplasm is of homogeneous enhancement.
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Schwannoma, Large exophytic soft tissue mass arising from the greater curvature of the stomach.
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Abdominopelvic computed tomography scans show a 1.5×1.0 cm sized homogenously-enhancing mass in the anterior wall of the duodenal bulb (arrow). (A) Axial section view. (B) Coronal section view.
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Schwannoma of the stomach.
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Pancreatic schwannoma is extremely rare with similar incidence in both genders. Pancreatic schwannoma is a slowly growing, encapsulated, benign neoplasm that typically arises in the peripheral epineurium of either the sympathetic or parasympathetic autonomic fibers or branches of vagus nerve that extend to the pancreas. Pancreatic schwannomas most frequently involve the pancreas head (40%), followed by body (21%), neck (6%), tail (15%), and uncinate process (13%), respectively. Patients with pancreatic schwannoma are usually asymptomatic, or have abdominal pain, nausea, and vomiting. Weight loss and jaundice may sometimes be seen. CT or MRI can help distinguish if a lesion is solid or cystic, can define the anatomic location of the lesion, delineate its relation to mesenteric vessels, and determine the lesion causes pancreatic duct dilation. The features of pancreatic schwannomas on CT scan include low-density and/or cystic degenerative areas. MR imaging usually shows hypointensity on T1-weighted images and hyperintensity on T2-weighted images but like the CT features, these findings are nonspecific. Two-thirds of pancreatic schwannomas undergo degenerative changes such as cyst formation, necrosis, calcification, and hemorrhage, and these changes can mimic pancreatic cystic tumors.
Slide 9-

60-year-old male with pancreatic schwannoma. A, B There is heterogeneously enhancing mass (arrows) in the pancreas uncinated process on arterial axial (A) and venous phase coronal (D) images. C, D On pathology, the mass showed cystic degeneration with hemorrhage (C H&E stain ×4) and was positive for S100 on immunohistostain (×10).
Slide 10-

40-year-old female with pancreatic schwannoma. A On venous phase axial CT, there is a round low-density cystic mass (arrow) in the pancreas neck. B On MRI axial T2WI, the cystic mass (arrow) shows small septations. C On post-contrast axial image of MRI, there is mild septal enhancement (arrow).
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Pancreatic schwannoma.
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Well-defined cystic lesion located in the retroperitoneal space under the cauda pancreatis slightly pushing it back and the adjacent jejunal loops. Distinct liquid T2 hypersignal of the tumour. a: injected CT-scan, coronal format; b: injected CT-scan, axial section; c: MRI in T2 weighting, axial plane.
Slide 13-

Pancreatic schwannoma showing increased FDG uptake on PET/CT.
Slide 14-

60-year-old female with peripancreatic schwannoma. A–C There is a well-circumscribed low-density solid mass (arrows) in the region of pancreas head/neck with central cystic degeneration/necrosis on arterial phase (A) and venous phase (B, C). Note vascularity in the solid portion of the mass seen inferiorly and mild upstream pancreatic duct dilation (C).
Slide 15-

Schwannomas that arise in the adrenal medulla are very rare. Often, schwannomas of the retroperitoneum, especially in the juxta-adrenal space, can be misdiagnosed as they can mimic more common primary adrenal lesions. Studies have shown that approximately 0.5% to 5% of schwannomas are retroperitoneal, constituting <0.2% of adrenal incidental tumors. Most of the patients do not have any symptoms and delayed diagnosis results in a significant size at the time of diagnosis. Both CT and MRI are nonspecific in diagnosis of adrenal schwannomas. Adrenal schwannomas often show septa and cystic change. Cystic changes are rare in other retroperitoneal tumors. Characteristic enhancement patterns of primary adrenal schwannomas are mild heterogeneous enhancement on arterial phase and progressive enhancement during the portal venous and equilibrium phases, which are likely due to variable degree of tumor cellularity or degenerative changes such as cystic degeneration, necrosis, and hemorrhage. Minimal contrast enhancement may be seen in neoplasms with low cellularity and edema. On MRI, schwannomas exhibit low-signal intensity on T1-weighted images and heterogeneous high-signal intensity on T2-weighted images
Slide 16-

