Diagnosis Of Schwannoma Research Articles

Giant renal schwannoma with obvious hemorrhage and cystic degeneration: a case report and literature review

BackgroundRenal schwannomas are very rare and are usually benign. Its clinical symptoms and imaging features are nonspecific, and the diagnosis is usually confirmed by pathology after surgical resection.Case presentationA 46-year-old Chinese female was admitted to the hospital with right flank pain that had persisted for the six months prior to admission. This pain had worsened for 10 days before admission, and dyspnea occurred when she was supine and agitated. A right abdominal mass could be palpated on physical examination. Computed tomography and magnetic resonance imaging examinations revealed a large, nonenhanced, cystic and solid mass in the right kidney. The patient received radical nephrectomy for the right kidney. The diagnosis of schwannoma was confirmed by pathological examination.ConclusionsWe report a case of a large renal schwannoma with obvious hemorrhage and cystic degeneration, which can be used as a reference for further study.

A Rare Case of Plexiform Schwannoma of the Little Finger and Its Management: A Case Report

Schwannomas are tumors of the Schwann cells found in the myelin sheath. They cause 5% of all benign soft-tissue cancers, occur equally in males and females, and occur later in life. Since they remain asymptomatic, diagnosing and treating them becomes challenging; current guidelines recommend imaging followed by excision. Here, we present a case of a 19-year-old male who presents in an outpatient setting with a history of painless swelling of the fifth digit for the past four years. Past medical history and physicals are unremarkable. Microscopic findings from fine-needle aspiration cytology (FNAC) confirmed the schwannoma diagnosis, showing loosely arranged spindle cells with elongated nuclei with pointed ends dispersed within the myxoid stroma.

Cervical sympathetic chain schwannoma: a case report

Neurogenic tumors including Schwannoma are the rare cause of the lateral neck swelling. We present a case of cervical sympathetic plexus schwannoma that was successfully managed by surgical excision. A 30-year-old male presented with complaints of painless slow growing swelling on the right side of neck of 6 months duration. On examination a single, non-tender, pulsatile swelling of 4×3 cm in the right lateral side of neck was seen beneath the anterior margin of the sternocleidomastoid and just below the angle of the mandible. Magnetic Resonance Imaging (MRI) neck showed a well-defined lesion of size 4.5×4.6×6 cm in the right carotid space with features suggestive of neurogenic tumour arising from sympathetic plexus, likely Schwannoma. Surgical excision of the tumour was done. Intra-operatively a well encapsulated lesion was present in the right carotid sheath arising likely from right cervical sympathetic plexus. Histopathological examination confirmed the diagnosis of Schwannoma. Post-operatively patient developed mild ptosis of right eye; however at 6 months follow-up patient is doing fine without any evidence of residual neurological loss or recurrence.

Schwannoma of the Upper Limb: Retrospective Study of a Rare Tumor with Uncommon Locations.

Background: Although schwannoma (neurilemmoma) is the most common tumor of the peripheral nerve, its low incidence, slow growth and vague symptoms often lead to misdiagnosis or delayed diagnosis. The aim of the study is to present a series with a large number of schwannomas in the upper limbs, some with very rare occurrence. Methods: We report 17 patients with a mean age of 58.5 years and upper limb schwannomas, located on the median, ulnar and radial nerves, but also on the posterior interosseous nerve and digital collateral nerves. The diagnosis was made by clinical examination and imaging tests, and in no case was a preoperative biopsy performed. Surgical treatment was established based on symptoms or aesthetic concerns. In all cases, a diagnosis of schwannoma was confirmed through histopathological and immunohistochemical examinations. Results: For all patients, a complete tumor enucleation was performed under a surgical microscope. No recurrence was recorded at 2 years after surgery. Patient satisfaction was good, with complete socio-professional integration in all cases. Conclusions: Although more frequently present on the main nerve trunks, schwannoma may be present on the collateral digital nerves in rare cases. A correct technique with complete tumor excision offers excellent postoperative outcomes and avoids recurrences.

