Abstract
Schwannomas commonly occur in the head and neck region and extremities, but nasal schwannoma is extremely rare. It accounts for less than 4% of benign solitary schwannomas of the head and neck region. Few cases and very few case series have been reported till date. We report the case of a six-year-old female who presented with mouth breathing of two years with persistent and progressive right nasal obstruction of three months. There was recurrent watery ipsilateral nasal discharge, but no epistaxis, no otologic or throat symptoms, no headaches, facial pain, proptosis or visual loss, no facial hypoesthesia, fever or weight loss. She also had right sided epiphora. She had used topical steroid and decongestant without improvement. Ten months prior to presentation, she had right dacrocystorhinostomy. Examination revealed mucosa mass completely filling the right nasal cavity with an ipsilateral deviation of nasal septum—it was painless with no contact bleeds. Nasal patency was clinically absent bilaterally. Computed tomogram revealed expansile isodense soft tissue mass in the right nasal cavity with heterogeneous enhancement on contrast administration which measured 2.5 cm by 3.7 cm by 5.2 cm. She had an intranasal excision of the tumour and histology revealed Antoni A and B patterns, which is diagnostic of schwannoma. She was fully relieved of symptoms after surgery. Conclusion: Solitary nasal schwannoma is rare especially in childhood. There are various causes of epiphora; definitive investigation of the cause in the index case was not established before dacrocystorhinostomy. Thorough nasal evaluation of epiphora or related ocular symptoms should be sought before definitive procedures.
Highlights
Schwannoma is the most common benign tumour of peripheral nerves [1]
Epiphora as the only presenting symptom has not been reported we report this unusual presentation
A Computerized tomogram of the paranasal sinuses revealed a well-defined expansile isodense mass appearing to arise from the lateral wall of the right nasal cavity causing deviation of the septum to the lateral wall of the left nasal cavity
Summary
Schwannoma ( known as neurilemoma, Neuroma, neurolemoma and Schwann cell tumour) is the most common benign tumour of peripheral nerves [1]. They are rare encapsulated tumours that are derived from the Schwann cells of the sheath of myelinated nerves They are usually solitary but can be multiple (Schwannomatosis), are universally S-100 positive and can occur as lesions associated with Neurofibromatosis. A six-year-old girl was referred to the Ear, Nose and Throat outpatient clinic by the ophthalmologist with persistent and progressive right nasal cavity obstruction with associated mouth breathing of three months. The nasal cavity mucosa over the mass appeared normal—it was painless with no contact bleeding Both nasal cavities were obstructed clinically, but worse on the right. A Computerized tomogram of the paranasal sinuses revealed a well-defined expansile isodense mass appearing to arise from the lateral wall of the right nasal cavity causing deviation of the septum to the lateral wall of the left nasal cavity. Tissue specimen was strongly immunoreactive to S-100 (Figure 4), had Verocay bodies (Figure 5), it was Epithelial Membrane Antigen (EMA) negative (Figure 6), Neuron Specific Enolase (NSE) negative (Figure 7), desmin negative (Figure 8) and vimentin positive (Figure 9)
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