Research Papers: Pathology:
Peritumoral lymphoid cuff correlates well with lymph node enlargement in gastrointestinal schwannomas
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Hyunsik Bae1,*, Michael Van Vrancken2,*, Tae Wook Kang3, Ha Young Park4, Jinah Chu1, Hyung Kyu Park1, Sang Yun Ha1, Dongil Choi3 and Kyoung-Mee Kim1
1Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Pathology, Christian Hospital, St. Louis, Missouri, USA
3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4Department of Pathology, Inje University Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
*These authors contributed equally to this work
Kyoung-Mee Kim, email: [email protected]
Keywords: schwannoma; gastrointestinal tract; lymphoid cuff; lymphadenopathy; subepithelial tumor; Pathology
Received: November 01, 2017 Accepted: February 01, 2018 Published: February 09, 2018
Background/Aims: To determine the incidence of regional lymphadenopathy in gastrointestinal (GI) schwannoma and to evaluate the relationship between peritumoral lymphoid cuff and lymphadenopathy.
Methods: We queried 118 GI tract schwannomas and reviewed radiologic findings, intraoperative findings, and electronic medical records of all cases for enlarged regional lymph nodes.
Results: Location of tumors included 85 gastric (72%), 11 colonic (9.3%), 7 esophageal (5.9%), 3 pancreatic (2.5%), 1 hepatic (0.8%), and 11 mesenteric (9.3%). The size of the tumors ranged from 0.2 to 11 cm (mean 3.8 cm). Histologically, 70.3% showed a peritumoral lymphoid cuff ranging in thickness from 0.3 to 6 mm (mean 1.6 mm). The peritumoral lymphoid cuff was significantly more frequent in gastric schwannomas (78.8%) followed by colonic (72.7%), esophageal (57.1%) and rare in other locations (p = 0.001). Of the 106 cases for which clinical or radiologic data was available for, 76 cases (71.7%) showed regional lymphadenopathy. The presence of peritumoral lymphoid cuff showed significant correlation with regional lymphadenopathy (p < 0.001) and the size of enlarged lymph nodes (p = 0.002).
Conclusions: A peritumoral lymphoid cuff is frequently seen in GI tract schwannomas and correlates well with regional lymphadenopathy. However, in a significant subset (29.7%), a lymphoid cuff was not present warranting continued need for caution in the preoperative radiologic and postoperative pathologic diagnoses.
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