A case of clinical stage I gastric cancer with a schwannoma on the left supraclavicular fossa suspected as Virchow’s node metastasis

BackgroundGastric cancer is relatively prone to metastasis, although distant metastasis is rare during the early stage of disease. Here we report a rare case of schwannoma-associated Virchow metastasis of a patient with early-stage gastric cancer.Case presentationA 73-year-old man, diagnosed with early-stage gastric cancer, underwent preoperative scrutiny, and was only suspected to have Virchow metastasis. Owing to atypical metastatic findings, a lymph node biopsy was performed to confirm the diagnosis and to determine the treatment strategy. The pathology results of the biopsy showed a diagnosis of schwannoma, the patient was judged to be surgically resectable, and a laparoscopic gastrectomy was performed to achieve a radical resection. The patient is currently under outpatient observation with no apparent recurrence.ConclusionSystemic chemotherapy is generally administered according to the physician’s clinical judgment, although the results of a lymph node biopsy contribute to a more curative treatment. When nonspecific metastases are found, it is important to make a reliable diagnosis and to select a treatment that achieves a cure.

Severe main bronchus obstruction due to pulmonary schwannoma: A Case Report

Pulmonary schwannoma is a rare neoplasm that arises from peripheral nerve sheath, Schwann cells, in the lungs and mostly remains asymptomatic for months. This report presents a seven-year-old female patient with an occasional cough and fever. She was hospitalized due to the lack of response to outpatient treatments, including antibiotics and antifebrile. A biopsy was taken from the mass by bronchoscopy, and the pathology report indicated the presence of a low-grade spindle cell, Verocay body, and Antoni B areas. Based on the pathologic findings, immunohistochemical (IHC) analysis was requested. The results indicated diffusely positive for S-100 protein, and accordingly, the diagnosis of schwannoma was confirmed. Thoracotomy and lobectomy were performed. Tracheobronchial schwannoma can be treated with surgical resection or bronchoscopy.

Multimode imaging characteristics and treatment of uveal schwannoma.

To delineate the different imaging characteristics of uveal schwannoma from melanoma and discuss the optimal treatment strategy for intraocular schwannoma. Case series of three patients diagnosed with intraocular schwannoma was collected at Zhongshan Ophthalmic Center, Guangzhou, China from July 2014 to December 2020. All the study patients underwent ultrasonography and magnetic resonance imaging (MRI). The clinical features, therapeutic strategies, and prognoses of all patients were reviewed. Ultrasonography of all three patients (all females, mean age, 39y, age range, 23-54y) showed low to medium reflectivity with a homogeneous internal structure. MRI of all three patients demonstrated isointensity on T1-weighted imaging spin-echo (T1WI SE) images and hypointense on fast spin-echo T2-weighted images (FSE T2WI) images with respect to the brain. Minimally invasive pars plana vitrectomy (PPV) and local resection of the tumor was performed for all patients, and the diagnosis of schwannoma was confirmed by histopathological examination. The present study indicates that ultrasonography and MRI features of uveal schwannoma may contribute to the differentiation of uveal schwannoma from melanoma, and the optimal therapy for intraocular schwannoma is minimally invasive PPV and local resection.

Wolves in Sheep's Clothing and Vice Versa: Fine-Needle Aspiration of Low-Grade Spindle Cell Lesions

