Case Of Schwannoma Research Articles

Schwannoma of the Hard Palate in a Child: Case Report

: Schwannoma is an uncommon benign encapsulated tumor that contains Schwann cells of the nerve sheath. About 25% of schwannomas are located in the head and neck region, and 1% of them are intraoral. In the oral cavity, the most common site of involvement is in the tongue, followed by the palate, buccal mucosa, lips, the vestibular mucosa, and gingiva. A rare case of schwannoma in the right side of the hard palate of the oral cavity in a 13 year old boy with yellowish surface color and 0.6 × 0.5 cm diameter was reported. The patient’s chief complaint was palatal swelling since four months ago, without any pain. Differential diagnosis and treatment were discussed based on the histopathologic report and clinical features. The most important point of this case is the occurrence of a slow-growing schwannoma in the hard palate of a very young patient. The presence of an intraoral neural tumor in a young patient is very rare.

Clinical analysis of head and neck neurogenic tumor in childhood

Objective:To investigate the clinical characteristics, imaging features and treatment of neurogenic tumor in chilehood and to improve the experience in diagnosis and treatment for the disease. Method:The twenty-nine inpatients of histopathologically proven neurogenic tumor from January 2015 to December 2018 were retrospectively analyzed. The pathological types, clinical characteristics, imaging findings, and management were analyzed. Result: There were five cases of schwannoma aged from 9 years to 14 years, five cases of neurofibroma aged from 9 months to 9 years, and nineteen cases of neuroblastic tumor aged from 3 months to 5 years in our series. The chief manifestations were soft tissue masses, snore, and Honer syndrome. As the tumors had different components pathologically, on scans they presented as masses with heterogeneous density. Schwannoma showed as oval masses with clear margins, with the characteristic of"tail sign". The imaging findings of neurofibromas showed unclear boundaries and plexiform neurofibromas showed multiple clumps with visible separation. The ultrasonography of neuroblastic tumor was characterized by hypoechoic, heterogeneous and spotty calcification. All the cases underwent surgical resections. In 5 cases of schwannoma, it was confirmed that the tumors originated from the vagus nerve during the operation, which could be completely removed without postoperative complications. Two cases of neurofibromas were completely resected, 2 cases were only partially resected, and 1 case which located at the entrance of the esophagus was resected under supportive laryngoscopic for three times. Thirteen of 19 children with neuroblastogenic tumors underwent resection in our department after chemotherapy, and 2 patients with postoperative recurrence underwent another operation. Conclusion:Neuroblastoma is the most common neurogenic tumor in the head and neck of children. Most neurogenic tumors have their corresponding characteristics on imaging and should be differentiated. Schwannoma has clear boundary and intact capsule, so it is easier to complete resection. The neurofibroma is commonly difficult to remove with safety margin because of its unclear boundaries. Neuroblastoma should be treated according to the lesion range and stage. Most of the lesions are difficult to remove completely due to the wide range, peripheral blood vessels and important nerves. So preoperative chemotherapy is generally required.

1625 Colonic Schwannoma Identified in Asymptomatic Middle-Aged Female

INTRODUCTION: Schwannomas are typically benign tumors of the neural sheath. Schwannomas of the colon are extremely rare entities; in fact, when schwannomas occur in the gastrointestinal tract, the colon is considered the least likely site. Schwannomas of the colon were previously misdiagnosed as gastrointestinal stromal tumors; however, with advances in immunohistochemical staining, the number of cases of intestinal schwannomas has gradually increased. Colorectal schwannomas can be divided into three clinicopathologic types: spindle cell, epithelioid, and plexiform. Here, we present a unique case of a colonic spindle cell schwannoma encountered in an asymptomatic patient on routine colonoscopy. CASE DESCRIPTION/METHODS: A 50-year-old female with no significant past medical history presented to gastroenterology clinic for routine colorectal cancer screening. The patient denied abdominal pain, nausea, vomiting, diarrhea, constipation, rectal bleeding, or weight loss. She also denied family history of neurofibromatosis. Physical examination was unremarkable. Laboratory studies showed that the patient had microcytic anemia (hemoglobin 10.9 g/dl, MCV 59 fL) but were otherwise unremarkable. A colonoscopy was subsequently performed and revealed a 6 mm sub-epithelial lesion in the sigmoid colon. Biopsy showed colonic mucosa with mild chronic inflammation and multiple spindle cell aggregates confined to the lamina propria (Figure 1). Cytological atypia, mitoses, and necrosis were identified in the biopsied specimen (Figure 2). Immunohistochemical assays demonstrated lack of reactivity to CD68, CD117, and DOG-1. The spindle cells were strongly positive for S100, confirming the diagnosis of mucosal Schwann cell hamartoma. DISCUSSION: Rectal bleeding, colonic obstruction, and abdominal pain are the three most common presenting symptoms for colorectal schwannoma; however, our patient denied any of these symptoms. The management of intestinal schwannomas remains controversial. Surgical resection with adequate margins remains the treatment of choice. Several sources question whether radical resection based on oncologic principles is necessary given the benign nature of these tumors. Our patient was managed conservatively with routine surveillance. Repeat colonoscopy performed approximately 3 months after the initial colonoscopy revealed no signs of recurrence or metastases. This case supports the notion that these rare mesenchymal tumors are commonly benign and aggressive therapeutic interventions are likely unnecessary.

