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2.
Neurosurgery ; 92(2): 317-328, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637268

RESUMO

BACKGROUND: Neurofibromatosis type 2 (NF2) is rare genetic disorder mainly characterized by the development of central nervous system lesions, but peripheral nerve pathology may also cause high morbidity including pain, motor, and sensory loss. OBJECTIVE: To describe the tumor burden of patients with peripheral nerve pathology in NF2 including peripheral neuropathies and schwannomas and the results of surgery in the latter group. METHODS: We conducted a retrospective chart review of all patients with NF2 followed up at our NF2 Reference Center to include all patients suffering from peripheral nerve pathology. Tumor detection relied on focal MRIs based on symptoms. RESULTS: Thirty-four patients harboring 105 peripheral nerve schwannomas and 1 perineurioma were included. Schwannomas were mainly located in major nerves (n = 74, 71%) compared with subcutaneous (n = 23, 22%) and intramuscular (n = 8, 7%) cases. Most schwannomas (81/90-90%) were classical discrete tumors while multinodular cases represented only 9 cases (10%). During follow-up, 63 (60%) tumors were operated in 24 patients, including 39 schwannomas of major nerves. A complete resection was achieved in most of the cases (52/63, 83%) with a complete relief of preoperative pain in most patients (57/60, 95%). Persistent motor deficits (5/39, 13%) were mostly encountered in patients operated from multinodular schwannomas (4/5, 80%). Six patients had an associated peripheral neuropathy with 5 cases of pseudo-Charcot-Marie-Tooth-associated amyotrophy. CONCLUSION: Surgery remains a safe and effective method of treating peripheral nerve schwannoma-associated pain in NF2, with the exception of rare multinodular tumors. Special attention should be drawn to patients harboring severely debilitating neuropathies and perineuriomas.


Assuntos
Neoplasias de Bainha Neural , Neurilemoma , Neurofibromatose 2 , Doenças do Sistema Nervoso Periférico , Humanos , Neurofibromatose 2/complicações , Neurofibromatose 2/diagnóstico por imagem , Neurofibromatose 2/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Doenças do Sistema Nervoso Periférico/complicações , Estudos Retrospectivos , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Nervos Periféricos/patologia , Neoplasias de Bainha Neural/complicações , Neoplasias de Bainha Neural/diagnóstico por imagem , Neoplasias de Bainha Neural/cirurgia , Dor
3.
World Neurosurg ; 157: 21-29, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34600160

RESUMO

BACKGROUND: Although partial cystic degeneration is commonly observed in schwannoma, cases of totally cystic forms have also been reported. A literature review of cases describing totally cystic schwannoma was performed to assess their imaging characteristics. METHODS: PubMed was queried with the phrases "totally cystic schwannoma," "purely cystic schwannoma," and "completely cystic schwannoma." A total of 19 papers encompassing 22 cases of reported totally cystic schwannoma were included. Patient characteristics, clinical presentation, and reported imaging characteristics were recorded. Computed tomography and magnetic resonance images from the papers were collected and reviewed by a senior musculoskeletal radiologist. RESULTS: The most frequent presenting location of these lesions was in spinal nerve roots. The interpretations of imaging reported in the papers described a homogeneous lesion that was isointense to slightly hyperintense to cerebrospinal fluid (CSF) on T1-weighted images. On contrast administration, the studies described a thin rim of "ring-like" enhancement around the lesion. Our reinterpretation of the imaging revealed heterogeneous lesions that were hyperintense to CSF on T1-weighted images. Post-contrast images typically demonstrated an irregularly thickened enhancing rim. Most images showed evidence of solid components in the lesion, with many containing enhancing soft tissue elements. The observed imaging features were not consistent with simple cystic lesions. CONCLUSIONS: Review of the imaging studies of the reported cases of completely cystic schwannoma did not produce any convincing examples of purely cystic lesions. The description of these lesions as "totally cystic" appears to be a misnomer and has diagnostic and therapeutic implications.


