Solitary extracranial neurilemmomas of the head; anatomo-clinical study of 16 cases

Abstract

16 cases of extracranial solitary neurilemmomas localized to the head and neck (middle ear, nose, parotid gland, lip, tongue, cheek, alveolar margin, laterocervical and frontoparietal regions) are referred. From an anatomopathological standpoint it is mainly underlined: 1) the opportunity of considering two types only (benign and malignant neurilemmoma), as the Anthoni's « B » type results to be conditioned by regressive-involutive phenomena which easily occur in classical « A » neurilemmomas with active growth; 2) the rare and aspecific palisade arrangement of the tumour elements which, however, often occurs in other neoplasms (fibromas, myomas, fibrosarcomas, ablastic sarcomas, etc.); 3) the difficult recognition of the malignant varieties which frequently show histoarchitectonic as well as histocytologic hyperdifferentiation; so the biological malignancy of the tumour is based more on clinical than on histo-cytological aspects. From a clinical standpoint, it is emphasized: 1) the seldom incidence of the extracranial solitary neurilemmoma at the level of the cephalic sector (derived from the analysis of more than 60,000 bioptical examinations); 2) the highest frequency in the 4th-5th decade of life, in female sex, and in oral and nasal regions; 3) the aspecificity of the symptomatological picture which is common to other neoplastic, dysplastic and phlogistic processes of this region, leading to difficulties of the diagnosis, which is relied upon the intraoperative microscopical observation; 4) the determinant value of an early and radical surgical treatment for a definitive clinical recovery.