Case Of Schwannoma Research Articles

Laparoscopic resection of a primary diaphragmatic schwannoma: a case report and literature review

BackgroundSchwannomas are nerve sheath tumors that commonly originate from the stomach and small intestine. A primary schwannoma of the diaphragm is rare and does not show any symptoms until it grows to a certain size. Hence, it is extremely rare that it was found at a size that allowed resection under videoscopic surgery.Case presentationA 77-year-old woman was referred to our department for surgical treatment of a tumor located near the gastric fornix. She underwent a routine esophagogastroduodenoscopy 2 years and 7 months prior to the referral. It was suspected that she had a submucosal tumor measuring 10 mm, located in the fornix, and was then referred to her previous physician. During her follow-up, endoscopic ultrasonography (EUS) revealed that the cystic structure had continued to grow toward the gastric wall, and she was then referred to the endoscopy division of our hospital. She continued to be followed-up, and it was noted that the tumor was gradually increasing in size. Therefore, she requested surgical resection, and was finally referred to our division. Since the tumor was rather small, we planned a laparoscopic surgery. An initial examination during the operation revealed that the tumor was located on the left diaphragm. Since the tumor was relatively small and visibility was good, we decided to continue with the laparoscopic surgery. Partial diaphragmectomy with complete inclusion of the tumor was performed, and the defect of the diaphragm was directly closed by a running suture. Pathological examination revealed a benign schwannoma that had originated from the diaphragm. To support our findings, we also reviewed the scientific literature on diaphragmatic schwannoma cases reported up to April 2020.ConclusionsIn this extremely rare case, we successfully resected the diaphragmatic schwannoma using laparoscopic surgery.

Laparoscopic nephrectomy for giant benign renal schwannoma: a case report and review of literature

Benign giant renal schwannoma is rarely found and the diagnosis difficulty only depends on physical and imagological examination. Pathological examination is essential to confirm the diagnosis of renal schwannoma. Nephrectomy and tumorectomy are primary treatments for renal schwannoma. Although most of the reported patients present satisfactory outcome, however, there is still not sufficient evidence to reveal the biological characteristics and post-operation recurrence rate of renal schwannoma. Herein, we report a rare case of giant and complicated renal schwannoma. A 56-years-old female patient was admitted to the urology department due to left lower back pain for approximately 5 days. No positive signs and other special abnormalities were found. CT scan presented a soft tissue tumor with inhomogeneous enhanced in the renal hilum. Surgery was performed to excise the tumor and left renal. Renal schwannoma was confirmed by pathological examination. At the 6-month follow-up, no evidence of recurrence was found. Our present report could provide more material for further study.

A Case of Schwannoma Arising from the Nerve Plexus around the Left Hepatic Artery

A Case of Schwannoma Arising from the Nerve Plexus around the Left Hepatic Artery

A Case of Anterior Cervical Intramuscular Schwannoma in the Strap Muscle

Schwannoma, also known as neurilemmoma, is a benign neoplasm that originates from any nerves wrapped with a sheath made of Schwann cells. Schwannoma occurring in the head and neck region is not rare, but schwannomas of the anterior neck, especially ansa cervicalis, are extremely rare that only 7 cases have been reported to date worldwide. Although rare, it should be considered in differential diagnosis of anterior cervical mass and may be confused with other cervical and thyroid mass. We report a case of intramuscular schwannoma in the sternohyoid muscle. Preoperative diagnosis was established with an ultrasound-guided core needle biopsy. Although it was removed entirely without connection to any other nerves identified or any complication, clinically, the mass was thought to be derived from the nerve. To our knowledge, this is the first case of the intramuscular schwannoma occurring from ansa cervicalis reported in the literature.

Schwannoma in Soft Palate: A Rare Case Report with Review of Literature.

Schwannoma is a benign tumor originating from Schwann cells of the nerve sheath. Approximately 25-45% of the schwannomas are seen in the head and neck region and are found rarely in the oral cavity (only 1%). The most common intra-oral site is tongue, followed by floor of the mouth, buccal mucosa, palate, gingiva and lips. We report a rare case of schwannoma in the soft palate in a 22years old female. She presented with 6months history of a painless swelling in palate. The provisional diagnosis was made as some benign neoplasm of minor salivary gland. The tumour was excised intra-orally under general anesthesia. Histopathologic examination showed neural tissue arranged in predominantly Antoni A pattern and formation of verocay bodies. It is difficult to diagnose this tumor based on clinical appearance. Therefore final diagnosis can only be done after histopathological examination of the lesion. Prognosis is good and recurrence is unknown.

