Gastric schwannoma: diagnostic challenges, pathological features, and surgical management : a narrative review

BACKGROUND: Gastric schwannoma is a rare benign mesenchymal tumour of the stomach that frequently mimics gastrointestinal stromal tumour (GIST) in clinical and radiologic presentation. MAIN BODY: This narrative review summarises current evidence on the epidemiology, diagnostic challenges, imaging characteristics, pathological features, and management of gastric schwannoma. Available literature from major medical databases was reviewed to synthesise findings related to clinical presentation, radiologic and endoscopic features, histopathological diagnosis, and treatment outcomes. Gastric schwannoma typically presents as an incidental subepithelial lesion in middle-aged adults. Imaging findings frequently overlap with those of GIST, limiting reliable preoperative differentiation. Definitive diagnosis relies on histopathological examination demonstrating spindle cell morphology with peripheral lymphoid cuffing and strong immunoreactivity for S-100 and SOX10 with absence of CD117 and DOG-1 expression. Complete surgical resection with negative margins remains the standard treatment and is associated with excellent long-term outcomes. CONCLUSION: Although rare, gastric schwannoma should be considered in the differential diagnosis of gastric subepithelial tumours. Accurate pathological diagnosis is essential to guide appropriate management and avoid unnecessary oncologic treatment.