Abstract The morphologic overlap between low-grade spindle cell lesions can lead to diagnostic dilemmas, particularly when attempting to interpret limited material. Evaluation of such specimens frequently requires correlating with clinical and imaging findings, as well as ancillary studies. We discuss the case of a 78-year-old woman with a remote history of breast carcinoma who presented with a left base of neck nodule. While imaging findings were highly suggestive of schwannoma, fine-needle aspiration biopsy of the nodule was performed for diagnostic confirmation. The patient reported tingling and an electrical shock sensation traveling down her arm during the fine-needle aspiration procedure. Cytomorphologic findings demonstrating a low-grade spindle cell neoplasm further supported a diagnosis of schwannoma, despite early immunohistochemistry results not being supportive. A last-minute suggestion that the differential diagnosis be broadened prompted additional immunohistochemical workup and follow-up molecular testing that confirmed an alternative diagnosis of solitary fibrous tumor. This case demonstrates the importance of correlating clinical, radiologic, and pathologic findings when approaching the differential diagnosis of low-grade spindle cell lesions on fine-needle biopsy specimens. Ancillary testing including immunohistochemistry, molecular studies, or fluorescence in situ hybridization is frequently utilized to establish a definitive diagnosis.

Supraglottic Schwannoma: Dilemma and Challenges in Management.

Laryngeal schwannomas are rare lesions that represent less than 1.5% of all benign laryngeal tumors. Its slow and submucosal growth may cause a delay in consultation and management. Herein, a case of right supraglottic schwannoma is diagnosed in a 34-year-old lady who was unconcerned about hoarseness for 10years. She was referred to otorhinolaryngology clinic for assessment when hoarseness was detected during consultation for a gynecology surgery. Apart from hoarseness, there were no noisy breathing, shortness of breath or aspiration symptoms. Flexible nasopharyngolaryngoscopy showed a submucosal bulge at the right vestibular fold obscuring the vocal fold causing an airway concern. Computer tomography scan of the neck revealed a heterogenous enhancing mass centered at the right supraglottis measuring 2.6 × 2.7 × 2.7cm. There were no erosions of the adjacent thyroid and arytenoid cartilages. Subsequently, complete excision of the lesion was done endoscopically. Definitive diagnosis of schwannoma was obtained via histopathology examination. This paper presents our approach and operative steps in the excision of this lesion using microlaryngoscopy with cold instruments.

Submandibular Gland Schwannoma - Case Report

Schwannomas are benign tumors that originate in the myelin sheath of neurons, more specifically in Schwann cells. Between 25-45% of these tumors occur in the topography of the head and neck, and may appear in various anatomical sites –oral cavity, larynx, pharynx, parapharyngeal space, and others. The main complaints are a painless, slow-growing mass and symptoms related to compression of nearby structures by the lesion. Its diagnosis is almost always given with the anatomopathological study after resection of the lesion, since fine-needle punctures usually show indeterminate results and imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI) cannot confirm this diagnosis, although they bring important information about location, size and contact with adjacent structures. Treatment, if there is no contraindication, is through surgical excision of the tumor. In this report, we present the case of a 47 year-old female patient complaining of left submandibular nodulation, whose diagnosis of schwannoma was only given after a left submaxillaryectomy, through the pathological examination.

Combined laparoscopic-endoscopic “rendez-vous” procedure in a case of gastric schwannoma in a toddler

Introduction. Schwannomas are rare benign tumors of the gastrointestinal tract. Despite the differences in features of schwannomas located in the stomach as opposed to peripheral or soft tissue schwannomas, their immunohistochemical characteristics are the same. We present a case of a 14-month-old boy with a gastric tumor who underwent a combined laparoscopic-endoscopic resection surgery, followed by gastric schwannoma diagnosis. Case outline. The patient was admitted to our pediatric hospital with a fever of unknown origin. Endoscopy, performed after recurrent hematemesis, revealed an ulcer in the gastric antrum. At the four-week follow-up, gastroscopic and microscopic findings were normal. Two weeks later, a flank mass in the antrum was detected by an ultrasound examination. A new gastroscopy and CT scan confirmed the presence of a tumor-like mass, 5 cm in diameter. A combined laparoscopic-endoscopic polypectomy was performed with a necessary conversion for complete resection of tumor. The initial histological findings were consistent with a gastrointestinal stromal tumor. Due to this tumor?s rarity in childhood, the paraffin-embedded tissue samples were referred for a second opinion. Histological and immunohistochemical characteristics of the tumor made the gastrointestinal stromal tumor diagnosis unlikely and consistent with a completely resected gastric schwannoma. No recurrence of the disease occurred during the seven-year follow-up. Conclusion. Combined laparoscopic-endoscopic surgery is a feasible and effective treatment for large gastric tumors that cannot be excised endoscopically. Schwannoma should be included in the differential diagnostic consideration of gastric tumor lesions even in childhood.