Assuntos
Cistos/patologia , Neurilemoma/patologia , Cistos/diagnóstico por imagem , Cistos/cirurgia , Humanos , Imageamento por Ressonância Magnética , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Terminologia como Assunto , Tomografia Computadorizada por Raios X
4.
Am J Case Rep ; 23: e938335, 2022 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-36560857

RESUMO

BACKGROUND Schwannoma is an uncommon benign tumor that develops from Schwann cells in the peripheral nervous system; 25-50% of such tumors occur in the head and neck. A rare variety of schwannoma, known as an ancient schwannoma, exhibits calcification, cystic degeneration, hemorrhage, myxoid stroma, pleomorphism, and nuclear hyperchromatism. Such characteristics may contribute to this tumor being incorrectly diagnosed as malignant. Almost all reported intra-oral ancient schwannomas behave innocuously. CASE REPORT A 20-year-old man presented to the oral surgery clinic with a right facial swelling that began a few months before. CT and MRI were performed and showed a well-defined cystic lesion anterior to the right masseter muscle, located in the subcutaneous area and measuring 28×24×20 mm. No extension to the surrounding tissues nor any other similar lesions were seen. Microscopic examination revealed an encapsulated nodular mass with cystic cavities, hemorrhage, and variably distributed myxoid and hyalinized stroma. The tumor demonstrated 2 distinct cell distributions: hypercellular areas (Antoni A) and myxoid hypocellular areas (Antoni B). Focal areas in high-power magnification showed atypical cells with hyperchromatic and pleomorphic nuclei. The tumor cells showed diffuse positivity for S-100 in IHC. The diagnosis of ancient schwannoma was made. At 1-year follow-up, there was no evidence of nerve injury or recurrence. CONCLUSIONS One more case of oral ancient schwannoma is added to the literature. This is the first reported in Saudi Arabia. It is prudent to be familiar with the degenerative and cytologic alterations of ancient schwannoma, as this may limit the likelihood of misdiagnosis and unnecessary treatment of this benign tumor, with an excellent prognosis.


Assuntos
Neurilemoma , Masculino , Humanos , Adulto Jovem , Adulto , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neurilemoma/patologia , Imageamento por Ressonância Magnética , Microscopia , Pescoço/patologia , Arábia Saudita
5.
BMC Neurol ; 22(1): 480, 2022 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-36517768

RESUMO

BACKGROUND: Schwannomas are benign tumors deriving from the sheath of cranial and peripheral nerves. The vagus nerve is comprised of a complex neuro-endocrine-immune network that maintains homeostasis, most tracts of it play a role in parasympathetic activity. We present an example of a rare cervical vagal schwannoma case accompanied by arrhythmia. CASE PRESENTATION: A 35-year-old female patient with a left cervical vagus schwannoma and ventricular arrhythmia underwent schwannoma resection in the operating room. The patient's suppressed heart rate increased after tumor removal, and the cardiac rhythm returned to normal postoperatively. Pathological examination demonstrated the diagnosis of schwannoma. CONCLUSIONS: This case explains the link between the vagus nerve and the cardiovascular system, proving that a damaged cervical vagus nerve can inhibit the heart rate and lead to arrhythmias, and eventually requiring surgical intervention.


Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Doenças do Nervo Vago , Feminino , Humanos , Adulto , Doenças do Nervo Vago/complicações , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/cirurgia , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico , Neurilemoma/complicações , Neurilemoma/cirurgia , Neurilemoma/diagnóstico , Nervo Vago/cirurgia , Arritmias Cardíacas/patologia
6.
BMC Neurol ; 22(1): 470, 2022 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-36494617

RESUMO

BACKGROUND: Facial nerve schwannomas account for about 0.8% of all petrous mass lesions. Schwannomas of the greater superficial petrosal nerve (GSPN) are a rare subtype with few case-reports up to date. CASE PRESENTATIONS: A retrospective analysis of clinical outcomes, radiographic findings and postoperative complication between June 2007 and December 2020 was performed. Four cases of GSPN schwannomas were reported. The presenting symptoms were facial nerve palsy and hearing loss. Imaging studies showed a subtemporal mass on the anterosuperior aspect of the petrous bone, in one case with extraordinary petrous bone and mastoid infiltration and destruction. Three cases were removed through a subtemporal extra- or intradural approach, one case via a combined pre- and retrosigmoid approach. Improvement of facial nerve palsy occurred in one case; new hearing loss was observed in another case. Xeropthalmia was a short-term temporary deficit in three cases. Short- to mid-term follow-up of the patients has not shown any tumor recurrence. CONCLUSIONS: GSPN schwannomas are rare entities presenting with heterogenous symptoms. Our surgical findings emphasize safe resection. Complete remission is possible by GTR. Since the small data set limits the expressiveness of statements regarding standard of care and alternative therapy options, additional data is needed.


