Peritumoral lymphoid cuff correlates well with lymph node enlargement in gastrointestinal schwannomas

// Hyunsik Bae 1, * , Michael Van Vrancken 2, * , Tae Wook Kang 3 , Ha Young Park 4 , Jinah Chu 1 , Hyung Kyu Park 1 , Sang Yun Ha 1 , Dongil Choi 3 and Kyoung-Mee Kim 1 1 Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 Department of Pathology, Christian Hospital, St. Louis, Missouri, USA 3 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 4 Department of Pathology, Inje University Busan Paik Hospital, Inje University School of Medicine, Busan, Korea * These authors contributed equally to this work Correspondence to: Kyoung-Mee Kim, email: kkmkys@skku.edu Keywords: schwannoma; gastrointestinal tract; lymphoid cuff; lymphadenopathy; subepithelial tumor; Pathology Received: November 01, 2017      Accepted: February 01, 2018      Published: February 09, 2018 ABSTRACT Background/Aims: To determine the incidence of regional lymphadenopathy in gastrointestinal (GI) schwannoma and to evaluate the relationship between peritumoral lymphoid cuff and lymphadenopathy. Methods: We queried 118 GI tract schwannomas and reviewed radiologic findings, intraoperative findings, and electronic medical records of all cases for enlarged regional lymph nodes. Results: Location of tumors included 85 gastric (72%), 11 colonic (9.3%), 7 esophageal (5.9%), 3 pancreatic (2.5%), 1 hepatic (0.8%), and 11 mesenteric (9.3%). The size of the tumors ranged from 0.2 to 11 cm (mean 3.8 cm). Histologically, 70.3% showed a peritumoral lymphoid cuff ranging in thickness from 0.3 to 6 mm (mean 1.6 mm). The peritumoral lymphoid cuff was significantly more frequent in gastric schwannomas (78.8%) followed by colonic (72.7%), esophageal (57.1%) and rare in other locations ( p = 0.001). Of the 106 cases for which clinical or radiologic data was available for, 76 cases (71.7%) showed regional lymphadenopathy. The presence of peritumoral lymphoid cuff showed significant correlation with regional lymphadenopathy ( p < 0.001) and the size of enlarged lymph nodes ( p = 0.002). Conclusions: A peritumoral lymphoid cuff is frequently seen in GI tract schwannomas and correlates well with regional lymphadenopathy. However, in a significant subset (29.7%), a lymphoid cuff was not present warranting continued need for caution in the preoperative radiologic and postoperative pathologic diagnoses.