Mayer-rokitansky-kuster-hauser syndrome with presacral schwannoma presenting as a pelvic mass: A literature review and case report

A 32-year-old woman was admitted to our gynecology outpatient clinic with primary amenorrhea, a pelvic mass, and pain. Sonographic examination and magnetic resonance imaging revealed an approximately 124×103 mm heterogeneous mass. Moreover, laparotomy revealed fibrotic uterine bands with normal ovaries, tubes, and a solid retroperitoneal lesion. On the second postoperative day, the mass was removed, and the patient was discharged with full recovery. Microscopic examination of the pelvic mass confirmed the diagnosis of schwannoma. To the best of our knowledge, this is the first report on the co-occurrence of Mayer-Rokitansky-Küster-Hauser syndrome and schwannoma, without the presence of any other pathology.

Scoring system for intraoperative diagnosis of intracranial schwannoma by squash cytology.

To assess the utility of a newly developed squash cytology (SC)-based scoring system for accurate intraoperative diagnosis of schwannoma. We first compared SC-based and frozen section (FS) diagnoses with final pathological diagnoses of schwannoma (16 cases), meningioma (39 cases) and low-grade astrocytoma (16 cases). Then, by logistic regression modeling, we identified features of SC preparations that were independently predictive of schwannoma. To develop a diagnostic scoring system, we assigned one point to each feature, and performed receiver operating characteristic analysis to determine the score cut-off value that was most discriminatory for differentiating schwannoma from the other tumour types. We then compared accuracy, sensitivity, and specificity of diagnosis before and after the application of the scoring system. Overall diagnostic concordance rates for SC and FS were almost the same, at 73.2% (52/71) and 77.5% (55/71 cases), respectively. Of the 16 SC features entered into the analysis, the following nine were found to independently predict schwannoma, and were thus incorporated into the scoring system: smooth cluster margins, few or no isolated tumour cells, fibrillary stroma, spindle-shaped nuclei, parallel arrangement of stroma, parallel arrangement of nuclei, presence of anisonucleosis, absence of nucleoli, and hemosiderin deposition. A cut-off score of four items yielded the best sensitivity, specificity and predictive values for prediction of schwannoma. Use of the scoring system improved accuracy of intraoperative diagnosis from 80.3% to 94.4%, sensitivity from 56.2% to 93.8%, and specificity from 87.3% to 94.5%. Our proposed SC-based scoring system will increase accuracy of intraoperative diagnosis of schwannoma vs non-schwannoma tumours.

Synchronous Schwannoma and Gastrointestinal Stromal Tumor in Small Intestine – A Rare Case

Abstract Introduction/Objective Small bowel Schwannoma is a benign neoplasm of nerve sheath cells. The Gastrointestinal stromal tumor (GIST) constitutes only about 1-2% of small bowel spindle cell tumors. The simultaneous presence of two tumors in the small bowel is extremely uncommon. Methods/Case Report We report a case of small bowel GIST co-existing with Schwannoma. A 64-year-old female with a known history of Neurofibromatosis was admitted for excision of a small bowel tumor. MRI of the abdomen revealed two enhancing lesions in the left upper quadrant adjacent to the small bowel. Differential considerations included GIST versus Neurofibroma. Left hemicolectomy with small bowel resection was performed. The proximal small bowel revealed GIST, spindle cell type, low risk (3.5 cm), low grade (<5 mitoses/ 5mm2). Tumor cells were diffusely reactive to CD34, CD117, and DOG1 immunostains and were nonreactive to S100 and SOX10 immunostains confirming the diagnosis of GIST. Another segment of the small bowel revealed a 1.5 cm well-circumscribed, predominantly spindle cell tumor with abundant myxoid stroma and prominent cyst formation. Tumor cells were diffusely reactive to S100 and SOX10 immunostains but nonreactive to CD34, CD117, and DOG1, favoring a diagnosis of Schwannoma. Gastrointestinal Schwannomas may be associated with Neurofibromatosis in some cases. GIST, a KIT- or PGDFRA-signaling driven mesenchymal tumor has also rarely been reported to be associated with Neurofibromatosis type 1. However, synchronous small bowel Schwannoma and GIST represent a rare co-existence of two different histopathologic subtypes of spindle cell tumors. Results (if a Case Study enter NA) NA Conclusion In summary, we present the rare co-existence of two different spindle cell lesions in Neurofibromatosis patient.

