Muhammad Aurangzeb.
An unusual case of Gastric Schwannoma.
J Coll Physicians Surg Pak Jan ;7(2):80-1.

Massive Schwannomas arising from the abdominal viscera are exceedingly rare. The case of a young male is reported who presented with a significant upper abdominal mass. Subsequent surgery and histopathology revealed a huge benign Schwannoma measuring 22 by 20 cm in the lesser sac adherent to the lesser curvature of the stomach. After a review of the literature and to the best of our knowledge it appears that a visceral benign Schwannoma of this proportion has never been reported.

Case Report: A 24-year old man presented with an eight-month history of a steadily increasing mass in his upper abdomen. This had recently started causing dragging discomfort and postprandial fullness. He was otherwise in a relatively good state of health. On examination he had an enormous abdominal mass, roughly 25 X 25 cms, filling the epigastrium which was nontender with transmitted pulsations. There was some mobility with respiration. General physical examination and review of other systems were normal. Routine investigations including serum amylase and liver function tests were all normal. An ultrasonographic examination revealed a complex mass, partially cystic and related to the left lobe of the liver. A contrast enhanced CT scan showed a similar lesion related to the left lobe of the liver (Figs. 1 and 2), with a differential diagnosis of a cavernous haemangioma, pancreatic pseudocyst, or a pancreatic tumour. The patient underwent an exploratory laparotomy via an extended upper midline incision. He was found to have a huge mass in the lesser sac with the stomach stretched over it. Access was gained to the mass via the gastrocolic omentum. Using both blunt and sharp dissection, the mass was ultimately mobilized to its final point of attachment to the lesser curvature of the stomach. This was finally carved out with repair of the lesser curvature. The specimen measured 22 X.20 cms. Histopathology of the lesion reported a benign Schwannoma with cystic degeneration. The patient made an excellent postoperative recovery and was discharged on the sixth postoperative day.

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