50-year-old female with retroperitoneal/adrenal schwannoma. The mass (arrows) shows low- signal intensity on T1WI (A), high-signal intensity on T2WI (B, C), with cystic component, multiple internal septa, and surrounding capsule. After contrast enhancement (D, E), the mass (arrows) shows peripheral enhancing solid component.
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A giant spinal schwannoma mimicking a renal mass.
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70-year-old male with small bowel schwannoma. A, B There is an incidentally found homogeneously enhancing mass (arrows) in the ileal loop on venous phase CT (A) and contrast-enhanced MR (B). C FDG uptake is seen on fusion image of PET/CT. D, E On pathology, the neoplasm (arrow) abuts the jejunal wall on H&E stain (D ×4). The neoplasm involved the submucosa and muscularis propria. The mass was composed of a bland spindle cell proliferation with a prominent lymphoid cuff. Neoplastic cells are diffusely positive for S-100 protein (E ×20). The mass was negative for c-Kit, DOG1, and SMA
Slide 19-

Abdominal CT and MRI findings of the patient. a Plain CT scan revealed a 4.0 × 3.2 × 3.0-cm hypodense mass in the porta hepatis (black arrow). b Enhanced CT scan revealed a mildly enhanced mass in arterial phase (black arrow). c Moderately enhanced mass in portal phase (black arrow). d MRI revealed a 4.0 × 3.0-cm mass in the sagittal section (black arrow). e Low signal intensity in T1-weighted imaging (black arrow). f High signal intensity in T2-weighted imaging (black arrow).
Slide 20-

Multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder:
Slide 21-

Incidental finding in patients with a history of splenectomy. in hilum loculated liver, hypodense, cystic appearance without mass effect or biliary dilatation associated injury. Schwannoma hepatic hilum.
Slide 22-

Retroperitoneal schwannoma.
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Schwannoma, well-defined, retroperitoneal soft tissue mass in close proximity to the superior mesenteric vessels with a feeding vessel from the superior mesenteric artery (SMA) and venous drainage to the superior mesenteric vein (SMV).
Slide 24-

CT injected at portal time revealing this mass along the etroperitoneal vessels and the independent and slightly retaining aspect of the intestinal loops. Presence of a central necrosis and several microcalcifications. a: oblique coronal format; b: axial section.
Slide 25-

Retroperitoneal schwannoma.
Slide 26-

Giant retroperitoneal ancient schwannoma
Slide 27-

Giant ossified benign mesenteric schwannoma
Slide 28-

Abdominal wall Schwannoma. Color flow showing hypovascularity of the mass. B-mode ultrasound shows the well-encapsulated mass in anterior abdominal wall (arrow).
Slide 29-

Abdominal Wall Schwannoma
Slide 30-

MRI and CT analysis confirmed the retroperitoneal Schwannoma.
Slide 31-

PET (first line), CT (second line) images and PET-scan fusion (third line) objectifying the fixation of 18-FDG within the tissue zones of the mass.
Slide 32-

Pelvic MRI revealing the tumour in distinct T2 hypersignal (a) enhanced after injection (b), the lesion appearing well defined developed at the expense of the right L5 root. a: coronal section in T2 weighting; b: axial section in T1 fat-sat weighting after injection of gadolinium.
Slide 33-

Retrorectal tumor: a case report of a patient with "schwannoma.
Slide 34-

Ancient schwannoma. (a) Axial T2-weighted MR image shows a well-defined, complex cystic lesion with internal septa and solid components (arrow) in the left hemipelvis. (b) Axial postcontrast T1-weighted MR image reveals heterogeneous enhancement of the internal septa and solid components (arrow). Surgical excision and histopathologic analysis helped confirm the diagnosis of ancient schwannoma.
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Slide 36-

Pelvic schwannoma, Fat-suppressed T2-weighted coronal (A), sagittal (B), axial (C) postoperative tumor image. There was remained tumor and capsule on magnetic resonance image in the post-operative 7 months.
Slide 37-

Pelvic schwannoma. (a) Axial T2W fat-suppressed and (b) post-contrast fat-suppressed T1W images show a heterogeneously hyperintense area in T2W image due to microcytic spaces (arrowheads). Peripheral contrast enhancement is observed in post-contrast T1W image (curved arrows).
Slide 38-

Rectal schwannoma in 67-year-old woman. Sagittal T2-weighted image (A) and axial T1-weighted image (B) show well-circumscribed homogeneous submucosal mass (arrows) in lower rectum.
Slide 39-

Malignant Schwannoma of Anterior Abdominal Wall
Slide 40-

Thank You.