Intraosseous neurilemoma of the mandible with unusual multilocular presentation: a case report.

This case report describes an intraosseous neurilemoma, observed radiographically as a multilocular lesion, in a 12-year-old patient. Physical examination revealed facial asymmetry, swelling on the right side of the mandibular body, and bone expansion in the region of the base of the buccal sulcus. Panoramic radiography revealed a multilocular radiolucency on the right side of the mandibular body in the periapical region extending from the distal region of the first premolar root to the second molar and adjacent to the third molar. Evaluation of a radiograph obtained 3 years earlier for an orthodontic assessment revealed that the lesion was present, appearing as a unilocular radiolucency near the root of the mandibular right first molar. An incisional biopsy of the multilocular lesion was performed, and Antoni A and Antoni B histologic patterns were identified by microscopic analysis. Immunohistochemical analysis was conducted, and neoplastic cells stained positive for the S-100 protein. The patient underwent conservative surgical excision of the lesion, and no recurrence was observed during 7 years of clinical follow-up. Based on analysis of the present case and previous cases reported in the literature, intraosseous neurilemoma, especially its multilocular variant, is an uncommon neoplasm. In the present case, evaluation of the lesion when it was first radiographically detectable, prior to orthodontic treatment, would have permitted a more limited surgical approach for the excision of a small intraosseous lesion.

Intramural schwannoma involving a vein.

Schwannoma involving the blood vessels is a rare phenomenon. So far, only three cases of intravascular schwannoma have been described (all of which were intraluminal), and the origin of the schwannoma in such cases is not yet completely understood. Here, we describe a very rare intramural venous schwannoma in the subcutaneous right prepatellar area of a 31-year-old man. The schwannoma grew by enlarging and thickening the blood vessel wall, between two preserved layers of the vein. In some areas, there was erosion of the luminal layer, with fibrin apposed to the tumor. The tumor expressed S100 and was negative for CD31, CD34, desmin, and smooth muscle actin. The expression of p16 was preserved. Endothelial markers such as CD31 and Factor VIII showed the endothelial lining (which was D2-40-negative) above the tumor. Although degenerative atypia was present, there were no mitotic figures or necrosis identified.

Giant schwannoma of the hard palate: a literature review and report of an uncommon case.

Schwannomas (also known as neurilemomas) are benign tumors that arise from the Schwann cells of the nerve sheath. While they seldom occur in the oral cavity, the tongue is the most common site. Palatal schwannomas are extremely rare. This article reports a case of a large, slowly developing schwannoma that caused bone erosion in the hard palate of an 18-year-old man. The diagnosis was based on histopathologic and immunohistochemical findings. The tumor was completely excised, and no recurrence was observed at a 1-year follow-up. This case is notable for the large dimensions, long period of evolution, and the uncommon anatomical site of the tumor. A review of the main clinical and histologic characteristics of palatal schwannomas reported in the last 40 years is also provided.

Small palatal swelling: an uncommon presentation of intraoral schwannoma.

Schwannomas are uncommon benign tumors arising in the nerve-supporting Schwann cells. Intraoral lesions usually present in the tongue or floor of the mouth as a submucosal nodule, while the palate is rarely affected. A 26-year-old white man presented with an asymptomatic submucosal fibroelastic nodule in the hard palate. The 2 × 2-cm lesion was covered by normal-appearing mucosa. Under the working diagnosis of minor salivary gland tumor, an incisional biopsy was performed, and analysis revealed an encapsulated tumor with a well-defined biphasic pattern: hypercellular areas with spindled cells arranged in palisades and less cellular areas formed by irregular arranged masses of elongated cells and fibers. The diagnosis of schwannoma was rendered, and the lesion was excised together with periosteum. No recurrence was observed after 30 months of follow-up. Palatal nodules usually present as minor salivary gland tumors; rarer lesions, such as schwannomas, represent a clinical diagnostic challenge. Clinicians should consider schwannoma in the differential diagnosis for palatal nodules and manage them with incisional biopsy and prompt treatment.

