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      Appendicular schwannoma presenting as vague abdominal pain

      case-report

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          Abstract

          Appendicular schwannomas are very rare condition with nonspecific clinical symptoms and frequently recognized during pathological examination. They arise less frequently in the gastrointestinal tract and comprise ~1% of all malignant gastrointestinal tumours. We presented a rare case of an appendicular schwannoma that was discovered incidentally in a 25-year-old student diagnosed with appendicular mucocoele with a suspected obstructing tumoural lesion based on computed tomography findings. A colonoscopy examination showed a bulging, nodular, erythematous lesion at the base of the caecum (appendiceal orifice). Biopsies showed mixed inflammatory infiltration in the lamina propria, with lymphoid-filled formations. No evidence of dysplasia or neoplasia. Tumour markers were negative. Appendicular neoplasms, such as schwannomas of the appendix, are rarely associated with nonspecific clinical symptoms and are frequently recognized during pathological examination of the resected appendix. Laparoscopic surgery with a clear resection margin is the cornerstone of treatment for appendicular schwannoma, and it is associated with a favourable prognosis.

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          Most cited references8

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          Gastric schwannoma. Clinical and pathologic considerations.

          Solitary gastric schwannomas are rare clinical entities. Presented are three cases encountered in a single hospital in a 4.5-year period. Solitary gastric schwannomas represent a small percentage of schwannomas and a small percentage of gastric tumors. These tumors are usually asymptomatic and may present as upper gastrointestinal bleeding or as mass lesions. Upper endoscopy is important in the initial evaluation of these patients. Pathologic diagnosis is based on features of palisading nuclei, spindle-cell morphology, and hyalinized vessels. Immunohistochemical stains and electron microscopy may be helpful for diagnosis. Complete excision of the tumor is adequate treatment. The risks of coexistent malignancies have not been stressed, but this association may be important; therefore, we recommend a diligent search for other tumors. Prognosis following treatment is good.
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            Abdominal schwannomas: review of imaging findings and pathology.

            Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the "gold standard." We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.
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              Incidence of acute appendicitis in patients with equivocal CT findings.

              The purpose of our study was to determine the incidence of acute appendicitis in patients for whom the CT interpretation is deemed equivocal. Of 1,344 patients referred for CT with suspected appendicitis between January 1998 and December 2002, 172 patients were identified in whom the radiographic findings were equivocal. Two radiologists reviewed the equivocal CT cases, reassessing appendiceal size and the presence of right lower quadrant stranding, fluid, or an appendicolith. The reviewers' findings were correlated with surgical pathology reports and clinical follow-up. Fifty-three (31%) of 172 patients with indeterminate findings on CT scans were subsequently diagnosed with appendicitis. For reviewers 1 and 2, respectively, appendicitis was present in five (14%) of 36 and six (13%) of 47 patients who had isolated appendiceal diameter less than 9 mm, and in 11 (52%) of 21 and in 10 (50%) of 20 patients who had isolated appendiceal dilatation equal to or greater than 9 mm. If a normal diameter appendix (< 6 mm) was visualized in a patient who had right lower quadrant stranding or fluid, appendicitis was present in only one (17%) of six and in four (27%) of 15 patients for reviewers 1 and 2, respectively. If the appendix could not be identified but there was right lower quadrant stranding or fluid, appendicitis was present in seven (37%) of 19 and in eight (53%) of 15 patients. Appendicitis is encountered in about 30% of patients with equivocal findings on CT, and the diagnosis should be considered in most of these patients if they are appropriately symptomatic. However, when the appendix measures less than 9 mm alone, the likelihood of appendicitis is much smaller.
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                Author and article information

                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                Journal of Surgical Case Reports
                Oxford University Press
                2042-8812
                July 2018
                03 July 2018
                03 July 2018
                : 2018
                : 7
                : rjy149
                Affiliations
                General Surgery Department, Security Forces Hospital Program, Riyadh, Saudi Arabia
                Author notes
                Correspondence address. General Surgery Department, Security Forces Hospital Program, PO Box 3643, Riyadh 11481, Saudi Arabia. Tel: +966-555085459; E-mail: jaguar656@ 123456gmail.com
                Article
                rjy149
                10.1093/jscr/rjy149
                6031008
                66eb473e-dcbf-4b2e-8931-2c2cf67b3207
                Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2018.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 April 2018
                : 08 June 2018
                Page count
                Pages: 3
                Categories
                Case Report

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