Introduction: Gastric submucosal lesions are a common finding during endoscopy. However, they rarely present as or cause any symptoms. We present an interesting and rare case of a gastric submucosal lesion causing symptoms Case Description/Methods: An 82-year-old woman with multiple comorbidities presented with worsening nausea and abdominal pain and early satiety. Physical examination had no findings of abdominal tenderness or a palpable mass. A contrast enhanced computed tomography (CT) scan was then performed, and a 6.2cm x 4.9 cm gastric mass was noted. (Figure a) An upper endoscopy revealed an extrinsic compression in the gastric antrum. An endoscopic ultrasound(EUS) examination was then performed, and on EUS, a large perigastric mass in the distal stomach was noted. The lesion appeared hypoechoic and measured 4.6 x 4.9cm with minimal amount of vascularity under EUS-doppler. (Figure b) Transgastric biopsies were obtained. Final pathology revealed spindle cell neoplasm with myxoid stroma, most consistent with schwannoma. The immunohistochemical profile was consistent with schwannoma (Figure c). The patient then underwent surgical resection (Figure d) and pathology confirmed a gastric schwannoma Discussion: Schwannomas are spindle cell mesenchymal tumors originating from the Schwann cell sheath. Gastric schwannomas arise from the gastrointestinal neural plexus. Gastric schwannomas are typically benign and incidentally found, but rarely can have malignant transformation. The tumors are predominantly found in middle-aged females. Gastric schwannoma usually presents in the gastric body. It is important to distinguish these tumors from the two other types of mesenchymal tumors, such as gastrointestinal stromal tumors and leiomyoma. Schwannomas typically have a spindle cell pattern with vague nuclear palisading and peritumoral lymphoid cuff without encapsulation with S100 positive staining and negative for CD34 and CD117, which differentiates them from gastrointestinal stromal tumors and autonomic nerve tumors. Schwannomas stain negatively for actin, unlike leiomyomas. Treatment is typically surgery with recurrence rarely described. The type of surgical approach is dependent on tumor size and location. Due to the excellent outcomes, some endoscopic options are also considered safe Our patient did well and on follow had resolution of all prior symptoms. This case report illustrates the importance of the consideration of schwannomas in the differential diagnosis of perigastric and submucosal lesionsFigure 1.: a: CT scan appearance of the perigastric mass; b: Mass as seen on EUS; c: Pathology with S100 staining; d: Resected specimen.
Abstract Objective The role of transition‐focused psychology appointments in managing the transition off therapy is unclear. The objective of this research was to explore caregiver perceived familial distress and the role of psychology in preparing families for transition. Methods Fifty‐seven caregivers of youth, who finished treatment, completed an online questionnaire through a quality improvement project on experiences of families at transition. Twenty‐two percent of caregivers had children who completed a transition‐focused psychology consult and 63% completed a cognitive assessment at transition. Retrospective analyses were conducted assessing the association of psychology visits on caregiver perceptions of being informed of and prepared to manage transition‐related challenges. Results Most caregivers reported experiencing adjustment concerns for family members. Caregivers of children completing a transition‐focused psychology consult or cognitive assessment reported feeling more informed and greater preparedness to manage difficulties. Although decreased distress was not associated with the visit, those who felt more informed and prepared reported lower distress. Conclusions Caregivers perceive transitioning off therapy as stressful for their family, though they experience decreased familial distress when informed of and prepared to manage transition‐related challenges. These findings highlight the importance of psychosocial support at transition.
