Large Schwannoma Research Articles

Schwannomas of the upper limb: Clinical presentation, preoperative management and outcomes of surgical treatment.

Schwannomas are the most common tumors of the peripheral nervous system. Surgical eradication with excision or enucleation is the treatment for symptomatic and large schwannomas.

Hybrid surgical approach for a large schwannoma from the cervical esophagus to the upper thoracic esophagus: a case report

BackgroundEsophageal schwannoma is an extremely rare esophageal submucosal tumor. We report a case of a hybrid surgery for a large esophageal schwannoma that had extended from the cervical to the upper thoracic esophagus by using thoracoscopic and cervical approaches.Case presentationA 58-year-old male was referred to our hospital for further examination and treatment of dysphagia and weight loss over the past 6 months. Upper gastrointestinal endoscopy revealed a 5.7-cm submucosal tumor from the cervical esophagus to the upper thoracic esophagus. The submucosal tumor was diagnosed as esophageal schwannoma by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Contrast-enhanced CT showed that the tumor had not invaded surrounding organs. Since the tumor extended from the cervical esophagus to the upper thoracic esophagus, we decided that it should be resected by not only the cervical but also the thoracoscopic approach. In operation, the patient was first placed in the prone position, and a thoracoscopic dissection of the upper thoracic esophagus containing the tumor was performed from the surrounding area. After changing the patient’s position from prone to supine, a cervical skin incision was performed, and we underwent the tumor enucleation. After enucleation, the esophageal wall was thinned, so the right sternocleidomastoid muscle was used to reinforce the esophageal wall. The tumor size of the specimen was 60 × 52 × 42 mm. The postoperative course was uneventful, and the patient was discharged on the 22nd day after surgery.ConclusionsEnucleation of a large esophageal schwannoma from the cervical to the upper thoracic esophagus could be safely performed using both thoracoscopic and cervical approaches. The sternocleidomastoid muscle flap is useful in the occasion considering stenosis by muscular layer suture.

Resection of a giant intraspinal and extraspinal schwannoma with cystic change using a two-step surgery: a case report

BackgroundSchwannomas originating from the intravertebral canal rarely extend into the paravertebral region or form large masses. There are few reports on such medical cases, and their clinical diagnosis and management are poorly understood. Here, we report a case of an intraspinal schwannoma with a giant extraspinal mass in a middle-aged Chinese woman and the clinical implications of the symptoms, diagnosis, and treatment of thoracic vertebral schwannoma.Case presentationA 59-year-old female patient who presented with sudden lower limb numbness and difficulty in walking was referred to our department. Magnetic resonance imaging (MRI) revealed a tumor compressing the T11-T12 spinal canal and extensively invading the left thoracic cavity to form a giant paravertebral mass. Schwannoma was diagnosed after intraoperative pathological examination, in which tumor cells were immunoreactive to S100 and Sox10 but negative for smooth muscle actin (SMH). Intraspinal mass resection through the posterior approach and extraspinal chest mass resection under video-assisted thoracoscopy through the left lateral approach were performed simultaneously, and instrumentation was used to maintain thoracic spinal stability.ConclusionIn patients with large schwannomas, customized treatment plans are crucial. Tailoring the approach to an individual’s specific condition by considering factors such as tumor size and location is essential for optimal outcomes.

Application of a hybrid approach to the removal of large esophageal schwannoma

Introduction. Esophageal schwannoma is a rare spindle cell tumor derived from Schwann cells. To date, only 17 cases of esophageal schwannoma have been reported, with most of them occurring in women over the age of 50 years. Surgical interventions using open (cervical approach, extirpation of the esophagus with simultaneous plasty of the gastric tube) and thoracoscopic approaches have long been considered standard methods of treating patients with nonepithelial tumors of the esophagus, but currently minimally invasive endoscopic interventions are widely used. Clinical case. The patient, 64 years old, was treated at the Vishnevsky National Research Medical Center for Surgery for a large schwannoma of the esophagus. Results. This article presents a rare clinical observation - removal of a large schwannoma of the esophagus using a hybrid approach. During a control endoscopic examination 4 months after surgery, no signs of residual tumor fragments, narrowing or pathological changes in the mucosa were found in the area of the previously performed dissection. Conclusion. The use of a hybrid approach for removing a large non-epithelial tumor of the esophagus using endoscopic dissection in the submucosal layer and subsequent extraction through the cervical approach made it possible to perform organ-saving surgery, minimize the risks of possible intraoperative and postoperative complications, thereby leading to a good clinical and functional result.

Surgical management of large lower cranial nerves schwannomas: long term results of a less aggressive resection strategy.

