A case of thoracoscopically resected benign esophageal schwannoma with high uptake on FDG-PET

Abstract

We report a rare case of esophageal schwannoma with high uptake of radiotracer on [18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET). A 37-year-old woman underwent surgery for sarcoma of the uterus and received general PET examination for postoperative follow-up, which revealed high uptake at the thoracic esophagus. Esophagography, esophageal endoscopy, endoscopic ultrasonography, and computed tomography (CT) scan confirmed a submucosal tumor, about 20 mm in diameter, in the right wall of the upper thoracic esophagus. We performed thoracoscopic enucleation with the preoperative diagnosis of esophageal leiomyoma or gastrointestinal stromal tumor (GIST). Histopathological examination showed a trabecular arrangement of spindle cells and no evidence of mitosis. Immunohistochemical studies were positive for S-100 protein and negative for c-kit, whereby we diagnosed a benign esophageal schwannoma. Even if benign, schwannomas often show high uptake of FDG, so that the evaluation of whether the tumor is malignant should be made by histological diagnosis. Thoracoscopic resection is less invasive and a clinically useful approach to treat such submucosal tumors of the esophagus.