Benign Solitary Schwannoma of the Cheek: A Case Report and a Review of the Literature.

Schwannomas are generally known to be benign tumors that arise from Schwann cells. The most frequently encountered tumors of this type in ENT are vestibular schwannomas or acoustic neuromas. However, head and neck localization, although rare, has been documented in the literature. We present the case of a 13-year-old girl who presented with chronic swelling of the left cheek, leading to aesthetic discomfort. Clinical examination objectified a palpable swelling on both the external and internal sides of the left cheek. No other abnormalities were detected during the clinical examination. Ultrasound of the soft tissues identified the left cheek swelling as corresponding to a subcutaneous cyst. No further investigations were indicated for this patient. The treatment consisted of surgical excision via an intraoral approach with an internal buccal incision. Histological analysis confirmed the diagnosis of schwannoma. Schwannoma, a benign neurologic tumor, is rarely located in the face, particularly in the jaw. Its diagnosis is confirmed through histopathological examination, and treatment typically involves complete surgical removal when feasible.

Rare Case of Nasal Tip Schwannoma - A Case Report.

Schwannoma is a benign neurogenic neoplasm which is arising from schwann cells of peripheral nerve sheath. It can occur in anywhere in the body. Schwannoma of sinonasal tract is extremely rare. Here we report a rare case of schwannoma of nasal tip. A 45 year old male presented with a swelling of tip of the nose, causing cosmetic deformity with no other associated symptoms. Surgical excision of the mass done by using external rhinoplasty approach. Histolopathology report of specimen showed a well circumscribed schwannoma with Antoni A and Antoni B areas.

Case Report: Neuroblastoma-Like Schwannoma in a Domestic Short-Haired Cat.

An axillary mass was detected in a 6-year-old, neutered, male, domestic short-haired cat during a wellness exam. Gross examination following surgical removal revealed a discrete, deep subcutaneous, discoid mass that was between 0.5- and 0.7-cm-in-diameter and diffusely firm and white. Histologically, the mass was well-demarcated, partially encapsulated, and expanded the panniculus carnosus. It was composed of tightly packed, giant rosettes of radially arranged fusiform cells stacked in one to 10 layers with peripherally palisading nuclei and with centrally oriented, fibrillary, cytoplasmic processes, and collagenous fibers. Laminin immunoreactivity and ultrastructural examination highlighted a continuous basal lamina outside the plasma membrane of each neoplastic cell. Neoplastic cells were immunoreactive for GFAP, S100, periaxin, and Sox-10 and were immunonegative for synaptophysin, smooth muscle actin, and pancytokeratin. Collective findings were consistent with a diagnosis of neuroblastoma-like schwannoma. This is the first veterinary report of this rare variant of benign schwannoma.

Systematic Review of Intra Parotid Facial Nerve Schwannoma and a Case Report.

To evaluate the clinico-epidemiological aspects, pathological features, diagnostic methods, management protocol and functional outcome of the intra-parotid facial nerve schwannoma (IFNS) and to present a case report on intra parotid facial nerve schwannoma. PubMed, ProQuest, Google scholar, Science direct and Scopus were screened for studies. Article selection and data extraction was done by one investigator and other investigator confirmed its accuracy. After abstract and text screening a total of 69 articles were finally selected for the study with the inclusion and exclusion criteria of the systematic review as per PRISMA guidelines. With addition of one case reported to our department. The mean age of diagnosis was 43 ± 16 years with a slight female predominance. The mean duration of the tumour was 29.5 months and the mean size of the tumour on initial diagnosis was 3.6 ± 1.67 cm. Pleomorphic adenoma was the primary diagnosis in 44 cases. Superficial parotidectomy was done in 64 cases followed by resection in 47 cases. Reconstructive treatment was carried out by an end-to-end anastomosis in 3 patients and by facial-hypoglossal anastomosis in 16 patients, GAN cable grafting in 5 patients, a greater auricular nerve graft was done in18 patients and end-to-side interposed sural nerve graft in 8 patients. The type D tumours are treated by extended resection of the facial nerve, which is difficult to reconstruct and also employs a nerve graft that does not often give acceptable recovery of facial function. Facial nerve schwannomas being a rare entity poses a dilemma in diagnosis and management. Managing the lesions is also difficult as intraoperative adherence to the nerve makes a tumour free margin difficult without sacrificing the nerve. At present there is no consensus regarding the management of various types of intra-parotid facial nerve shwannoma.