In an effort to reduce the high morbidity and life-threatening complications after radical resection in large schwannoma surgery, alternative strategies of nontotal resections have emerged. To evaluate the long term clinical and oncological outcome after lower cranial nerves (LCN) schwannoma surgery operated on with a cranial nerve-sparing technique. Single center retrospective cohort study of 8 consecutive patients harboring LCN schwannomas operated on between March 2005 and October 2021. The mean LCN schwannoma diameter was 33mm (range 26-51). Seven patients (87,5%) underwent a modified retrosigmoid approach. Three patients underwent gross total resection (37,5%), 3 had received neartotal resection (mean tumor residue 0,25cc) and subtotal resection in 2 patients who presented with an extracranial extension of the tumor (mean tumor residue 2,44cc). Both patients had received upfront additional GKRS. The three patients who presented with preoperative CN IX & X injuries recovered within 6months after surgery. All of the five patients freed from any preoperative CNs IX & X symptoms experienced transient (80%) or definitive (one patient) disturbances after surgery. They all improved within 6months but one who required long term gastrostomy feeding tube. This patient harbored a schwannoma originating from the glossopharyngeal nerve, which could not be anatomically preserved during surgery. Tumor control was achieved in 100% of cases with a mean follow-up of 91months. LCN schwannomas could be surgically removed through a less aggressive non-radical resection strategy with acceptable functional results and excellent tumor control.

Surgery of Schwannoma in the upper limb – sensitivity and specificity of preoperative magnetic resonance imaging and relation between tumour size and symptoms

BackgroundBenign peripheral nerve tumours consist of different types, most commonly Schwannomas. Preoperative Magnetic Resonance Imaging (MRI) is commonly performed before surgery and Pathoanatomical Diagnosis (PAD) confirms the diagnosis. Our aims were to study the utility of MRI and the relation between tumour size and symptoms.MethodsRetrospectively, patients, surgically treated for benign nerve tumours between 2008 and 2019, were identified and preoperative MRI, with measurement of tumour size, PAD, symptoms, peroperative details, and symptomatic outcomes of surgery, were analysed.ResultsThe sensitivity and specificity to correctly identify Schwannomas with preoperative MRI were 85% and 50%, respectively, based on 30 Schwannomas and nine neurofibromas that were identified. Tumour size did not affect the presence of preoperative symptoms, but patients with sensory dysfunction at last follow-up had larger Schwannomas (p < 0.05). Symptoms as a palpable tumour, paraesthesia and pain improved by surgical excision (p < 0.001, p < 0.001 and p < 0.012, respectively), but sensory and motor dysfunction were common postoperatively. No malignant peripheral nerve sheath tumours (MPNST) were found. Using a surgical microscope, instead of only loop magnification, lowered the risk of perioperative nerve injuries (p < 0.05), but did not further diminish postoperative symptoms.ConclusionsEarly and accurate diagnosis of Schwannomas is valuable for adequate presurgical preparation and prompt surgical intervention. Preoperative examination with MRI has a high sensitivity, but low specificity; although recent advancement in MRI technology indicates improvement in diagnostic precision. Surgical excision is preferably performed early in conjunction with symptomatic debut to improve outcome.

Large schwannoma of the median nerve at the distal forearm

Introduction. Schwannoma, also known as neurilemmoma, is a rare but one of the most common tumors of the peripheral nerves. It originates from Schwann cells of the peripheral nerve sheaths. Schwannoma mostly occurs in adults between 20 to 70 years of age. The regions where the tumor most commonly occurs are the head and neck, but it can occur almost anywhere in the body or the organs. Schwannomas are usually up to 2.5 cm in size but may grow to 4?5 cm. In this study, the rare case of large schwannoma of the median nerve in the distal part of the forearm is presented. Case report. A 46-year-old male patient was referred to a plastic surgeon with a diagnosis of lipoma on the anterior side of the distal third of the left forearm. Ultra-sound and magnetic resonance imaging were done, and the surgery was performed after that. An encapsulated tumor of the median nerve was found, and the tumor was completely removed without nerve damage. Histological analysis showed a benign schwannoma of cellular type and biphasic shape. In the postoperative course, there was transient paresthesia. One year after surgery, no tumor recurrence nor neurological deficit was recorded. Conclusion. Schwannoma is the most common benign tumor of peripheral nerves. Schwannomas over 5 cm in size are extremely rare. Appropriate physical examination, pre-operative imaging studies, and histological verification are required for the final diagnosis. The method of choice in treating large schwannomas is complete surgical excision.

S2002 Colonic Schwannoma: A Cause for Nerves?