Upper Esophageal Schwannoma: Rare Differential Diagnosis of Dysphagia

Esophageal schwannomas are rare primary sub mucosal tumors, 45 cases have been reported so far. We herein report the 46th case of an esophageal schwannoma from Nepal. A 60-year-old woman presented with progressivedysphagia. Oesophago-Gastro-Duodenoscopy (OGD) showed a sub mucosal mass with mucosal puckering in the upper esophagus; Computed tomography (CT) of the chest showed an upper esophageal mass of size 8x7x6cm3compressing the trachea. Bronchoscopy showed external compression of the mid trachea. The patient under went three incision VATS esophagectomy. Histopathological examination and immunohistochemical (IHC) staining confirmed the diagnosis of schwannoma.

S1733 Schwannoma of the Sigmoid Colon Discovered on Screening Colonoscopy

INTRODUCTION: Schwannomas may present anywhere in the body along the peripheral nervous system, but one of colonic origin is very rare. Here we present a case of a colonic schwannoma diagnosed on routine screening colonoscopy. CASE DESCRIPTION/METHODS: A 63-year-old woman with past medical history significant for only hypertension underwent her routine screening colonoscopy. There was no history of any abdominal pain, discomfort, change in bowel movement or any significant change in stool color. During the colonoscopy, four polyps, ranging from 0.3 cm to 0.6 cm in size, were found and removed with via cold snare polypectomy. Post-procedure recovery was uneventful. The microscopic evaluation of the tissue showed proliferating spindle cells arranged in a fascicular palisading pattern. Immunohistochemistry showed that the cells were positive for S-100. Very few cells were positive for Ki-67. The tissues were negative for CD 117, CD 34, desmin and smooth muscle actin. The final diagnosis of Schwannoma of the colon was given. The patient is currently asymptomatic and being managed conservatively. DISCUSSION: Sigmoid colon Schwannomas are rare. Nearly 60% of patients are female and having a median age of 61.5 years. Mesenchymal tumors of the gastrointestinal system such as the slow-growing Schwannoma can be a diagnostic challenge when attempting to differentiate them from their cancerous counterpart, the gastrointestinal stromal tumor. Although Schwannomas tend to be found in the stomach, when they are found in the colon, they have an excellent prognosis, unlike the gastrointestinal stromal tumor which have up to a 30% chance of malignancy. In the colon, they can present as polyps as in our case. These polyps may ulcerate and cause symptoms such as abdominal pain, bleeding and obstruction, though these manifestations are extremely rare. After removal of the suspected tumor, microscopic evaluation and an immunohistochemical panel of the specimen help in the diagnosis. Discovering S-100 protein immune-expression and observing a slow mitotic rate while investigating the proliferative activity using Ki-67 antibodies, provides a definitive diagnosis of Schwannoma. Upon discovery, complete resection of the tumor with adequate free margins is recommended. The chance of malignancy is low and adjuvant chemotherapy is not considered necessary.Figure 1.: colonoscopy finding of sigmoid polyp and after polypectomy.

S3017 That's Not a GIST: A Case of Gastric Schwannoma

S3017 That's Not a GIST: A Case of Gastric Schwannoma

Surgical outcomes and factors related to postoperative motor and sensory deficits in resection for 244 cases of spinal schwannoma

In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01).

Lateral Suboccipital Approach in Semisitting Position for Resection of Vagal Schwannoma: 2-Dimensional Operative Video.

