Thoracoscopic Resection of an Esophageal Schwannoma Demonstrating a Malignant Pattern on Dual-Time-Point FDG-PET: A Case Report

TL;DR

A rare case of esophageal schwannoma showed high FDG uptake on PET scans, mimicking cancer, but was successfully treated with minimally invasive surgery after a biopsy confirmed it was benign.

Contribution

First reported case of esophageal schwannoma with a malignant FDG-PET pattern successfully treated via thoracoscopic surgery.

Findings

The schwannoma showed increased delayed FDG uptake, resembling malignancy on dual-time-point PET.

Thoracoscopic surgery confirmed a benign tumor with no tissue invasion and minimal complications.

No recurrence was observed at 6-month follow-up, supporting the effectiveness of the treatment approach.

Abstract

Esophageal schwannomas are rare benign tumors arising from Schwann cells and are among the least common mesenchymal neoplasms of the gastrointestinal tract. While fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in the preoperative assessment of submucosal tumors, schwannomas are known to exhibit unexpectedly high FDG uptake, often mimicking malignant lesions. Dual-time-point FDG-PET, which evaluates both early and delayed FDG accumulation, has been employed to improve diagnostic specificity in various malignancies, including esophageal cancer. However, to date, no cases of esophageal schwannomas showing a malignant FDG uptake pattern on dual-time-point FDG-PET and resected thoracoscopically have been reported. We present a rare case of esophageal schwannoma demonstrating increased delayed FDG uptake, initially suggestive of malignancy that was successfully treated with thoracoscopic surgery following preoperative diagnosis via EUS-FNA.

A 55-year-old woman was referred to our hospital for evaluation of an esophageal submucosal tumor detected during health screening. FDG-PET demonstrated a high uptake pattern (SUVmax; early; 9.4, delayed; 11.8) suggestive of malignancy. However, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed histopathological features consistent with a benign schwannoma. The patient underwent thoracoscopic enucleation, and the intraoperative findings confirmed a well-circumscribed tumor without invasion of the surrounding tissues. The procedure was completed within 2 h and 5 min with minimal blood loss. The final pathological diagnosis confirmed esophageal schwannoma. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. At the 6-month follow-up, no recurrence was observed.

This case highlights that even when dual-time-point FDG-PET suggests malignancy, thoracoscopic resection may be a viable treatment option for esophageal schwannoma if a benign diagnosis is supported by preoperative EUS-FNA. This underscores the importance of integrating metabolic imaging with histopathological assessment in surgical planning.

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