Introduction: Schwannomas arise from schwann cells, and though they are the commonest of all peripheral nerve tumors, it is exceedingly rare for them to be detected in the lower gastrointestinal (GI) tract. Here, we present the case of a submucosal colonic schwannoma detected incidentally as part of a routine colonoscopy for colorectal cancer (CRC) screening and discuss the clinical significance of such tumors. Case Description/Methods: A 59-year-old male patient with intermittent constipation presented for colonoscopy for CRC screening. A previous colonoscopy 7 years prior had been unremarkable. Family history was notable for CRC in several second-degree relatives. The patient’s past medical history was significant for non-alcoholic fatty liver disease, well-controlled human immunodeficiency virus infection and prediabetes. Physical examination was unremarkable. At colonoscopy, an 8 mm submucosal lesion was found in the cecum. This was sessile and firm, and did not demonstrate a pillow sign characteristic of lipoma. The lesion was resected using a saline injection-lift technique and hot snare. At histology, the lesion was described as tan-pink polypoid tissue, with negative margins (Figure). Immunohistochemically, the tumor cells were diffusely and strongly positive for S100 and negative for CD117, DOG1, SMA and desmin. This was consistent with a diagnosis of schwannoma. Discussion: When GI schwannomas arise, they are most commonly found in the upper GI tract, with 60-70% of GI cases found in the stomach and only 3% in the colon. There are no clear risk factors for their development other than advanced age. As in our patient’s case, colorectal schwannomas are typically detected incidentally on screening colonoscopies. They can be asymptomatic, or present with rectal bleeding (22.9%), abdominal pain (15.6%) or constipation (7.3%). The mass effect of large schwannomas can lead to colonic obstruction necessitating surgical resection of the tumor, but smaller lesions can typically be resected endoscopically. Schwannomas present as submucosal lesions and are almost always benign, with only atypical versions harboring any malignant potential. Numerous studies have demonstrated that recurrence after complete resection is rare, even after extended follow-up. There is no established guidance regarding follow-up intervals for patients with colorectal schwannomas, owing to their rarity. Based on the lack of malignant potential and the low risk of recurrence, we recommended a repeat colonoscopy in 5 years for our patient.Figure 1.: Cecal schwannoma in macroscopic (left) and microscopic (right) views.

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 case of large gastric schwannoma without symptoms

A case of large gastric schwannoma without symptoms

Massive retinal gliosis mimicking an intraocular neoplasm

Background: Massive retinal gliosis (MRG) refers to a pseudoneoplastic proliferation of retinal glial cells.1 MRG is associated with trauma, phthisis bulbi, microphthalmia, and retinal detachment.1 MRG has overlapping microscopic features with other entities; namely: astrocytic lesions of tuberous sclerosis, retinoblastoma, choroidal melanoma, medulloepithelioma, and large schwannomas.2

How I Do It: endoscope-assisted resection of a large dumbbell-shaped cervical schwannoma.

Cervical dumbbell-shaped schwannomas are often challenging in terms of complete resection. There are few reports on the use of endoscope-assisted surgery for foraminal schwannomas. We used the wide-angle endoscope to assist in resecting a large cervical 3-4 dumbbell-shaped schwannoma. The well-designed set-up allowed the surgeon to achieve easier manipulation ins a straight surgical trajectory with minimal intraoperative adjustment. The endoscope allowed surgeons to visualize and operate in regions beyond the straight line of sight, without the need for facetectomy and subdural inspection. We believe that this case demonstrates the feasibility of applying endoscope-assisted surgery for large cervical dumbbell-shaped schwannomas.

Nerve compression due to benign tumors or ganglion cysts in the upper limb – case series

Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts and benign tumors. We present a case series of five patients with peripheral nerve compression in the upper limb due to tumor or cystic masses- ulnar nerve compression in the Guyon’s tunnel due to a ganglion cyst, large median nerve schwannoma compressing anterior interosseous nerve and median nerve, voluminous lipoma compressing median nerve in the proximal forearm, superficial branch of radial nerve compression by a synovial cyst and elbow region lipoma compressing radial nerve. In the beginning, those benign lesions are asymptomatic but, as they continue to grow adjacent to a peripheral nerve clinical manifestations appear progressively as compressive neuropathies. After a preoperative imagistic analysis, tumor resection with careful dissection, in order to preserve the neurovascular structures, is the elective surgical procedure in order to obtain an optimal functional recovery.

Video-assisted thoracoscopic resection of a giant esophageal schwannoma: A case report.

Introduction and importanceIntrathoracic schwannomas are rare and difficult to diagnose. However, they are the most common type of neurogenic tumor in the chest. Most patients are incidentally diagnosed or develop symptoms from mass effect, such as chest pain, dysphagia or dyspnea. Larger tumors have been resected using open approaches, while smaller ones are often excised with minimally invasive approaches.Case presentationA 60-year-old woman with a prior Roux-en-Y gastric bypass and a history of dysphagia, decreased appetite, and weight loss was referred for evaluation. CT chest revealed an 8 cm soft tissue mass centered in the distal esophagus. Gastroscopy showed the tumor to be 8 cm as well, with 2 cm of normal esophagus prior to the gastric pouch. A right-sided video-assisted thoracoscopic (VATS) approach for enucleation was successfully completed with primary esophageal repair for an 8.0 × 5.5 × 6.5 cm schwannoma.Clinical discussionSurgical resection for schwannomas is often indicated due to symptoms from mass effect (Moro et al., 2017). There are reports of VATS and robotic-assisted thoracic surgery approaches for small tumors. These techniques are appealing due to shorter length of stays and less post-operative pain. None have been described for lesions larger than 6 cm.ConclusionMinimally invasive approaches such as VATS for large schwannomas are technically feasible and safe to perform without the need for a thoracotomy.