Assuntos
Paralisia Facial , Neurilemoma , Humanos , Gânglio Geniculado/patologia , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia , Neurilemoma/cirurgia , Neurilemoma/diagnóstico
8.
Neurosurg Rev ; 46(1): 27, 2022 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-36576615

RESUMO

Evacuation of middle fossa trigeminal schwannomas (TS) warrants a subtemporal interdural approach through the lateral wall of the cavernous sinus (CS). The dura comprises the dura propria, which follows the trigeminal nerve and develops into the epineurium, and periosteal layer. The interdural approach involves peeling off the dura propria and exposing the epineural sheath. The venous route around the CS is often obstructed due to TS progression. The interdural approach based on venous route preservation remains to be discussed. The laterocavernous sinus (LCS) is formed in these layers, draining to either the medial or lateral route. In the lateral route, the LCS drains to the pterygoid plexus via the middle cranial fossa foramen. Exposure of the interdural space disturbs the lateral route's venous flow. We describe an operative strategy for venous route preservation in TS via the LCS lateral route. The venous route can be preserved by peeling off the dura propria from the posterior end of the foramen ovale short of the venous drainage route to the pterygoid plexus epidurally and then cutting from the middle cranial fossa dura posterior to the venous route subdurally to the exposed interdural space. This technique helps in avoiding postoperative venous complications.


Assuntos
Seio Cavernoso , Neoplasias dos Nervos Cranianos , Neurilemoma , Humanos , Seio Cavernoso/cirurgia , Espaço Subdural/cirurgia , Dura-Máter/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia
9.
Am J Case Rep ; 23: e938448, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36383504

RESUMO

BACKGROUND Sciatica, which is pain radiating along the sciatic nerve distribution, is most often caused by degenerative conditions of the lower back and rarely results from lesions of the spinal cord. This case report illustrates a patient with suspected lumbar radiculopathy, ultimately diagnosed with a thoracic schwannoma after visiting a chiropractor. CASE REPORT A 61-year-old woman presented to a chiropractor with progressively worsening lower back pain radiating to the right lower extremity and unsteady gait. Her symptoms began 10 years previously and she had been diagnosed by an orthopedist with lumbar disc herniation causing radiculopathy via magnetic resonance imaging (MRI) and was treated with physical therapy and diclofenac. Upon examination by the chiropractor, the patient had bilateral lower-extremity neurologic deficits, hyperreflexia, and upgoing Babinski responses. The chiropractor ordered thoracic MRI, but the patient preferred to initiate a trial of care, which was unsuccessful. After a delay imposed by cardiac bypass surgery, the patient returned to the chiropractor with worsened symptoms and underwent thoracic MRI, revealing an intraspinal mass at T9. The patient underwent laminectomy and tumor removal, with histopathology confirming a diagnosis of schwannoma. The patient gradually improved after surgery with the help of rehabilitative exercises. CONCLUSIONS Clinicians should suspect a spinal cord lesion as a cause of sciatic pain when patients fail to improve with treatment, have a broad sensorimotor distribution unexplained by lumbar imaging findings, hyperreflexia/pathological reflexes, or other atypical findings (eg, negative neural tension tests). In such cases, MRI of the cervical and thoracic spine may be indicated.


Assuntos
Quiroprática , Neurilemoma , Radiculopatia , Feminino , Humanos , Pessoa de Meia-Idade , Vértebras Lombares/patologia , Reflexo Anormal , Neurilemoma/complicações , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Dor , Imageamento por Ressonância Magnética
10.
J Clin Neurosci ; 106: 173-179, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36343501

RESUMO

BACKGROUND: Dumbbell schwannomas of the thoracic spine are challenging to cure surgically. Surgeons are familiar with posterolateral approaches to the spine, however, these may provide inadequate exposure for large tumors extending to ventral extraspinal compartments. Ventrolateral transpleural approaches offer direct access to the ventral thoracic spine and intrathoracic cavity, though are associated with increased morbidity and pulmonary complications, and may necessitate a staged procedure in order to address concomitant dorsal pathology. Herein we describe our experience with single-stage, posterior approach to dumbbell schwannomas with large ventral extraspinal components, and review the literature regarding surgical approaches for these tumors. METHODS: Retrospective review of patients who underwent a single-stage, posterior spinal surgery for thoracic dumbbell schwannomas from 2008 to 2018. Inclusion criteria were age > 18 years and ventral thoracic tumor component. RESULTS: Three patients underwent a simultaneous retropleural thoracotomy and posterior spinal approach, through a single incision, for the resection of dumbbell (intradural and extradural) schwannomas. Mean age was 49.7 years and 2 patients were female. All patients were neurologically intact at baseline. Lesions were 4-8.2 cm in the largest dimension (mean 6.1 cm). GTR was achieved in all patients. One pleural rent occurred intraoperatively; there were no other intraoperative or perioperative complications. At a mean follow-up of 14.1 months all patients remained motor and sensory intact and there was no evidence of recurrence. CONCLUSIONS: The combined retropleural thoracotomy-posterior spinal approach provides safe and sufficient access for resection of large dumbbell schwannomas of the thoracic spine.


