{"id":19951,"date":"2025-04-29T06:30:00","date_gmt":"2025-04-29T06:30:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=19951"},"modified":"2025-04-21T01:39:00","modified_gmt":"2025-04-21T01:39:00","slug":"schwannoma-de-colon-ascendente-uma-rara-lesao-diagnosticada-por-ecoendoscopia","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/schwannoma-de-colon-ascendente-uma-rara-lesao-diagnosticada-por-ecoendoscopia\/","title":{"rendered":"Schwannoma de c\u00f3lon ascendente: Uma rara les\u00e3o diagnosticada por ecoendoscopia"},"content":{"rendered":"\n

Apresenta\u00e7\u00e3o do caso:<\/strong><\/h2>\n\n\n\n

Paciente de 73 anos, do sexo feminino, foi submetida a colonoscopia de rastreamento que evidenciou les\u00e3o elevada s\u00e9ssil de aspecto subepitelial, sinal da tenda positivo e do travesseiro negativo, no c\u00f3lon ascendente, medindo 30 mm, recoberta por mucosa \u00edntegra e com suspeita tomogr\u00e1fica de p\u00f3lipo inflamat\u00f3rio.<\/p>\n\n\n

\n
\"\"<\/a><\/figure>\n<\/div>\n\n\n

Optado pela investiga\u00e7\u00e3o adicional com ecoendoscopia para decis\u00e3o terap\u00eautica, sendo poss\u00edvel alcan\u00e7ar a les\u00e3o com ecoendosc\u00f3pio setorial.<\/p>\n\n\n\n

Avalia\u00e7\u00e3o ecogr\u00e1fica revelou les\u00e3o nodular hipoecoica, heterog\u00eanea, de limites bem definidos, medindo 27 x 26 mm, localizada e restrita a camada muscular pr\u00f3pria, sem linfonodomegalias perilesionais.<\/p>\n\n\n\n

\n
\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n<\/figure>\n\n\n\n


Realizada pun\u00e7\u00e3o ecoguiada utilizando agulha FNB 22 Gauge, revelando neoplasia fusocelular de baixo grau.<\/p>\n\n\n\n

\n
\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n<\/figure>\n\n\n\n


Exame imunohistoqu\u00edmico com resultado positivo para S100 e negativo para C-KIT , DOG-1, actina e CD34.<\/p>\n\n\n

\n
\"\"<\/a><\/figure>\n<\/div>\n\n\n

Tais achados corroboram o diagn\u00f3stico de Schwannoma.<\/p>\n\n\n\n

Paciente foi submetida a colectomia direita videolaparoc\u00f3pica com retirada completa da les\u00e3o e sem necessidade de fazer linfadectomia oncol\u00f3gica.<\/p>\n\n\n

\n
\"\"<\/a><\/figure>\n<\/div>\n\n\n

Discuss\u00e3o:<\/strong><\/h2>\n\n\n\n

O Schwannoma \u00e9 um tumor origin\u00e1rio de c\u00e9lulas de Schwann, presente na bainha de mielina de nervos perif\u00e9ricos.<\/p>\n\n\n\n

Essa neoplasia possui menor incid\u00eancia no trato gastrointestinal acometendo o plexo mioent\u00e9rico de Auerbach, nos quais a maioria dos casos reportados est\u00e3o localizados no est\u00f4mago e intestino delgado, acometendo raramente o c\u00f3lon.<\/p>\n\n\n\n

Possui maior preval\u00eancia a partir da sexta d\u00e9cada de vida e n\u00e3o tem predomin\u00e2ncia de g\u00eanero.<\/p>\n\n\n\n

O quadro cl\u00ednico comumente \u00e9 assintom\u00e1tico ou composto por sintomas inespec\u00edficos como dor e desconforto abdominal, tenesmo, constipa\u00e7\u00e3o, sangramento retal ou melena.<\/p>\n\n\n\n

A descoberta geralmente \u00e9 incidental por meio do rastreamento endosc\u00f3pico, revelando les\u00e3o de aspecto subepitelial de formato regular e bem definido, podendo ou n\u00e3o ser ulcerada.<\/p>\n\n\n\n

O diagn\u00f3stico definitivo \u00e9 por meio de exame patol\u00f3gico com imunohistoqu\u00edmica positiva para S100 e negativo para SMA, Desmina, CD117 e P53.<\/p>\n\n\n\n