Schwannoma at the Junction of Hard and Soft Palate

Schwannomas are benign neurogenic neoplasm arise from the peripheral Schwann cells of the nerve sheaths. These tumors present as solitary and encapsulated lesions. Intraoral schwannoma is not commonly found in the palate and extremely rare at the junction of hard and soft palate. These benign lesions are slow-growing tumors with low potential for malignant transformation and need complete excision as treatment. As it has uncommon occurrence and nonspecific clinical presentations, the diagnosis is usually confirmed by histopathological examination and immunohistochemical evaluation. Here, we report a case of a large schwannoma at the junction of the hard and soft palate, which is an extremely rare location of this tumor.

Transoral laser resection of a large schwannoma in the retropharyngeal space

Introduction: The contents of the retropharyngeal space are limited to fat and retropharyngeal nodes. Primary tumors originating from the retropharyngeal space are rare, therefore, the existence of schwannoma in the retropharyngeal space is infrequent. Method: This paper describes a case of a large schwannoma of the retropharyngeal space excised transorally with the use of co2 laser. This lesion measured about 6/6 x 3/5. Result: No peri-or post-operative complications were encountered. The procedure allowed quick resumption of an oral diet and a return to normal activity for the patient. Conclusion: This is, to our knowledge, the first report of this technique used in the excision of a large retropharyngeal space schwannoma.

Schwannoma in the External Auditory Canal.

Schwannoma is a slow-growing, benign tumor originating from the Schwann cells of peripheral nerve sheaths. Schwannoma in the external auditory canal is rare but should be included in the possible diagnosis of a cystic mass. If schwannoma is suspected, computed tomography or magnetic resonance imaging should be performed to explore tumor size, location, possible extension, and origin before excision. The authors here present a large schwannoma that almost completely occluded the external auditory canal and was completely excised using a transcanal approach.

Minimally invasive esophagectomy for a large malignant schwannoma of the esophagus: a case report and review of the literature

Minimally invasive esophagectomy for a large malignant schwannoma of the esophagus: a case report and review of the literature

Microsurgical Resection of Vestibular Schwannomas, Presentation of Cases in 3D: 3-Dimensional Operative Video

Vestibular schwannomas are the most common benign tumors of the pontocerebellar angle,1,2 their microsurgical complexity is related to their size and neurovascular relationships. The purpose of this work is to analyze the clinical, anatomic characteristics, microsurgical treatment, and the postoperative results according to the Hannover gradual scale in 4 patients with vestibular schwannomas. The 4 patients gave their consent to the procedure and all consented to the use of their surgical videos, preoperative and postoperative studies, and postoperative pictures. Case 1: A 39-yr-old woman, with left ear hearing loss. Magnetic resonance imaging (MRI) showed small Intracanalicular schwannoma (T1 classification by Hannover). Microsurgery was performed and resection through a retrosigmoid approach2,3 with anatomic and functional preservation of the facial and cochlear nerve. Case 2: A 40-yr-old woman, with left ear hypoacusia. MRI showed an extrameatal schwannoma reaching the brainstem (T3b Hannover classification). The complete re-section through retrosigmoid approach were performed. Case 3: A 69-yr-old woman, without hearing in the right ear. RM: Medium schwannoma (T4a classification of Hannover). Microsurgery was performed with anatomic and functional preservation of the facial nerve.4-6 Case 4: A 32-yr-old woman, without hearing in the left ear. In addition, cerebellar syndrome and headache. RM: Large schwannoma (T4b classification of Hannover). Sur-gery was performed, anatomic preservation of the facial nerve, with moderate paresis in the postoperative period. Microsurgical resection with functional preservation of the facial and cochlear nerve is the main objective7 when addressing this pathology.

Successful endoscopic endonasal surgery for very huge trigeminal schwannomas in nasopharynx

We present a 60-year-old female diagnosed with a giant trigeminal tumor (5.2*6.4*8.2 cm) situated in the middle cranial fossa and nasopharyngeal area. The patient was operated on by endoscopic endonasal transmaxillary, transpterygoid and infratemporal approaches. Postoperatively she was stable, with no neurologic complication and no cerebrospinal fluid leakage. We review the literature on extremely large trigeminal schwannomas.