We present a case of a sizeable vagal schwannoma that was resected through a lateral suboccipital approach in semisitting position. An extra-axial lesion, occupying the left cerebellomedullary cistern and extending from the pontomedullary junction to the jugular foramen was incidentally discovered in a 40-year-old woman afflicted with secondary progressive multiple sclerosis during repeated magnetic resonance imaging ( Fig. 1 ). On physical examination, a mild deviation of the uvula to the right and a diminished gag reflex were observed. The patient was referred to our department after considerable growth of the lesion was noted and a broad interdisciplinary consensus was reached to treat the lesion surgically. A gross total resection was achieved, histopathology confirmed a WHO I schwannoma with a low proliferation index. Postoperative dysphonia resolved completely within a few weeks, there was no collateral neurological deficit and especially no functional dysphagia. At 3-year follow-up, there was no indication of residual or recurrence. This 2-dimensional video demonstrates pre- and postoperative imaging, positioning and set-up of operating room, anatomical and surgical nuances of the skull base approach, and the operative technique for microdissection of the schwannoma from the critical neurovascular structures ( Fig. 2 ). In summary, the lateral suboccipital approach in semisitting position is a powerful tool in the armamentarium for the microsurgical management of various pathologies residing in the posterior cranial fossa, especially large and vascularized schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semisitting position is safe and effective. The link to the video can be found at: https://youtu.be/-9o_qJGkQhg .

Endoscope-assisted transoral resection of parapharyngeal space tumors: a retrospective study

Objective:To evaluate the feasibility and safety of the endoscope-assisted transoral approach for the parapharyngeal space（PPS） tumors. Method:This retrospective study included 22 patients who were diagnosed with PPS tumors and treated with the endoscope-assisted transoral approach. Result:The postoperative pathological diagnosis included 10 cases of schwannoma, 7 cases of pleomorphic adenoma, 1 case of paraganglioma, 1 case of branchial cleft cyst, and 3 cases of malignant tumors for a diagnostic purpose. The surgical duration was between 15 minutes and 430 minutes（median duration 105 minutes）, and the intraoperative bleeding was between 10ml to 500ml（median bleeding 20 mL）. Complete resection with minor complication was performed in 21 cases, 1 case of recurrent schwannoma was done in an incomplete style because of intraoperative massive bleeding. With a 12-to-72-months follow up, there was no relapse on the 18 cases of benign tumor which were completely resected. Conclusion:Endoscope-assisted transoral resection provide cosmetic, micro-invasive and increased operative exposure to the PPS, especially for the benign tumors that medial to the carotid sheath. But is not recommend for relapsed cases and lesions that encompassing or lying posterolateral to the carotid sheath.

A case report of primary multiple obturator nerve schwannomas

Primary multiple obturator nerve schwannomas originate from Schwann cells and are extremely rare. Patients with schwannomas are asymptomatic and a retroperitoneal schwannoma is often misdiagnosed as an adnexal mass. In the present study, we describe a 58-year-old woman in whom a right adnexal mass accompanied by endometrial polyp was found incidentally through transvaginal ultrasound. The mass was diagnosed as multiple obturator nerve schwannomas after laparoscopy. Immunohistochemical assay confirmed the schwannomas to be positive for SOX10. To our knowledge, this is the first report to demonstrate a case of multiple schwannomas originating from the obturator nerve and treated by laparoscopic resection.

Laryngeal schwannoma: A case report with short literature review

Introduction. Laryngeal schwannomas are rare benign neuro-genic tumors. They are usually localized in the supraglottic portion of the larynx. We reported a rare case of laryngeal schwannoma with a focus on clinical presentation, diagnosis and management. Case report. A 61-year old male patient with a 3-year history of hoarseness underwent telescopic examination which revealed an oval submucosal tumefaction of the left ventricular fold extending over the left vocal fold toward the right ventricular fold. Multislice computed tomography showed a 22 x 15 mm well defined, oval heterodense mass in the region of the left ventricular fold, extending toward the left vocal fold and the posterior commissure of the larynx, with signs of initial compression lesion of the thyroid cartilage. Biopsy and histopathology revealed a primary benign encapsulated mesenchymal tumor, while immunohistochemistry analysis confirmed schwannoma diagnosis. The patient underwent tracheotomy and left hemilaryngectomy, with complete removal of the tumor. There were no signs of recurrence at the six-month follow-up. Conclusion. Schwannomas are rare among benign tumors of the larynx and might grow for years before being diagnosed. Biopsy with histopathology analysis is used to confirm the diagnosis of laryngeal schwannoma, although extreme care should be taken during biopsy. Treatment consists of complete surgical excision; the surgical approach depends on the size and localization of the tumor, as well as on the presence of a peduncle.