Jack in the Duct: A Case of Common Biliary Duct Schwannoma.

Jack in the Duct: A Case of Common Biliary Duct Schwannoma.

Benign pericardial schwannoma with massive pericardial effusion in a Chinese man: A case report

Primary cardiac neoplasms are rare, and the pericardial schwannoma has an even lower occurrence. We report a case of pericardial schwannoma in China, which is the eighth reported case adding to the existing literature on pericardial schwannoma, and this is the first case reported complicated with massive pericardial effusion. Pericardial schwannomas are usually benign, but they can sometimes have a malignant tendency and cause life-threatening complications. Thus, it should be managed aggressively and completely resected.

A rare case of median nerve schwannoma of ARM

Schwannoma is a tumor that develops from nerve sheath. The author reports an unusual case of swelling on the medial side of the arm noticed 2 yrs back. The swelling increased in size over the last 6 months. It was associated with pain. The diagnosis of schwannoma was based on MRI and Cytological studies. Surgical removal is usually curative. The asymptomatic character of the tumor remains an essential factor in delayed diagnosis.

32 Long Term Results of 120 Cases of Vestibular Schwannoma Treated with Cyberknifetm Robotic Stereotactic Radiosurgery at the Ottawa Hospital Cancer Centre

32 Long Term Results of 120 Cases of Vestibular Schwannoma Treated with Cyberknifetm Robotic Stereotactic Radiosurgery at the Ottawa Hospital Cancer Centre

Endoglin-based assessment of neoangiogenesis in sporadic VIII cranial nerve schwannoma

Although the diagnosis and treatment of sporadic vestibular schwannoma has improved in recent years, no factors capable of predicting its growth have been identified as yet. Endoglin (CD105) is a proliferation-associated protein expressed in angiogenic endothelial cells, and a potential prognostic indicator for several solid tumors. The aim of the present study was primarily to investigate the expression and role of CD105 in a series of sporadic vestibular nerve schwannomas.In 71 consecutive cases of vestibular schwannoma, vessel cross-sectional area and density were calculated from immunohistochemically assessed CD105 expression using image analysis to correlate them with: (i) tumor dimensions; and (ii) tumor growth rate measured on high-resolution contrast-enhanced MRI (ceMRI).Based on assessments of CD105 expression, a significant positive correlation was identified between vessel cross-sectional area and tumor size at the time of surgery (p = 0.0024), and between vessel density and tumor size (p = 0.013). Vessel cross-sectional area (p = 0.0006) and vessel density (p = 0.003) were significantly greater in tumors measuring ≥10 mm in size than in those <10 mm. Conversely, when tumor growth rate could be calculated from two or more ceMRI (38 cases), there was no significant correlation between tumor growth rate and cross-sectional vessel area or vessel density as assessed with CD105.Further investigations are needed to ascertain the feasibility of: (i) using circulating endoglin assay to monitor tumor growth; and (ii) targeting neoangiogenesis with anti-endoglin antibodies in sporadic vestibular schwannoma.

Cerebellopontine angle schwannomas arising from the intermediate nerve: a scoping review.

Intermediate nerve schwannomas (INS) are extremely rare lesions in literature. They have been described mimicking facial nerve schwannomas, but not vestibular schwannomas (VS). We aimed to review the previously published cases, as well as the evidence to believe that they are far more common, though usually misdiagnosed as facial or VS. We performed a review of PubMed/Medline and Embase of "intermediate nerve schwannoma," "facial nerve schwannoma," "greater superficial petrosal nerve schwannoma," "geniculate ganglion schwannoma," and "chorda tympani schwannoma" to identify all cases of INS, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement. Furthermore, 2 cases operated at our center are shown to exemplify the proposed hypotheses. No article was excluded from review. Thirteen cases of INS, 11 cases of chorda tympani schwannoma, and 18 cases of greater superficial petrosal nerve schwannoma were found in literature. In facial nerve schwannomas, the predilection of schwannomas for sensory nerves, and the ability to preserve the motor facial nerve during tumor resection support the hypothesis of intermediate nerve as the nerve of origin. For VSs, the different arachnoidal arrangement of medial VS, the sharing of pia mater by the intermediate nerve and vestibular nerve, and the medial Obersteiner-Redlich zone of the intermediate nerve, support the hypothesis of intermediate nerve origin of some VS. The correct identification of the intermediate nerve as a nerve of origin of cerebellopontine angle schwannomas is of uttermost importance, especially when mistaken for VS, as this may account for the heterogeneity of facial and cochlear outcomes after surgery.