Assuntos
Neurilemoma , Vértebras Torácicas , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Masculino , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/patologia , Toracotomia/métodos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurilemoma/patologia , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos
11.
BMC Cardiovasc Disord ; 22(1): 498, 2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36418938

RESUMO

BACKGROUND: Primary cardiac schwannoma remains extremely rare and difficult to distinguish from other myocardial tumours. We report a case of cardiac schwannoma that occurred in the lateral wall of the right ventricle and grew in the myocardial walls. It is the third case of schwannoma that occurred in the free wall of the right ventricle. Moreover, we reviewed and summarised the literature for cases involving benign cardiac schwannomas. CASE PRESENTATION: We present a case of a 64-year-old woman who presented to our centre with syncope for 1-2 min. Echocardiogram and contrast-enhanced computed tomography subsequently revealed a 2.9 × 1.9 cm homogeneous mass originating from the anterior wall of the right ventricle. The patient underwent thoracotomy to resect the mass, which was pathologically verified as Schwann cell tumour. CONCLUSIONS: This is a rare case added to the limited existing literature on cardiac schwannoma. Comprehensive analysis of various imaging examinations is helpful to determine the extent of the tumour. Complete surgical resection is recommended for similar cases involving cardiac schwannomas, especially when the patient has related symptoms. Patients generally have a good prognosis. The pathogenesis of cardiac schwannoma needs further research in order to prevent and manage this rare lesion.


Assuntos
Neoplasias Cardíacas , Neurilemoma , Feminino , Humanos , Pessoa de Meia-Idade , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Ventrículos do Coração/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Tomografia Computadorizada por Raios X , Ecocardiografia
12.
Ethiop J Health Sci ; 32(Spec Iss 1): 41-46, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36339955

RESUMO

Background: Spinal tumors constitute 10-32% of all primary central nervous system tumors. Accurate radiologic and histopathology diagnosis is crucial in the management and prognosis. The aim of the study was to describe the imaging patterns and to determine the agreement of imaging pattern of spinal tumors with intra-operative and histopathology findings. Methods: A retrospective cross-sectional study of 47 patients with spinal tumor done from May 2018 to October 2020. Medical records were reviewed for clinical data, history, physical examination, magnetic resonance imaging (MRI), intraoperative findings and histopathology reports. The agreement between imaging, intraoperative finding and histopathology diagnosis was analyzed. Results: Intradural extramedullary tumors constituted 37 (78%) cases followed by six (12.8 %) extradural tumors and four (9.2%) intramedullary tumors. Schwannoma accounted for 13 (27.7%) cases followed by meningioma, 12 (25.5%) cases. Twenty-seven (57.4%) cases were thoracic level and cervical level were nine (19.1%) cases. Twelve (25.5%) cases did not have a definite intraoperative diagnosis. Imaging and intraoperative diagnosis was in agreement in 21 (44.6 %) cases and disagreed in 14 (29.7%) cases. For the imaging diagnosis and histopathology, 29 (61.7%) were in agreement and 18 (38.3 %) were in disagreement. Conclusion: In conclusion, the commonest site to be involved was the thoracic spine and schwannoma was the commonest tumor. The low agreement between imaging and histopathology could have been improved by optimizing the imaging reports and techniques.


Assuntos
Neoplasias Meníngeas , Neurilemoma , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Estudos Retrospectivos , Estudos Transversais , Etiópia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia
13.
Neurol India ; 70(5): 2132-2136, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352622

RESUMO

Segmental schwannomatosis involving a nerve in single limb is uncommon. Schwannomatosis is used to describe a distinct clinicopathological disease of multiple schwannomas without manifestations of neurofibromatosis, and it is termed segmental when a single extremity is involved. Surgery is indicated when there is progressive clinical deterioration or progressive increase in size of the tumors. We present a case series of segmental schwannomatosis involving the lower limb.