Analysis of High-Frequency Ultrasound in the differential Diagnosis of Lumps in Foot and Hand

Objective: To investigate the ultrasonogram characteristics of common lumps in hand and foot, pursuing for greater understanding of hand and foot lumps. Methods: 65 cases of ultrasonographic characteristics of lumps in hand and foot were retrospectively analyzed, including the location, size, shape, boundary, internal echo and posterior echo, surrounding relationship and blood flow. Results: Among 65 cases, there were 26 cases of tendon sheath cyst, 16 cases of tenosynovitis giant cell tumor, 10 cases of hemangioma, 4 cases of tendon sheath fibroma, 3 cases of epidermoid cyst, 2 cases of Schwannoma, 2 cases of fibrolipoma, 1 case of angiolipoma and 1 case of neurofibroma. The preoperative and postoperative pathological diagnoses of 45 cases, accounting for 69.23%, were consistent, 3 cases (4.62%) were misdiagnosed, which included that 2 cases of tenosynovitis giant cell tumor were misdiagnosed as tendon sheath cyst, 1 case of neurofibroma as epidermoid cyst, and the preoperative diagnosis of the rest 17 cases(26.15%) were indefinite. Conclusion: The high-frequency ultrasound can diagnose properties of lumps in foot and hand well, providing diagnosis basis for further treatment in clinic.

Schwanoma of tonsil

Background: Schwannoma is mostly benign lesion that originates from the Schwannoma cells that cover the myelinated nerve fibers. Schwannoma arising from the tonsil are very rare. In head and neck region the incidence rate of schwannoma is between 25 to 45%. In most of the cases vestibular nerve followed by a parapharyngeal space is involved. It is also known as neurilemmoma.&#x0D; Objective: To diagnoses and manage the case of a Schwannoma of Tonsil.&#x0D; Findings: A case of tonsillar schwannoma in a 42 years old males was reported. The patient presented with unilateral enlargement of left tonsil with congested pharyngeal mucosa.&#x0D; Conclusion: Proper clinical examination with radiological assessment plays a vital role to diagnosis this accurately.&#x0D; Bangladesh Med Res Counc Bull 2020; 46(2): 142-144

Long-term results of Gamma Knife radiosurgery for facial nerve schwannomas

ABSTRACT Objective Long-term outcomes of eleven cases of facial nerve schwannoma were evaluated and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery for treating patients with facial nerve schwannoma. Methods Eleven patients with facial nerve schwannoma (7 women and 4 men; mean age, 44.2 years; range, 19–73 years) underwent Gamma Knife radiosurgery. The most common symptoms were facial palsy (n = 10) and hearing loss (n = 7). Five patients presented with headache. Two patients had undergone prior resection. The patients’ clinical and radiographic data were evaluated retrospectively. Results For the 11 cases of facial nerve schwannoma, mean tumor volume was 3.1 cm3 (range, 0.4–7.4 cm3) and the mean marginal dose applied was 11.9 Gy (range, 11–13 Gy). The mean follow-up period was 84.3 months (range, 66–117 months). Tumor control was achieved in all patients. At the time of writing, four patients experienced tumor volume regression and the other seven were in stable condition. During follow-up, nine patients experienced no change in their facial function, two experienced deteriorated facial function, and none developed new facial palsy. Ten patients who had serviceable hearing prior to Gamma Knife radiosurgery retained their hearing. Conclusions Gamma Knife radiosurgery achieves excellent results with respect to tumor control for 7 years on average. In addition, Gamma Knife radiosurgery provides good results in facial nerve and hearing function at long term. Our series demonstrates that Gamma Knife radiosurgery is an effective and safe treatment for patients with either primary or residual facial nerve schwannoma.

