Schwannomas are benign tumors that originate from Schwann cells that form the myelin sheath of peripheral nerves (1). Although these tumors can occur in any part of the body, gastrointestinal schwannomas are extremely rare, accounting for less than 3% of all gastrointestinal stromal tumors (GISTs) (2). Among gastrointestinal schwannomas, the duodenum is a particularly rare site, with most cases occurring in the stomach or colon (3–5).

Duodenal schwannomas typically grow slowly and are often asymptomatic, which may lead to their incidental discovery during imaging or endoscopic examinations for unrelated diseases. Symptoms are usually non-specific and may include abdominal pain, nausea, vomiting, or gastrointestinal bleeding. Owing to the non-specificity of these symptoms, duodenal schwannomas are prone to be misdiagnosed as other types of submucosal tumors, such as GISTs, adenocarcinoma, or neuroendocrine tumors (6).

Histopathological examination is crucial for a definitive diagnosis of schwannomas. The tumors are characterized by spindle-shaped cells arranged in the Antoni A and B regions and positive immunohistochemical staining of the S-100 protein, confirming their origin from Schwann cells. Unlike GISTs, schwannomas typically do not express c-KIT (CD117) or DOG1, which aids in their differentiation from other submucosal tumors (7, 8).

Currently, the preferred treatment for duodenal schwannomas is surgical resection, which can be accomplished via open surgery or endoscopic techniques, depending on the size and location of the tumor (9, 10). Given its benign nature, complete resection generally leads to a favorable prognosis, with a low risk of recurrence or malignant transformation. Nevertheless, close follow-up is recommended to monitor for recurrence or complications. Backes et al. assert that endoscopic submucosal dissection (ESD) can achieve complete resection of lesions, reduce the risk of recurrence, and is comparable in efficacy to surgical procedures, while featuring less trauma, lower cost, and a shorter hospital stay (11). This article reports a rare case of duodenal schwannoma and elaborates on its clinical manifestations, diagnostic difficulties, and treatment methods to supplement the lack of relevant literature on duodenal schwannomas.

Schwannoma is a benign tumor originating from the perineural sheath cells and myelin-forming cells of the peripheral nervous system and can occur in any tissue or organ containing nerve fibers. It typically occurs in individuals aged between 20 and 50 years, with a peak incidence in women aged approximately 50 years. It is most commonly found in the head and face, extremities, and central nervous system but can also occur in the retroperitoneum and gastrointestinal tract. Schwannomas arising from the Auerbach’s plexus of the muscularis mucosae of the gastrointestinal tract are relatively rare, accounting for only 2.9% of gastrointestinal interstitial tumors. It was believed that the incidence of duodenal lesions is low. However, with the development of endoscopic technology and increased awareness of duodenal lesions among clinicians, the detection rate has increased from 0.3% to 4.6% (12–14). Clinically, the most common site of occurrence is the gastrointestinal tract, accounting for 60% to 70%, followed by the colon and rectum, with less common occurrences in the small intestine and esophagus, especially in duodenal schwannomas, which are often reported in case form in the literature (15).

With advancements in diagnostic techniques, such as high-resolution endoscopy and abdominal imaging (CT and MRI), clinicians are more likely to detect submucosal tumors in the duodenum that might have gone unnoticed in the past (16). Increased awareness of gastrointestinal lesions among clinicians has also contributed to this enhanced detection. As demonstrated in this case, duodenal schwannomas may be discovered incidentally during routine health check-ups or endoscopic procedures performed for unrelated reasons. The benign nature of these tumors often makes them asymptomatic until they are discovered by imaging or endoscopy. We emphasize the importance of considering duodenal schwannomas in the differential diagnosis of other gastrointestinal submucosal tumors, such as GISTs, ectopic pancreas, and neuroendocrine tumors, as these conditions may present with similar clinical and radiological features. We highlight how endoscopic procedures, including gastroscopy and endoscopic ultrasound, are increasingly used to identify and evaluate submucosal lesions, providing a more accurate assessment of the duodenal wall structure and enabling early detection of rare lesions such as schwannomas.

Duodenal schwannomas are rare submucosal tumors that present diagnostic and therapeutic challenges because of their non-specific clinical and imaging features. Traditional treatment approaches, such as surgical resection (e.g., local excision or pancreaticoduodenectomy), are the standard treatments for managing duodenal tumors (17). However, these methods often involve major trauma, increase the risk of complications, prolong the recovery time, and reduce the quality of life of patients, especially when dealing with benign lesions such as schwannomas (18, 19). In contrast, ESD is a minimally invasive procedure with several unique advantages (20). ESD can be performed en bloc to ensure complete resection of the tumor and preservation of gastrointestinal function. This technique reduces patient morbidity, shortens the recovery time, and avoids the need for invasive surgical procedures (21, 22). Compared with pancreaticoduodenectomy, which is traditimplex or malignant lesions, ESD is a safer and less invasive option for benign tumors such as schwannomas. Surgical procedures have higher morbidity rates and longer hospital stays, whereas ESD minimizes surgical trauma and preserves the integrity of surrounding tissues. We demonstrated that ESD yielded comparable or better results than surgery, particularly in terms of resection success and post-treatment quality of life. This case highlights the efficacy and safety of ESD as an alternative to surgery for treating duodenal schwannomas. Long-term follow-up is necessary to monitor for recurrence, and ESD holds promise for broader application in managing other rare gastrointestinal submucosal tumors. Future studies are essential to further refine ESD protocols and evaluate its long-term outcomes, enabling its integration as a standard approach for the treatment of rare duodenal lesions.

In summary, duodenal lesions are relatively less common than lesions in other parts of the gastrointestinal tract, but their detection rates are increasing. The diagnosis of a duodenal schwannoma is difficult before surgery and is usually confirmed by pathological examination during or after surgery. ESD can achieve large-scale and curative resection, and has been well proven in the endoscopic treatment of esophageal, gastric, and colonic tumors, with satisfactory safety (23–25). By improving the endoscope and cutting device types, as well as postoperative closure techniques for mucosal defects, the incidence of complications can be effectively reduced (26). However, continuous experience summarization and improvements in duodenal ESD are needed to provide precise treatment to patients, reduce complications, and improve surgical satisfaction. We believe that ESD technology can be a good choice for minimally invasive treatment of duodenal lesions in the future.

Duodenal schwannomas are rare submucosal tumors that require accurate histopathological and immunohistochemical diagnosis. This case highlights ESD as a minimally invasive and effective treatment option that offers faster recovery, fewer complications, and preserves gastrointestinal function compared with traditional surgery. Despite their benign nature, regular follow-ups are essential to monitor for the recurrence of duodenal schwannomas. This case underscores the potential of ESD in managing rare gastrointestinal lesions and calls for further studies to confirm its long-term efficacy.