A ecoendoscopia baixa \u00e9 desafiadora, mas com habilidade t\u00e9cnica ela pode ser realizada de forma eficaz, contribuindo para a defini\u00e7\u00e3o diagn\u00f3stica e direcionando a escolha da t\u00e9cnica cir\u00fargica, resultando em uma abordagem menos invasiva.<\/p>\n\n\n\n

Usualmente os tumores s\u00e3o benignos com progn\u00f3stico favor\u00e1vel, com raros casos de transforma\u00e7\u00e3o maligna.<\/p>\n\n\n\n

De forma geral, a ressec\u00e7\u00e3o cir\u00fargica \u00e9 o tratamento de escolha para evitar a transforma\u00e7\u00e3o maligna.<\/p>\n\n\n\n

Coment\u00e1rios finais:<\/strong><\/h2>\n\n\n\n

Schwannoma de c\u00f3lon \u00e9 uma les\u00e3o extremamente rara, sendo diagn\u00f3stico diferencial de tumor estromal gastrointestinal. A avalia\u00e7\u00e3o por ecoendoscopia com pun\u00e7\u00e3o permite o diagn\u00f3stico pr\u00e9-operat\u00f3rio, possibilitando ressec\u00e7\u00f5es cir\u00fargicas menos extensas e com menor morbidade, contribuindo com um bom progn\u00f3stico. Na maioria dos casos o diagn\u00f3stico \u00e9 feito ap\u00f3s an\u00e1lise histopatol\u00f3gica de pe\u00e7a cir\u00fargica. Se faz necess\u00e1rio a avalia\u00e7\u00e3o imunohistoqu\u00edmica para diferencia\u00e7\u00e3o de outros tipos histol\u00f3gicos de tumores que acometem o c\u00f3lon.<\/p>\n\n\n\n

Refer\u00eancias<\/strong><\/h2>\n\n\n\n
    \n
  1. Bohlok, A., El Khoury, M., Bormans, A., et al. Schwannoma of the colon and rectum: a systematic literature review. World Journal of Surgical Oncology, 16, 125 (2018). DOI: 10.1186\/s12957-018-1427-1.<\/li>\n\n\n\n
  2. Schwannoma of the ascending colon: A rare case report. Asian Journal of Surgery, Volume 46, Issue 6, 2023, Pages 2417-2418. ISSN: 1015-9584.<\/li>\n\n\n\n
  3. Kim, G., Kim, S. I., Lee, K. Y. Schwannoma of the sigmoid colon: a case report and review of literature*. Journal of Surgical Case Reports, 2019 Feb;2019(2):rjz046. DOI: 10.1093\/jscr\/rjz046.<\/li>\n\n\n\n
  4. Baig, M. M. A. S., Patel, R., Kazem, M. A., Khan, A. Schwannoma in the ascending colon, a rare finding on surveillance colonoscopy. Journal of Surgical Case Reports, 2019 Feb;2019(2):rjz 046. DOI: 10.1093\/jscr\/rjz046.<\/li>\n<\/ol>\n\n\n\n

    Como citar este artigo<\/strong><\/h2>\n\n\n\n

    Botelho PF, Costa LS. Schwannoma de c\u00f3lon ascendente: Uma rara les\u00e3o diagnosticada por ecoendoscopia Endoscopia Terapeutica 2025 Vol I. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/schwannoma-de-colon-ascendente-uma-rara-lesao-diagnosticada-por-ecoendoscopia\/<\/a><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Apresenta\u00e7\u00e3o do caso: Paciente de 73 anos, do sexo feminino, foi submetida a colonoscopia…<\/p>\n","protected":false},"author":4014,"featured_media":19972,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[409,798],"ano":[783],"tipo":[154],"volume":[263],"class_list":["post-19951","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","tag-eus","tag-schwannoma","ano-783","tipo-ecoendoscopia","volume-volume-i"],"yoast_head":"\nSchwannoma de c\u00f3lon ascendente: Uma rara les\u00e3o diagnosticada por ecoendoscopia • Endoscopia Terapeutica<\/title>\n<meta name=\"description\" content=\"Schwannoma de c\u00f3lon ascendente: Uma rara les\u00e3o diagnosticada por ecoendoscopia %\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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