Abstract
Gastric schwannoma (GS) is an infrequent, indolent, and predominantly benign neurogenic tumor, often identified incidentally due to the lack of specific symptoms in patients. During clinical evaluation, these lesions are commonly misidentified as gastric stromal tumors owing to the higher prevalence of the latter. In recent years, standard diagnostic techniques for GS have encompassed abdominal CT, abdominal MRI, gastroscopy, and gastric contrast-enhanced ultrasound. This report details a case of GS initially identified through gastric filling contrast-enhanced ultrasound (GF-CEUS) and intravenous contrast-enhanced ultrasound (IV-CEUS) with definitive diagnosis achieved via postoperative histopathological and immunohistochemical specimen analysis. Findings from this case underscore the substantial diagnostic value of using dual contrast-enhanced ultrasound for the preliminary identification of GS.
1 Introduction
Gastric schwannomas (GS) are neurogenic tumors that originate from Schwann cells, primarily located in the muscularis or submucosa of the gastric wall. These tumors are classified as rare and benign (1, 2). They most frequently appear in the gastric body, with rarer occurrences in the antrum or cardia (2). The prognosis following surgical resection of GS is typically favorable. However, due to the lack of distinctive imaging and clinical features, preoperative diagnosis remains challenging, often leading to confusion with other lesions such as gastrointestinal stromal tumors (GISTs), leiomyomas, and lipomas (1–3). This report presents a case involving a 40-year-old woman diagnosed with a GS. This study is covered by the hospital’s general primary ethical review approval for retrospective clinical research, and patient informed consent was obtained prior to this primary review. A separate secondary case-specific ethical review has been waived for this report, as all clinical data are fully anonymized.
2 Case description
A 40-year-old woman presented with a 1-month history of abdominal pain and discomfort. She reported no weight loss and had not traveled recently. Her past health was otherwise unremarkable, and she had no family history of gastrointestinal or inherited disorders. After the symptoms started, she took a low-dose proton pump inhibitor for a short period. On examination, she was hemodynamically stable; her abdomen was soft and non-tender, with no rebound or guarding. We saw no jaundice, palpable lymph nodes, or other systemic findings. Routine blood work, liver function tests, and an electrocardiogram all fell within normal limits. Upper gastrointestinal endoscopy identified chronic superficial gastritis, a submucosal elevation at the gastric angle, and a polyp in the cardia, which, upon biopsy, was confirmed as an inflammatory polyp. Gastric filling contrast-enhanced ultrasound (GF-CEUS) was conducted using a multi-frequency convex array transducer. Following the oral administration of 500 ml of contrast agent, grayscale ultrasound revealed a hemispherical hypoechoic nodule within the muscularis propria near the gastric angle on the lesser curvature, protruding into the gastric lumen. The nodule measured approximately 37×32×28 mm, displaying a regular shape, clear margins, and posterior acoustic attenuation (Figure 1). During intravenous contrast-enhanced ultrasound (IV-CEUS), the transducer was positioned subxiphoidally and directed at the lesion. After a rapid bolus injection of 2.5 mL of SonoVue suspension into the left median elbow vein, the lesion began enhancing in the arterial phase (14 s) (Figure 2A), exhibited uniform progressive enhancement at 23 s (Figure 2B), and the enhancement began to fade during the portal venous phase (33 s). Ultrasound features of small GS and GISTs are similar, typically appearing as hypoechoic solid masses with circumscribed borders and homogeneous internal echogenicity. As tumor size increases, GISTs frequently become irregular in contour and are predisposed to liquefactive necrosis, resulting in heterogeneous enhancement on contrast-enhanced ultrasonography. Conversely, GS generally retain a more regular configuration, occasionally demonstrate cystic degeneration or calcification, and exhibit homogeneous contrast uptake. Based on these distinctive sonographic differences, GS were considered the leading initial diagnosis in the present case.
Figure 1
Figure 2
We chose surgery for this patient because GS can only be confirmed by immunohistochemistry. After talking it over, the patient and family agreed. The tumor sat in a good spot, with clear edges, so we opted for laparoscopic wedge resection. This method causes less tissue damage, fewer post-op problems, and a faster recovery. Before the operation, we checked the patient’s overall health. We ran a complete blood count, blood chemistry, clotting tests, heart and lung function, and tumor marker panels. Nothing suggested any anesthesia risks. We also thought through every possible complication that might arise during or after surgery. When we looked inside with the laparoscope, we found a firm, well-defined mass about 4×3 cm on the front wall of the stomach, right where the antrum meets the body. We cut it out with a 3-cm margin of healthy tissue and sent it to the lab. Hematoxylin-eosin staining (Figures 3A, B) and diffuse S-100 staining (Figure 4) proved it was a schwannoma. The operation went smoothly; blood loss was minimal, and vitals stayed stable all through. Afterward, the patient did well. No leakage from the anastomosis or other problems occurred. She went home on day 10. We then set up regular check-ups: at 3 months, at 6 months, and then every year. A gastroscopy at 6 months showed no recurrence. At her latest visit, she felt perfectly fine. Table 1 gives a step-by-step timeline of how we diagnosed and treated this case.