Assessing the Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Differential Diagnosis Between Spinal Schwannomas and Meningiomas.

ObjectiveThe advantage of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) for the differential diagnosis of schwannoma and meningioma remains unclear. The purpose of this study was to compare the maximum standardized uptake value (SUVmax) with computed tomography (CT) and magnetic resonance imaging (MRI) findings and assess its utility in the differential diagnosis of schwannomas and meningiomas.MethodsThis study included 42 patients who underwent surgery and had pathological diagnoses of schwannomas (S group) or meningiomas (M group). Multivariate logistic regression analyses were conducted using meningioma prevalence as the dependent variable, and confounders were selected from those with p-values <0.05, including calcification, dural tail sign, tumor volume, and SUVmax at each spinal level as independent variables.ResultsThe SUVmax of the spinal canal type at the level of the cervical vertebrae was significantly higher in the M group (4.6 ± 0.8) than in the S group (2.7 ± 1.4; P = 0.017). Multivariate logistic regression analysis showed that the dural tail sign was significantly associated with differential diagnosis between the S and M groups (odds ratio [OR], 0.851; 95% confidence interval [CI], 0.704-1.031, p<0.001).ConclusionsThe dural tail sign on MRI, but not the SUVmax of FDG-PET, was the most useful for the differential diagnosis between schwannomas and meningiomas.

Schwanoma Parafaringeo. Reporte de caso

Parapharyngeal tumor lesions present a low incidence, representing between 0,5 and 0,8% of all head and neck tumors. Approximately 80% show benign behavior. The uniqueness of these lesions derives from their complex anatomical situation and the symptoms with which they usually appear, being in most cases nonspecific and almost always derived from the compressive effect produced by the lesion on the oropharynx and the oropharynx. Schwannomas of the parapharyngeal space are very rare tumors that originate from the sheath of schawnn, generally slow growing, and are usually asymptomatic. Treatment is surgical, often complex due to the anatomical location.The case of a 42-year-old female patient with a diagnosis of Schwannoma in the left parapharyngeal region, demonstrated by incisional biopsy, is presented; undergoing surgical treatment, which was carried out without complications.

Schwannoma orbitario, una entidad poco frecuente. Reporte de caso

Introduction: Orbital schwannoma is a rare pathology, which constitutes approximately 1 to 6.5% of orbital tumors, and can originate from the ophthalmic branch of the 5th cranial nerve or from perioptic sympathetic nerves. Its diagnosis is made by magnetic resonance imaging (MRI) with contrast. The first-line treatment is surgery, and total resection provides a good prognosis. The time of illness is used to evaluate the visual prognosis in these patients. Clinical Case: A 12-year-old woman, with a 9-year illness, characterized by a progressive decrease in right visual acuity until reaching amaurosis. Brain MRI with contrast shows an isointense tumor on T1, adhered to the medial aspect of the optic nerve sheath, which captures contrast, slightly hyperintense on T2. Total resection of the lesion is performed, and the diagnosis of schwannoma is confirmed by pathological anatomy. A month after surgery, the patient had slightly recovered her vision, without presenting other complications. Conclusion: Orbital schwannoma is a rare pathology that must be treated surgically as soon as possible to achieve a better visual prognosis for the patient. Keywords: Neurilemmoma, Optic Nerve, Orbital Neoplasms, Cranial Nerves, (source: MeSH NLM)