A fast-growing schwannoma of the tongue in a 15-year-old Iranian male: Review of literature and case report.

Schwannoma can be included in the list of differential diagnoses of tongue masses but seems to be a rare finding in the Iranian population. The current case was presented as an exophytic nodular sessile mass which was growing fast.

Investigation of Schwannomas in the Forearms, Hands, and Digits: A Retrospective Study.

Background: Previous reports on schwannomas of the upper extremities have mainly focused on proximal involvement. This study aimed to evaluate pre- and peri-operative findings in schwannomas of the distal upper extremities and assess the accuracy of diagnosis and surgical outcome. Methods: We identified 24 patients with isolated tumors. Seven patients had schwannomas located in the forearm, eleven in the hand, and six in the digits. We collected the following data: preoperative clinical and magnetic resonance imaging findings, provisional diagnosis, surgical findings and procedures, tumor volume, and postoperative clinical findings. Data were compared between tumors of different locations. Results: The mean age of our cohort at the time of surgery was 48.0 years and the mean follow-up period was 10.6 months. All patients with forearm schwannomas were diagnosed preoperatively by the presence of the Tinel-like sign and suggestive magnetic resonance imaging findings. In contrast, schwannomas in the hands and digits often lacked these diagnostic features; only five patients with hand schwannomas and one with digit schwannoma were correctly diagnosed. Microsurgical enucleation was the most common treatment. Ten patients reported newly acquired paresthesia after operation, which resolved within the follow-up period in nine patients. Three of the four patients with preoperative paresthesia and one patient who underwent enucleation with surgical loupes still had paresthesia at the final follow-up. Conclusions: In schwannomas of the distal upper extremities, a more distal location is associated with a lower occurrence of the Tinel-like sign and fewer suggestive magnetic resonance imaging findings, resulting in lower diagnostic accuracy. However, intra-operative diagnosis is usually straightforward and microsurgical enucleation does not cause iatrogenic nerve deficit. When treating soft tissue tumors in the hand and digits that present without specific or suggestive findings, the possibility of schwannoma should be considered.

Intraocular schwannoma with extrascleral extension.

PURPOSE: To report a rare case of intraocular schwannoma with extrascleral extension in a patient with juvenile idiopathic arthritis and to review the literature for this topic. METHODS: Case report. RESULTS: A 19-year-old male with a history of juvenile idiopathic arthritis was referred for diagnosis and management of an episcleral mass, initially thought to be focal nodular scleritis. The ocular surface of the right eye revealed an elevated amelanotic episcleral nodule inferonasally, with thin strands of overlying sclera, feeding episcleral vessels, and measuring 11 mm × 11 mm in diameter and 5 mm in thickness. Ophthalmoscopic examination revealed a minimally pigmented ciliochoroidal tumor measuring 13 mm in diameter and 11.4 mm in total thickness and without associated subretinal fluid, orange pigment, or drusen. Ultrasound biomicroscopy and anterior-segment optical coherence tomography confirmed a solid mass with scleral disruption and extraocular extension. Shave biopsy revealed palisading spindle cells and interspersed eosinophilic fibrillary cytoplasmic processes, forming Verocay bodies. The specimen stained positive for S-100 and negative for Melan-A, consistent with benign schwannoma. Observation was recommended. CONCLUSION: Intraocular schwannoma is a rare, benign uveal tumor that can demonstrate extrascleral extension, mimicking inflammatory and malignant neoplastic processes. Clinical diagnosis is challenging, and tissue biopsy is required for definite diagnosis.

