Acute Hemorrhage From Gastric Schwannoma: An Uncommon Presentation of a Rare Submucosal Neoplasm

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Introduction: Submucosal tumors of the GI tract, especially the stomach, are often asymptomatic and found incidentally. Gastric Schwannoma is one of the less commonly found gastric neoplasms and accounts for only 0.2% of all submucosal GI lesions. Schwannoma is most commonly found in females in their fourth to fifth decade and can be misinterpreted on imaging as a result of their similarity to other submucosal lesions. It is important for the clinician to maintain a broad differential diagnosis of these rare submucosal neoplasms, especially in the setting of acute upper GI hemorrhage, as demonstrated by the uncharacteristic presentation of our patient. We present the case of an 82-year-old Vietnamese male who underwent EGD for hematemesis and anemia. Endoscopy revealed a 3 cm donut shaped mass in the distal gastric body with central depression that bled upon contact. He underwent CT of the abdomen which revealed an 8 cm mass arising from the body suggestive of GIST. The patient underwent open surgical enucleation of the lesion without any complication. Histopathology of the lesion was consistent with gastric schwannoma. He recovered without complication and was discharged home and did well without any symptoms at 6 month follow-up. This patient represents a rare case of overt upper GI hemorrhage in a patient with a previously asymptomatic and unknown gastric schwannoma. It highlights the importance of maintaining a high suspicion for less common gastrointestinal neoplasms and rare causes of overt hemorrhage. This case also highlights that radiologic findings of schwannoma may share similarities with other types of GI neoplasms. In a less acute situation, it would be prudent to discern the type of lesion prior to pursuing a treatment strategy. In our case, further studies would find that our schwannoma was distinguished from GIST by immunohistochemistry which was positive for neural antigen S100 and negative for other markers such as CD34, CD117/KIT Receptor Tyrosine Kinase, and DOG, which are detected in GIST.Figure 1: Gastric schwannoma arising from gastric body.