Figure 3
Figure 4
Table 1
| Event | Time point | Principal findings |
|---|---|---|
| Symptom onset | 1 month prior to admission | A 40-year-old woman presented with abdominal pain/discomfort. Physical examination and routine laboratory tests were unremarkable. |
| Upper gastrointestinal endoscopy | Pre-admission | Chronic superficial gastritis; submucosal protuberance at the gastric angle; cardia polyp (biopsy-proven inflammatory). |
| DCEGU | Day 0 | Well-circumscribed hypoechoic nodule (37×32×28 mm) within the gastric wall with homogeneous enhancement, suggestive of GS. |
| Preoperative workup | Day 1–2 | All parameters within normal limits; no surgical contraindications. |
| Surgery | Day 3 | Laparoscopic wedge resection; complete excision with 3-cm safety margin. |
| Pathology | Day 5-6 | Microscopic HE morphology and diffuse S-100 positivity confirmed GS. |
| Discharge | Day 10 | Uneventful recovery; no bleeding, anastomotic leakage, or intra-abdominal infection. |
| Follow-up | 6 months post-surgery | Patient asymptomatic; no recurrence detected on endoscopy or imaging studies. |
Chronological itinerary of clinical assessment, imaging characterization, surgical resection, histopathological confirmation, and postsurgical surveillance.
3 Discussion
Daimaru and colleagues first described GS in 1988 (4). GS arise from Schwann cells in the gastric wall’s nerve plexus. They are benign and slowly progressive. These neoplasms represent roughly 0.2% of all gastric neoplasms and about 4% of benign gastric masses (1, 5). They also constitute 6.3% of all mesenchymal tumors arising in the stomach (6). Clinically, GS frequently resemble other gastric lesions, particularly GISTs. Currently, several imaging tools—standard endoscopy, endoscopic ultrasound (EUS), CT, MRI, and contrast-enhanced ultrasound—can be used to evaluate gastric tumors. Among these, conventional endoscopy remains the first-line tool because of its high sensitivity and specificity—it allows direct viewing of the lesion and easy biopsy sampling for histology (7). However, this method is invasive and usually requires sedation or general anesthesia to keep patients comfortable, which adds extra risks (8). Elderly patients often tolerate gastroscopy poorly, largely owing to age-related frailty, coexisting illnesses, and psychological factors (9). GF-CEUS has emerged from recent refinements in high-resolution color Doppler ultrasound. After oral intake of a contrast agent, GF-CEUS can clearly depict the layered structure of the gastric wall and the characteristics of any lesion. It is simple, safe, and noninvasive, and it allows multi-angle, multi-plane observations, providing information on tumor size, shape, internal echotexture, relation to nearby structures, and vascularity. Earlier reports have suggested that GF-CEUS may be a useful adjunct for assessing gastric diseases (10–12). When GF-CEUS is combined with IV-CEUS, the resulting double contrast-enhanced gastric ultrasound (DCEGU) can simultaneously evaluate lesion morphology, wall layering, and perfusion patterns, suggesting it might serve as a supplementary diagnostic method. He and colleagues (13) retrospectively assessed EUS versus DCEGU for their relative diagnostic performance in detecting gastric stromal tumors. In a series of 139 pathologically verified lesions, DCEGU yielded an accuracy of 86.3%, whereas EUS reached 81.3%. These data point to DCEGU as a valuable adjunct for differentiating gastric tumors.
4 Conclusion
GS shares many clinical features with other gastric tumors—GISTs, leiomyomas, and lipomas. To establish the diagnosis, we rely on histopathology plus immunohistochemical findings. As a first-line screening tool, DCEGU offers a non-invasive way to diagnose and manage GI disorders without endoscopy. This imaging technique enables a comprehensive appraisal of the lesion by assessing its layer of origin within the gastric wall, morphological appearance, echotexture, contrast-enhanced ultrasonographic features, and the presence of invasion into neighboring structures. At present, investigations specifically addressing the use of DCEGU to differentiate GS from GISTs remain scarce. Hence, there is a pressing need for well-designed, multicenter prospective studies with large sample sizes to rigorously compare, through DCEGU, the imaging characteristics that distinguish these two tumor types—namely, enhancement timing, homogeneity of enhancement, clarity of the lesion margin, and peritumoral vascular patterns. By integrating these imaging parameters with pathological data, a quantitative diagnostic model could be developed, which would markedly improve the accuracy of preoperative differential diagnosis and in turn offer more dependable guidance for the clinical management of GS.
