Apparent Endoscopic Decrease in the Size of a Large Ulcerated Gastric Schwannoma After Helicobacter pylori Eradication Therapy: A Case Report

Abstract

Gastric subepithelial lesions (SELs) comprise a heterogeneous group of tumors, among which gastric schwannomas are rare and generally benign. We report a case of a large gastric schwannoma with ulceration and symptomatic anemia that showed an apparent endoscopic decrease in size following Helicobacter pylori eradication.

An 85-year-old man presented with iron deficiency anemia. Esophagogastroduodenoscopy revealed a large ulcerated SEL in the lower body of the stomach, along with multiple gastric ulcers. Endoscopic ultrasonography demonstrated a 56 mm tumor originating from the fourth layer, raising suspicion for a gastrointestinal stromal tumor. Boring biopsy from the ulcer base enabled a definitive diagnosis of gastric schwannoma based on immunohistochemical findings. Although surgical resection was recommended, the patient declined. After successful H. pylori eradication, follow-up endoscopy at 6 months showed healing of the ulcerative lesion and an apparent endoscopic decrease in the size of the tumor. Although objective post-treatment assessment was unavailable, this case suggests that inflammatory or ulcer-related changes associated with H. pylori infection may influence the endoscopic appearance of gastric SELs.