Abstract
Background and study aims Data are lacking on the natural history of gastrointestinal tract schwannomas. We
aimed to study the natural history of all gastrointestinal schwannomas including location,
diagnosis, management, and long-term outcomes.
Patients and methods Patients with a pathological diagnosis of gastrointestinal schwannoma between January
2000 and March 2020 were identified. Data on baseline demographics, presentations,
associated malignancies, malignant transformation, treatment, and recurrence were
collected.
Results Our cohort consisted of 44 patients with a mean age of 58.6 years, with 63.6 % women
and 84.1 % White. The stomach (38.6 %) was the most common location followed by the
colorectum (31.8 %). Only 22.7 % of patients were symptomatic and 22.0 % had a personal
history of other malignancies. Tissue diagnosis was obtained via endoscopy in 47.7 %
and from surgical pathology in 52.3 %. On histology, 65.9 % of the tumors were solid,
11.4 % had mixed features, and 2.3 % had necrosis. SP100 was tested in all but one
patient and was positive in all. Mean Ki-67 in 12 patients with tumors measuring ≥ 2 cm
was 3.0 % indicating a low proliferation rate. Of the patients, 77.3 % had surgery
and 18.2 % underwent endoscopic resection. At a mean follow-up of 5.0 ± 4.31 years,
there was no malignant transformation, recurrence or mortality associated with gastrointestinal
schwannomas.
Conclusions Gastrointestinal schwannomas are diagnosed in the fifth to sixth decade with predominance
in women and Whites. They are benign, mostly asymptomatic, and diagnosed incidentally.
Asymptomatic gastrointestinal schwannomas including lesions ≥ 2 cm in size do not
appear to need further monitoring or intervention. Patients with them should be counseled
to remain up to date with routine screening guidelines pertaining to the colon, breast,
and lung cancer due to the high incidence of concomitant malignancy.