Extremely rare case of retropharyngeal space benign plexiform schwannoma - Excised through Smith- Robinson Approach

Background: Approximately 25–45% of schwannomas are typically slow-growing, encapsulated, and noninvasive tumors that occur in the head-and-neck region where they rarely involve the retropharyngeal space. Here, we report deep-seated benign plexiform schwannoma located in the retropharyngeal C2-C5 region excised utilizing the Smith-Robinson approach.Case Description: A 30-year-old male presented with dysphagia and impaired phonation attributed to an MR documented C2-C5 retropharyngeal schwannomas. On examination, the lesion was soft, deep seated, and extended more toward the right side of the neck. Utilizing a right-sided Smith-Robinson’s approach, it was successfully removed. The histopathology confirmed the diagnosis of a plexiform schwannoma.Conclusion: Retropharyngeal benign plexiform schwannomas are rare causes of dysphagia/impaired phonation in the cervical spine. MR studies best document the size and extent of these tumors which may be readily resected utilizing a Smith-Robinson approach.

Analysis of clinical diagnosis and treatment of 12 cases of intraparotid facial nerve schwannoma

Objective: To investigate the clinical manifestation and management strategy of intraparotid facial nerve schwannoma. Methods: The clinical data of 12 patients with parotid schwannoma treated in Henan Cancer Hospital from January 2009 to January 2019 were analyzed retrospectively, including 5 males and 7 females, aged from 23 to 72 years. All the 12 patients complained of a mass in the parotid region, of whom 4 patients had local discomfort and pain, and 6 patients had varying degrees of pain during palpation. Ultrasound examination showed solid mass in parotid region in 8 cases and mixed mass in 4 cases. The treatment methods, the relationship between tumor and facial nerve, the modes of treatments and the nerve functions before and after operation were analyzed and summarized with House-Brackmann grade. Results: All 12 patients received surgical treatment: 8 patients underwent tumor resection plus partial or total superficial parotidectomy, 1 patient underwent tumor resection and total parotidectomy, and 3 patients underwent tumor resection, with 1 patient in whom tumor could not be removed completely due to tumor extention to the skull base. In 9 cases, the tumor occurred in the trunk or main branch of the facial nerve, and there was no facial nerve injury occurred after surgery; in 1 case, the tumor occurred in the terminal branch of the facial nerve, and part of the severe small branches of adhesion were cut off during the operation; in 1 case, the total trunk of the facial nerve was not found and the broken end of the nerve could not be found during the operation, so the nerve transplantation was not performed. In 1 case, nerve grafting was performed after nerve transection because it was impossible to separate the trunk of the facial nerve from the tumor during the operation. Preoperatively, House-Brackmann grade (H-B)Ⅰfacial nerve function was shown in 10 patients, H-BⅡ in 1 patient and H-B Ⅴin 1 patient. Postoperatively, the facial nerve function recovered to H-B Ⅰfor 7 patients, H-B Ⅱfor 2 patients, H-B Ⅲ for 1 patient, grade Ⅳ for 1 patient with nerve transplantation, and H-B Ⅴfor 1 patient with a revised surgery due to tumor recurrence. Conclusions: The intraparotid facial nerve schwannoma is rare, and it is easy to be misdiagnosed before operation. Surgery is a main treatment for intraparotid facial nerve schwannoma. Attention should be paid to the protection of facial nerve during operation.

Presacral schwannoma: a bizarre presentation in the Pandora’s box of abdomen and pelvis

Schwannomas are benign tumors arising from the Schwann cells of nerve fibers. They are extremely rare in the pelvis accounting for only 1-3% of all schwannomas. These tumors are nonaggressive, slow growing, solitary neoplasms with an extremely low possibility of malignant transformation or recurrence after excision. We present a case of a 19 years old male with complaints of radiating pain from lower back to the left thigh associated with altered bowel and bladder habits. Following a detailed work up he underwent laparotomy and mass excision. Histopathological report revealed presacral schwannoma. Post-surgery patient improved symptomatically and is on regular follow up. There are a smaller number of cases of presacral schwannoma reported in the literature. Due to its outlandish striking presentation, diagnosis is very challenging. Although presacral schwannoma is rare, it should be considered as a differential diagnosis in the back of the mind of a surgeon while dealing a case of pelvic mass. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors.

Transoesophageal endoscopic removal of a benign mediastinal tumour: a new field for endotherapy?

The approach to paraoesophageal structures and lesions via the oesophagus was initiated by the introduction of peroral endoscopic myotomy (POEM), followed by peroral endoscopic removal of tumours within the muscular...