SCHWANNOME MALIN DE LA PAROI CAECALE REVELE PAR UNE INVAGINATION INTESTINALE AIGÜE CHEZ L’ADULTE A L’UNITE DE CHIRURGIE ONCOLOGIQUE DE DONKA, CHU DE CONAKRY

Abstract Introduction: Gastrointestinal schwannoma is thought to account for only 2-6% of all sub-mucosal tumours of the gastrointestinal tract, with the stomach being the preferred site. The diagnosis of schwannomas is histoimmunohistochemical. Surgical treatment consists of complete removal of the mass due to the risk of malignant degeneration. Because of their rarity, these lesions are often overlooked. Case report: We report a case of a 26-yearold female patient who was admitted for a painful abdominal mass with cessation of feces and gas. The clinical examination showed a slightly distended, asymmetric abdomen with a mass extending from the right flank to the umbilical region, firm in consistency, mobile in relation to the deep plane and well limited. The abdominopelvic CT scan showed distension of the bowels upstream of an image of ileal intestinal invagination extending over approximately 8 cm, close to Bauhin's valve. Surgery by supra-umbilical and subumbilical laparotomy revealed a 12 cm ileocecal intussusception. Exploration revealed a hard caecal mass, with a firm consistency, mobile in relation to the deep plane, 17 cm from the ileo-caecal angle. We proceeded with coeco-ileal resection with termino-lateral and colo-ileal anastomosis, removing the mass. The postoperative course was simple. The result of the anatomopathological analysis showed a malignant schwannoma of the caecal wall with healthy margins of resection. The patient is currently under surveillance. Keywords : malignant Schwannoma ; gastrointestinal ; cancer ; Surgery

Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature

IntroductionSchwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling. ObjectiveIn this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature. MethodsPatients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done. ResultsTwenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root. ConclusionA long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.

Neurofibroma intraósseo versus schwannoma, importância do diagnóstico diferencial histológico no diagnóstico definitivo: Relato de caso

As neoplasias de origem neurais representam 8% e 12% de todas as neoplasias de tecidos moles malignas e benignas, respectivamente. Nesse conjunto estão inseridos os tumores da bainha do nervo periférico (TBNP), um grupo relativamente raro de doenças que são classificadas de acordo com as características específicas de diferenciação, componentes celulares e matriz extracelular. Neurofibroma e schwannoma são exemplos de lesões pertencentes a esse grupo. O objetivo desse estudo é apresentar um caso clínico de uma paciente, sexo feminino, 60 anos de idade, diagnosticada com lesão central na região de corpo mandibular direito. A lesão foi descoberta após exame de rotina para reabilitação protética e, após biopsia incisional, obteve-se diagnóstico inicial de schwannoma. O tratamento proposto foi uma ressecção marginal, por meio da instalação de placa de reconstrução de 2,4mm e enucleação da lesão. Uma biopsia excisional foi então solicitada onde se obteve como diagnóstico final neurofibroma. A paciente apresentou resposta satisfatória ao tratamento, sem sinais de recidiva. Embora o diagnóstico decisivo de neurofibroma seja baseado em achados histológicos, lesões como schwannoma devem ser incluídas como diagnóstico diferencial histológico, o que pode dificultar o diagnóstico definitivo. Nesse sentido, características peculiares do schwannoma e neurofibroma, seus comportamentos imunoistoquímicos e suas semelhanças são necessários para traçar suas repercussões no estabelecimento do diagnóstico. Ainda que não haja diferença no tratamento, tais lesões podem estar associadas a síndromes diferentes, o que torna necessária sua diferenciação final, especificamente para os casos em que haja dúvida.