The Schwannoma of the facial nerve in the extra-skull segment – a case report

The aim of the report is to present a rare case of facial schwannoma in the parotid gland. Schwannomas are benign, well-defined tumors arising from Schwann cells that form myelin sheaths of peripheral, cranial or spinal nerves. 25-45% of them are located within the head and neck, mainly in the parapharyngeal space. The intraparotid location is rare. The etiology of cancer is unknown. Preoperative diagnosis, both radiological and cytological, is difficult and often does not give the correct diagnosis. Radiologically, a multiform adenoma is usually suspected, and the fine needle biopsy is non-diagnostic. Due to the rarity and benign nature of the tumor, there is a debate about the need for surgical treatment.

Tongue Schwannoma: A Clinicopathologic Study of 19 Cases.

Schwannomas commonly occur in the head and neck but infrequently involve the oral cavity and rarely affect the tongue. The clinical and pathologic features of 19 cases of schwannoma arising in the tongue were analyzed. There were 13 males and 6 females ranging in age from 12 to 82years (mean 34years; median 29years). The majority of tumors presented as an asymptomatic mass localized to the anterior two-thirds of the tongue. Histologically, 18 schwannomas exhibited characteristic Antoni A and B areas with the former pattern predominating. One tumor was composed exclusively of cellular Antoni A tissue and was classified as a cellular schwannoma. Tumor encapsulation was variable with nearly half of the lesions lacking a well-defined fibrous capsule. All were strongly and diffusely positive for S-100 protein. No recurrences were observed on clinical follow-up. Schwannoma of the tongue, although rare, should be separated from other types of lingual nerve sheath proliferations and tumors.

미주신경초종 수술 중 성대 근전도 감시의 유용성: 증례보고

Postoperative vagal dysfunction is a serious complication can lead to dysphonia, dysphagia, pharyngeal or airway obstruction. Therefore, intraoperative monitoring of vagus nerve during surgeries involving the lower brain stem is important to prevent such deficits. Monitoring of vagus nerve can be performed by monitoring free running and stimulated electromyography from the vocal cords. Recording using adhesive surface electrodes on the endotracheal tube approximating the vocal cords can be used to monitor vagus nerve. We report a case of vagal schwannoma with intraoperative vocal cord electromyographic monitoring during the craniotomy and tumor removal. Our case suggests that intraoperative vagus nerve monitoring using surface electrodes on the endotracheal tube could be aid in identifying neural structures and assessing the functional integrity.

Early stage of primary tracheal schwannoma mimicking a foreign body

: Primary tracheal schwannoma is an extremely rare clinical entity that accounts for less than 0.5% of primary tracheal tumors. It is usually diagnosed at an advanced stage of disease, when the tumor occupied more than 50% of tracheal lumen and obstructive symptoms were seen. Treatments ranged from surgery to endoscopic resections, and the choice was influenced by the characteristics of the tumor and patient’s clinical condition. Herein, we reported a clinical case of early stage primary tracheal schwannoma that was incidentally found on high resolution computed tomography scan in a patient with asthmatic symptoms. Based on patient’s past medical history (he referred accidental inhalation of a concrete fragment several months ago), lesion size (2 mm) and endoscopic findings (lesion covered by normal tracheal mucosa, not pulsatile or friable), the tumor was misdiagnosed as a foreign body and easily resected with standard bioptic forceps during fiber bronchoscopy. Pathological findings diagnosed the lesion to be a primary tracheal schwannoma. In this case, the early diagnosis of tracheal schwannoma and its resection prevented the tumor growing and the needing of more complex treatments.

Schwannomas of Ear, Nose, Throat and Neck

Schwannoma is a benign tumour of nerve sheath origin with latent malignant potential. All cranial nerves can give rise to schwannoma except for olfactory and optic nerves, which are devoid of Schwann cell. Schwanommas are usually asymptomatic and present late owing to compression of nerve of origin. We present our study of 19 cases of schwannoma arising from unusual sites in head and neck, having varied presentation and the challenges faced in management of these cases. These cases presented in detail to the department of Ear, Nose and Throat, KEM Hospital, and were thoroughly evaluated clinically and radiologically to formulate a management strategy. Schwannoma of the head and neck is a rare entity but should be considered as differential diagnosis in unilateral nasal mass cases, palatal masses, anterior and lateral neck masses. Nerve of origin may not always be clear preoperatively but the possibility of postoperative loss of nerve function should be kept in mind. Radiological investigations like computed tomography scan and magnetic resonance imaging play a pivotal role in management. In case of nonvascular neck tumours, fine needle aspiration cytology is crucial but has low accuracy in the diagnosis of neural tumors. Histopathology of excised tumour remains the gold standard in diagnosis.