Multiple Schwannomas of the Median Nerve: A Case Report and Review of the Literature.

INTRODUCTION: Schwannomas are rare benign tumors affecting the peripheral nerves. They can grow in clusters when associated with neurofibromatosis Type II or with schwannomatosis. Typically, patients present with a palpable painless mass. However, some patients, on the other hand, present with symptomatic lesions that resemble a focal nerve compression caused by the encapsulating nature of these tumors. Surgical excision is an excellent solution for solitary symptomatic lesions. However, multiple schwannomas affecting the same nerve add another level of complexity to the surgery since these secondary masses can be too small to be detected on physical examination. A high index of suspension for schwannomatosis complemented with magnetic resonance imaging (MRI) ensures a more efficient pre-operative workup that can save the patient potentially an additional visit to the operating room. CASE REPORT: This is a case of a 36-year-old right-handed female presented to our clinic with a several-years history of a painful mass in her forearm. On physical examination, she had a palpable painful mass that was Tinel positive with pain and paresthesia radiating distally over the median nerve distribution. A subsequent MRI scan showed a second smaller mass distally adjacent to the main lesion along with the median nerve, both appearing to be schwannomas of the median nerve. In this case report, we discuss the patient presentation, diagnostic workup and radiographic finding, surgical technique, and pathological findings in addition to a review of the literature regarding multiple schwannomas affecting the upper extremity. CONCLUSION: Schwannomas are rare benign tumors affecting the peripheral nerves. Despite their solitary nature, a handful of cases are reported in the literature that describes multiple masses encapsulating the same nerve. MRI is utilized to allow proper pre-operative planning and more accurate localization of these tumors to avoid an unplanned return to the operating room.

Abducens nerve schwannoma of the cavernous sinus: A case report and literature review.

BACKGROUND: Schwannomas of the abducens nerve are a rare pathology and are encountered less within the cavernous sinus. We describe a case of sixth cranial nerve schwannoma, in the cavernous sinus. CASE DESCRIPTION: A 50-year-old lady, presented with 2 years history of double vision and left facial numbness that started 6 months before presentation, found to have hyperintense lobulated mass at the left cavernous sinus extending into Meckel's cave with bony remodeling on magnetic resonance imaging. She underwent left frontotemporal craniotomy, combined extra-intradural approach, gross total resection. She had a gradual recovery of the sixth cranial nerve function. CONCLUSION: Abducens nerve schwannoma of the cavernous sinus is a rare and challenging tumor. However amenable to surgical intervention with favorable neurological outcome.

Different clinical presentation of intralabyrinthine schwannomas - a systematic review.

INTRODUCTION: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. OBJECTIVE: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. METHODS: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. RESULTS: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. CONCLUSION: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.

Schwannoma de colon derecho: a propósito de un caso / Schwannoma of the right colon: case report

RESUMEN El schwannoma de colon es una entidad sumamente rara que puede debutar como lesión subepitelial con signos ulcerativos de melena y anemia. El estudio de imágenes nos orienta a la localización mientras que la biopsia colonoscópica no es de ayuda. Muchas veces el diagnóstico y tratamiento se efectúa con la resección de la lesión en tanto que el diagnóstico final se realiza en el posoperatorio por histopatología y por la inmunohistoquímica, la cual muestra positividad intensa para S100 y vimentina en las células tumorales con un índice de proliferación KI67 menor al 1%, por lo que se concluye que se trata de una lesión benigna. Presentamos el siguiente caso por su dificultad diagnóstica pre e intraoperatoria, clínica inespecífica y diagnóstico definitivo por inmunohistoquímica.