Assuntos
Neurilemoma , Neurofibromatoses , Neoplasias Cutâneas , Humanos , Neurofibromatoses/cirurgia , Neurofibromatoses/patologia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neurilemoma/patologia , Neoplasias Cutâneas/cirurgia , Extremidade Inferior
14.
Hinyokika Kiyo ; 68(10): 327-331, 2022 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-36329381

RESUMO

A 48-year-old man presented with a painless nodule on the right ventral aspect of the penile shaft root. The patient visited the hospital and complained that the mass was growing. On physical examinations, a 5 cm mass without tenderness was palpated. An isoechoic mass about 4 cm in size was observed on ultrasonography. Inhomogeneous high signal intensity was observed on T2-weighted magnetic resonance imaging. A needle biopsy revealed schwannoma. During surgery for excision of the tumor, another small tumor was detected both tumors were resected. Both tumors were diagnosed as schwannoma by pathological examination. Out of 40 cases of penile schwannoma reported, eight were of multiple tumors. In our case, it was difficult to detect the other small tumor by preoperative diagnosis. Therefore, we recommend careful observation during surgery.


Assuntos
Neurilemoma , Neoplasias Penianas , Masculino , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias Penianas/diagnóstico por imagem , Neoplasias Penianas/cirurgia , Imageamento por Ressonância Magnética , Ultrassonografia , Pênis/patologia
17.
Medicine (Baltimore) ; 101(40): e31062, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36221358

RESUMO

RATIONALE: Bronchial schwannomas are extremely rare among the benign tracheobronchial tumors and little are known about its epidemiology and optimal clinical management. Here, we report a case of bronchial schwannoma in a young Japanese man and clinical implications about epidemiology, symptom, diagnosis, and treatment of bronchial schwannoma. PATIENTS CONCERN: A 37-year-old man visited our department with a nodule incidentally found on his chest radiograph during a routine medical checkup. DIAGNOSIS: The tumor was diagnosed as a bronchial schwannoma after pathological evaluation. Microscopically, the tumor consisted of spindle cell proliferation characterized by an alternating highly ordered cellular Antoni A component with occasional nuclear palisading and a loose myxoid Antoni B component. Tumor cells were immunoreactive for S100 but not for smooth muscle actin or KIT. INTERVENTIONS: A video-assisted right middle and lower bilobectomy was performed. OUTCOME: He remains under observation without recurrence. LESSONS: In our review, many reports have come from Asian countries. Bronchial schwannoma can occur within a wide range of age groups and in both men and women. No difference in incidence was observed between right and left bronchial tree. Bronchial schwannoma is sometimes difficult to differentiate from malignant diseases. We should include bronchial schwannoma as one of the differential diagnoses of primary bronchial tumors.


Assuntos
Neoplasias Brônquicas , Neurilemoma , Actinas , Adulto , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Neurilemoma/diagnóstico , Neurilemoma/patologia , Neurilemoma/cirurgia , Pneumonectomia
19.
Medicina (Kaunas) ; 58(10)2022 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-36295506

RESUMO

BACKGROUND: Schwannomas, also called neurinomas, are rare benign tumors of the neural cells that can develop from the sheaths of nervous structures of several districts, although the most frequent sites are the cranial nerves (25%-45%). Rarely, cases show neck schwannomas in the thyroid parenchyma, while the cases of thyroid-bed schwannomas mimicking a thyroid-gland lesions are anecdotal. METHODS: We report the case of a 70-year-old man with a preoperative-imaging diagnosis of a thyroid neoplasm, confirmed as Thyr 4 by fine-needle cytology. RESULTS: During surgery, an extra-thyroidal lesion was discovered, determined to be a neck schwannoma through definitive pathology. A literature review of cases of thyroid-bed-lesion schwannomas misinterpreted as thyroid neoplasms was carried out. CONCLUSIONS: In the case of suspicious extra-thyroidal lesions, we advocate for a close routine cooperation between the cytologist, the radiologist, and the surgeon in the attempt to reach an accurate preoperative diagnosis.


Assuntos
Neurilemoma , Neoplasias da Glândula Tireoide , Masculino , Humanos , Idoso , Tireoidectomia/métodos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Neurilemoma/diagnóstico , Neurilemoma/patologia , Neurilemoma/cirurgia , Pescoço
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