Beyond mere appendicitis: A case report on an unforeseen diagnosis of appendiceal schwannoma

Introduction

Appendiceal schwannomas are a rare diagnosis, with little evidence to guide management and follow-up. There are currently no case reports focusing on follow-up for appendiceal schwannomas after complete surgical resection.

Presentation of case

A 64-year-old female presented to the emergency department, febrile, with migratory right iliac fossa pain and focal peritonism, consistent with acute appendicitis. The diagnosis was supported by a computed tomography scan and she underwent a laparoscopic appendicectomy. Histopathology was reported as acute appendicitis associated with a schwannoma at the appendiceal base. The patient underwent a colonoscopy six weeks after her initial surgery with no abnormal findings. Following multidisciplinary team discussion it was decided that no further follow up was required.

Discussion

There are only 15 case reports of appendiceal schwannomas in the literature. As a result, the management and follow up in this case was guided from evidence reported in studies of other schwannomas elsewhere in the gastrointestinal tract, standard management of benign appendiceal lesions and MDT discussion. One retrospective single-centre cohort study of histopathology records collected over a 20 year period showed that in 44 patients with GI schwannomas, there was no malignant transformation or recurrence during a mean follow up period of 5.0 ± 4.31 years (Singh et al., 2022). Based on this study there is a very low risk of malignant transformation associated with these lesions.

Conclusion

Based on limited published data resection remains the mainstay of management of appendiceal schwannomas. Colonoscopy is recommended to exclude any underlying lesion or synchronous pathology.