A Case Report of Metachronous Quartet Malignant Tumors Including Primary Malignant Schwannoma of the Small Intestine

Takeshi Shimizu, Masashi Nakata, Seishiro Inaba, Yuki Matsushita, Yasunobu Araki, Hiroshi Koyama, Atsuhiro Ogino and Eiji Yamada^*

Department of Surgery, National Nara Hospital
^*Department of Pathology, Nara Medical University

Neurogenic tumors of the small intestine are rare. We present a case of metachronous quartet malignant tumors including primary malignant schwannoma of the small intestine. A 79-year-old woman admitted for severe abdominal pain and abdominal fullness, had a history of sigmoidectomy for sigmoid colon cancer and thyroid lobectomy for thyroid cancer. Peritonitis was clinically suspected, so emergency laparotomy was conducted, showing a ruptured tumor in the small intestine necessitating resection of the small intestine. The tumor was mesenchymal, consisting of cells with anisocytosis, pleomorphism, and mitoses. Immunohistochemically, cells were positive for S-100, NSE, and vimentin, but negative for MSA, desmin, CD-34, and c-kit, so the tumor was diagnosed as malignant schwannoma originating from the small intestine. The patient was found to have esophageal cancer during the postoperative course and died of an exacerbated general condition. This is a very rare case of metachronous quartet malignant tumors involving the sigmoid colon, thyroid, small intestine, and esophagus (sequential). Immunohistochemical staining was useful for accurately diagnosing malignant schwannoma.

Key words
malignant schwannoma, small intestine, quartet cancer

Reprint requests
Takeshi Shimizu Department of Surgery, National Nara Hospital 1-50-1 Higashikidera-cho, Nara-shi, 630-8305 JAPAN

Accepted
May 1, 2002

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