ABSTRACT Colon schwannoma is an extremely rare entity that may debut as a subepithelial lesion with ulceration signs, such as melena and anemia. Imaging studies guide us to localization, while a colonoscopy biopsy is not helpful. Many times, the diagnosis and treatment are made with lesion resection, and the final diagnosis is postoperatively made with histopathology and immunohistochemistry, which shows intense positivity for S100 and vimentin in tumor cells with a KI67 proliferation index of less than 1%, therefore, it is concluded that this is a benign lesion. We present this case due to its pre- and intraoperative diagnostic difficulty, non-specific symptoms, and its definitive diagnosis that was achieved with immunohistochemistry.

Posterior Interosseous Nerve Syndrome due to Schwannoma - A Case Report / Síndrome interóssea posterior devido a schwannoma - Um relato de caso

Abstract Posterior interosseous nerve syndrome is the most frequent syndrome of radial nerve compression, with the arcade of Frohse being the main site of compression. Its symptoms include difficulties in finger and wrist extension with possible radial deviation. Herein, we present a case of posterior interosseous syndrome caused by a schwannoma, a type of neurological tumor.

Resumo A síndrome interóssea posterior é a síndrome mais frequente de compressão do nervo radial, com a arcada de Frohse sendo o principal local de compressão. Seus sintomas incluem dificuldades na extensão do dedo e punho, com possível desvio radial. Aqui, apresentamos um caso de síndrome interóssea posterior causada por um schwannoma, um tipo de tumor neurológico.

Schwanoma palatino en paciente pediátrico de 12 años: una rara presentación clínica / Palatine Schwannoma in a 12 year-old pediatric patient: a rare clinical presentation

El schwanoma es un tumor neural que se origina en las células de Schwann presentes en la vaina nerviosa cuya localización más frecuente a nivel oral es el dorso de lengua, siendo mucho más frecuente en adultos. En población pediátrica la presentación es muy rara siendo lengua su ubicación más frecuente, mientras que a nivel palatino solo se conocen 11 reportes en menores de 16 años. El objetivo de este reporte es presentar un caso clínico inusual de schwanoma palatino en un niño chileno de 12 años de edad, quien fue derivado con diagnóstico clínico presuntivo de carcinoma mucoepidermoide. El caso se complementó con radiografía panorámica, Conebeam, y luego biopsia incisional. Finalmente, se diagnosticó schwanoma palatino variedad sólida. Es importante considerar al schwanoma como diagnóstico diferencial en casos de tumores palatinos, en especial en casos pediátricos ya que se pueden presentar similares características clínicas a tumores de glándula salival.

The Schwannoma or neurilemmoma tumor originates from Schwann cells present in nerve sheaths. At oral level, its most frequent location is at the back of the tongue, being much more frequent in adults. In the pediatric population, this occurrence is rare and most frequently found in the tongue. At palatal level, only 11 reports are known in children under 16 years of age. The aim of this report is to present an unusual clinical case of palatal schwannoma in a 12-year-old Chilean boy, referred with a clinical diagnosis of mucoepidermoid carcinoma. The case was complemented with panoramic radiography and Cone beam, for its subsequent incisional biopsy. Finally, a solid palatal schwannoma was diagnosed. It is important to consider schwannoma as a differential diagnosis in cases of palatal tumors, especially in pediatric cases, since they can present similar clinical characteristics to salivary gland tumors.