Primary Thyroid Schwannoma with Papillary Carcinoma and Hurtle Cell Adenoma in a Background of Hashimoto’s Thyroiditis

Schwannomas are common benign neurogenic tumours that arise from Schwann cells of nerve roots; up to 45% arise in head and neck. However primary thyroid schwannomas are extremely rare. Among thyroid tumours papillary carcinoma of thyroid (PCT) are the most common. Hurthle cell neoplasms are also rare. In addition occurrence of all the three neoplasms in the same patient is extremely rare. In this report we discuss a case of left lobe intrathryroidal schwannoma with papillary carcinoma of thryroid (PCT), Hurthle cell adenoma and background Hashimoto thyroiditis in a 25 year old female. On FNAC it was diagnosed as colloid nodule with cystic change, total thyroidectomy was done and histopathological examination showed that the largest well circumscribed nodule was a benign neurogenic tumour, schwannoma (left lobe of thryroid gland). There were other smaller thyroid nodules; one showing papillary carcinoma with lymph node metastasis and other showing hurthle cell adenoma with background Hashimoto’s thyroiditis.

Treatment of benign tumors in thoracic spinal canal by modified replanting posterior ligament complex applying piezoelectric osteotomy

To investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal. The clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score. The operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value ( t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value ( t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%. Modified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.

Schwannoma of the breast: a report of rare location and a brief literature review

Schwannoma is a slow-growing tumor developed from a nerve sheath. Breast localization is extremely rare. We report the first described case of mammary schwannoma in Madagascar, in a 38-year-old woman with right breast swelling. The clinical and paraclinical examination carried out led us to a benign pathology. A total mastectomy was performed. Much differential diagnosis can be evoked in front of a clinical picture of a benign tumor but the histological examination found a nodule composed of fusiform cells, non-atypical, organized in bundles, whose arrangement of palisades gives a zebra appearance called “Verocay’s nodule”, posing the diagnosis of breast schwannoma. This clinical case demonstrates the importance of complete excision of the tumor and definitive histopathological examination in the diagnosis of breast tumor.

Assessment of costs in open surgery and stereotactic radiosurgery for vestibular schwannomas.

Microsurgical resection and radiosurgery remain the most widely used interventions in the treatment of vestibular schwannomas. There is a growing demand for cost-effectiveness analyses to evaluate these two treatment modalities and delineate the factors that drive their total costs. Here, the authors evaluated specific cost drivers for microsurgical and radiosurgical management of vestibular schwannoma by using the Value Driven Outcomes system available at the University of Utah. The authors retrospectively reviewed all cases involving microsurgical and radiosurgical treatment of vestibular schwannomas at their institution between November 2011 and September 2017. Patient and tumor characteristics, subcategory costs, and potential cost drivers were analyzed. The authors identified 163 vestibular schwannoma cases, including 116 managed microsurgically and 47 addressed with stereotactic radiosurgery (SRS). There were significant differences between the two groups in age, tumor size, and preoperative Koos grade (p < 0.05), suggesting that indications for treatment were markedly different. Length of stay (LOS) and length of follow-up were also significantly different. Facility costs were the most significant contributor to both microsurgical and SRS groups (58.3% and 99.4%, respectively); however, physician professional fees were not specifically analyzed. As expected, microsurgical treatment resulted in an average 4-fold greater overall cost of treatment than for SRS cases (p < 0.05), and there was a greater variation in costs for open cases as well. Costs remained stable over time for both open resection and SRS. Multivariable analysis showed that LOS (β = 0.7, p = 0.0001), discharge disposition (β = 0.2, p = 0.004), nonserviceable hearing (β = 0.1, p = 0.02), and complications (β = 0.2, p = 0.005) affected cost for open surgery, whereas no specifically examined factor could be identified as driving costs for SRS. This analysis identified the fact that facility utilization constitutes the majority of total costs for both microsurgery and SRS treatment modalities of vestibular schwannomas. LOS, discharge disposition, nonserviceable hearing, and complications contributed significantly to the total costs for the microsurgical group, whereas none of the factors could be identified as driving total costs for the SRS group. This information may be used to establish policies and protocols to reduce facility costs, with the goal of decreasing the total costs without jeopardizing patient care.

A Case of Schwannoma Originated from the Posterior Nasal Septum

A Case of Schwannoma Originated from the Posterior Nasal Septum

A case of a vestibular schwannoma in the cerebellopontine angle associated with the initial symptoms of hypoesthesia of the lower lip and skin on the chin

A case of a vestibular schwannoma in the cerebellopontine angle associated with the initial symptoms of hypoesthesia of the lower lip and skin on the chin