Statements
Data availability statement
The data analyzed in this study is subject to the following licenses/restrictions: The datasets presented in this article are not readily available because they contain identifiable information from human subjects that cannot be shared in open access repositories for legal reasons. Anonymized data will be shared upon request from any qualified investigator. Requests should be directed to the corresponding authors. Requests to access these datasets should be directed to wangchengfang@lygey.com.
Ethics statement
The studies involving humans were approved by Ethics Committee of the Second People’s Hospital of Lianyungang. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
LL: Resources, Funding acquisition, Formal analysis, Supervision, Writing – original draft, Investigation, Data curation, Validation, Methodology, Conceptualization. CW: Data curation, Validation, Methodology, Investigation, Writing – review & editing, Software.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Acknowledgments
The authors sincerely thank the patient for her contribution to the publication of this case report.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1
HongXWuWWangMLiaoQZhaoY. Benign gastric schwannoma: how long should we follow up to monitor the recurrence? A case report and comprehensive review of literature of 137 cases. Int Surg. (2015) 100:744–7. doi: 10.9738/INTSURG-D-14-00106.1
2
ZhongZXuYLiuJZhangCXiaoZXiaYet al. Clinicopathological study of gastric schwannoma and review of related literature. BMC Surg. (2022) 22:159. doi: 10.1186/s12893-022-01613-z
3
MiaoGZhangDLiJDengYGuXFengT. Gastric schwannoma with post-surgical gastroparesis: a case report and literature review. Front Oncol. (2025) 14:1496074. doi: 10.3389/fonc.2024.1496074
4
DaimaruYKidoHHashimotoHEnjojiM. Benign schwannoma of the gastrointestinal tract: a clinicopathologic and immunohistochemical study. Hum Pathol. (1988) 19:257–64. doi: 10.1016/s0046-8177(88)80518-5
5
MelvinWSWilkinsonMG. Gastric schwannoma. Clinical and pathologic considerations. Am Surg. (1993) 59:293–6.
6
Sánchez-MoralesGETrolle-SilvaAMMoctezuma-VelázquezPRodríguez-QuinteroJHAlcazar-FélixRJ. Gastric schwannoma: A rarity among mesenchymal tumors of the gastrointestinal tract. Rev Gastroenterol Mex (Engl Ed). (2020) 85:102–4. doi: 10.1016/j.rgmx.2019.03.006
7
WillisSTruongSGribnitzSFassJSchumpelickV. Endoscopic ultrasonography in the preoperative staging of gastric cancer: accuracy and impact on surgical therapy. Surg Endosc. (2000) 14:951–4. doi: 10.1007/s004640010040
8
HabermannCRWeissFRieckenRHonarpishehHBohnackerSStaedtlerCet al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. (2004) 230:465–71. doi: 10.1148/radiol.2302020828
9
LiuLLuDYCaiJRZhangL. The value of oral contrast ultrasonography in the diagnosis of gastric cancer in elderly patients. World J Surg Oncol. (2018) 16:233. doi: 10.1186/s12957-018-1527-y
10
PeiFLiuYZhangFLiNHuangDGuB. Cholecystoduodenal fistula: ultrasonographic diagnosis with oral gastrointestinal ultrasound contrast medium. Abdom Imaging. (2011) 36:561–4. doi: 10.1007/s00261-010-9661-1
11
IshigamiSYoshinakaHSakamotoFNatsugoeSTokudaKNakajoAet al. Preoperative assessment of the depth of early gastric cancer invasion by transabdominal ultrasound sonography (TUS): a comparison with endoscopic ultrasound sonography (EUS). Hepatogastroenterology. (2004) 51:1202–5.
12
PolkowskiMPaluckiJButrukE. Transabdominal ultrasound for visualizing gastric submucosal tumors diagnosed by endosonography: can surveillance be simplified? Endoscopy. (2002) 34:979–83. doi: 10.1055/s-2002-35839
13
HeHTangTWangXZhouLWangL. Comparing endoscopic ultrasonography and double contrast-enhanced ultrasonography in the preoperative diagnosis of gastric stromal tumor. Cancer Imaging. (2023) 23:122. doi: 10.1186/s40644-023-00646-8
Summary
Keywords
case report, double contrast-enhanced gastric ultrasound, gastric schwannoma, gastrointestinal stromal tumors, S-100 protein
Citation
Li L and Wang C (2026) Case Report: A case of gastric schwannoma diagnosed by dual-contrast-enhanced gastric ultrasound. Front. Oncol. 16:1851663. doi: 10.3389/fonc.2026.1851663
Received
09 April 2026
Revised
29 June 2026
Accepted
15 July 2026
Published
28 July 2026
Volume
16 - 2026
Edited by
Jean-Michel Escoffre, Université de Tours, France
Reviewed by
Enrique Cervantes-Pérez, Civil Hospital of Guadalajara, Mexico
Alejandro Hernandez-Alejo, Radiology Department “Dr. José Eleuterio González” University Hospital, Mexico
Updates
Copyright
© 2026 Li and Wang.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Chengfang Wang, wangchengfang@lygey.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.