Schwannoma retroperitoneal primario. Presentación de un caso

Los schwannoma son tumores de tejidos blandos que se originan en las células de Schwann de la vaina nerviosa en los nervios periféricos, craneales o viscerales, en cualquier parte del cuerpo. Se trata de una entidad extremadamente inusual. En el artículo se describe el caso de un paciente de piel negra, 47 años de edad y con antecedentes de salud, quien acudió a consulta de clasificación, refiriendo que desde hacía un mes había comenzado a presentar dificultad para orinar, hasta llegar a la retención aguda de orina. Al examen físico se constató, mediante tacto rectal, esfínter tónico, ampolla rectal vacía, próstata aumentada de tamaño grado IV con consistencia fibromuscular de superficie lisa y móvil; no dolorosa. Tras realizarle estudios imagenológicos y complementarios, recibió tratamiento quirúrgico en el Hospital Provincial Docente Oncológico María Curie, de Camagüey, Cuba. Se le diagnosticó un schwannoma retroperitoneal, confirmado por el informe de Anatomía Patológica. Actualmente la evolución del paciente es favorable, sin tratamiento médico, pero con seguimiento periódico.

Schwannoma are soft tissue tumors that originate in Schwann cells of the nerve sheath in peripheral, cranial or visceral nerves, anywhere in the body. This is an extremely unusual entity. The article describes the case of a 47-years-old black-skinned patient with a history of health who attended a triage consultation, reporting that one month ago he had started having difficulty urinating, leading to acute urinary retention. The physical examination confirmed, through digital rectal examination, a tonic sphincter, an empty rectal ampulla, a grade IV enlarged prostate with a fibromuscular consistency with a smooth and mobile surface; not painful. After carrying out imaging and complementary studies, he received surgical treatment at the María Curie Provincial Oncological Teaching Hospital, in Camagüey, Cuba. He was diagnosed with a retroperitoneal schwannoma, confirmed by the Pathology report. Currently the evolution of the patient is positive, without medical treatment, but with periodic follow-up.

Schwannoma intraóseo en fémur, una presentación inusual. Reporte de caso / Intraosseous Schwannoma in femur, an unusual presentation. Case report

El Schwannoma o Neurilemoma es un tumor benigno de derivación neuroectodérmica que se origina en las células de Schwann, que constituyen la envoltura de los nervios. Es el tumor benigno más común de los nervios periféricos, tiene predisposición a originarse a partir de nervios periféricos sensoriales y puede presentarse como tumores en tejidos blandos. La presentación intraósea del Schwannoma es rara y corresponde al 0,2% de los tumores óseos primarios. Se presenta caso clínico de paciente masculino de 36 años de edad con tumor en cóndilo femoral medial de rodilla derecha de 4 años de evolución, cursando con dolor intermitente moderado a quien se le practicó el protocolo oncológico, imagenológico e histológico, de la Unidad de Oncología Ortopédica del estado Monagas. Se diagnosticó Schwannoma intraóseo, se procedió a realizar resección marginal y reconstrucción con alloinjerto y fijación con placa y tornillos con excelente evolución postoperatoria. El Schwannoma intraóseo es extraordinariamente raro y su ubicación en el fémur lo es aún más. El objetivo del presente trabajo es reportar un caso de Schwannoma Intraóseo, mostrar las estrategias para su diagnóstico y los tratamientos aplicados, así como la revisión de los datos al respecto existentes en la literatura(AU)

Schwannoma or Neurilemoma is a benign tumor of neuroectodermal derivation that originates in Schwann cells, which constitute the nerve sheath. It is the most common benign tumor of the peripheral nerves, has a predisposition to originate from peripheral sensory nerves, and can present as soft tissue tumors. The intraosseous presentation of Schwannoma is rare and corresponds to 0,2% of primary bone tumors. A clinical case of a 36-yearold male patient with a tumor in the medial femoral condyle of the right knee of 4 years of evolution is presented, presenting with moderate intermittent pain who underwent the oncological, imaging and histological protocol of the Oncology Unit. Monagas State Orthopedic. Intraosseous Schwannoma was diagnosed, marginal resection and allograft reconstruction and plate and screw fixation were performed with excellent postoperative evolution. Intraosseous Schwannoma is extraordinarily rare and its location in the femur is even more so. The objective of this paper is to report a case of Intraosseous Schwannoma, show the strategies for its diagnosis and the treatments applied, as well as the review of the existing data in the literature(AU)