Schwannoma Presenting Research Articles

Cutaneous Schwannoma Presenting as a Parotid Tumour - A Case Report and Literature Review

Cutaneous Schwannoma Presenting as a Parotid Tumour - A Case Report and Literature Review

Varied foci of primary benign schwannoma of the thorax: a case series.

Schwannomas are the most common tumor of peripheral nerves. It comprises 1 to 2% of total thoracic tumor. Posterior mediastinum is the most common site in thorax. Hereby we are reporting two cases of schwannoma with different sites of origin. The classical presentation of schwannoma is an asymptomatic mass found on chest radiograph. This tumor is usually benign and slow growing. Imaging followed by histopathological examination is key to the diagnosis of this neoplasm. Resection of tumor cures the disease.

Facial nerve schwannoma presenting as mixed hearing loss, tinnitus, and dizziness

Introduction: Facial nerve involvement in skull base tumors is quite a common finding. However, facial nerve tumors are rare. Facial nerve schwannomas can be observed in 75% of facial nerve tumors. They are slowly growing, benign tumors that can arise from any segment of the facial nerve—from the cerebellopontine angle to the parotid gland. The most common clinical presentation in patients with an intratemporal schwannoma is a slowly progressing facial nerve dysfunction. Less frequently, a fluctuating or a sudden facial nerve weakness can be seen. Hearing loss, tinnitus, and dizziness can also be observed in facial nerve schwannomas. Hearing loss can be conductive, sensorineural or mixed, depending on the size and site of the tumor that can extend into the middle ear or erode the cochlea. Tumors of the internal auditory canal or of the cerebellopontine angle usually lead to a retrocochlear sensorineural hearing loss. Case Presentation: The authors present the case of a 19-year-old man suffering from a left-sided hearing loss, tinnitus and dizziness without any facial nerve dysfunction. Results: The patient underwent computed tomography (CT) scan and magnetic resonance imaging (MRI) with gadolinium to investigate the middle ear and internal auditory canal. A left facial nerve schwannoma, involving the geniculated ganglion, was diagnosed. Conclusion: Even if the most common symptoms of facial nerve schwannomas are facial nerve-related symptoms, we should always keep in mind that hearing-related and equilibrium-related symptoms can be the first presenting symptoms.

Thoracic spine schwannoma presenting with traumatic spinal cord injury: A case report

Background: The presentation of a thoracic spinal tumor due to high-impact trauma is quite rare and we found no other case reported.Case Description: This is a case report and literature review. A patient presented with severe paraparesis on day 4 after trauma. Thoracic MRI showed an oval image centered to T4-T5 suggestive of hemorrhage. The patient underwent a bilateral T4 and T5 laminectomy and microsurgically assisted intradural exploration. After laminectomy, we found no extradural lesions, so we proceeded to dural opening, after which we found a large extramedullary lesion which was completely removed. Pathology revealed a schwannoma. The patient had a very good recovery after surgery and motor rehabilitation. At 6 months after surgery, inferior limbs muscle strength was completely normal. We found no other case reported.Conclusion: Thoracic spine schwannomas are difficult to early diagnose unless there is a clinical suspicion. Initial presentation as bleeding after trauma was not described before. This presentation should be kept in the differential diagnosis of any patient with an acute neurological deficit without trauma signs on admission imaging.

Simultaneous Treatment of Vestibular Schwannoma and Concurrent Middle Ear Disease Using the Enlarged Translabyrinthine Approach

Unilateral presentation of vestibular schwannoma with concurrent chronic middle ear disease or cholesteatoma is rare. We report a series of patients with ipsilateral chronic middle ear disease and vestibular schwannoma, which were simultaneously removed via the enlarged translabyrinthine approach. All tumors were near-totally removed, and middle ear disease was completely excised; there were no major postoperative complications such as cerebrospinal fluid leakage, cholesteatoma recurrence, or meningitis. If hearing preservation of the affected ear is not necessary, simultaneous surgical removal of both pathologies is more convenient than staged treatment. The enlarged translabyrinthine approach can achieve complete treatment with one corridor.

Peripancreatic schwannoma: A case report.

IntroductionSchwannomas are a benign tumor of peripheral nerve sheath origin. Although most commonly arising in the extremities, head, and neck there have been rare cases of schwannomas presenting within or adjacent to the pancreas reported in the literature.Presentation of caseWe present an asymptomatic and otherwise healthy 57-year-old male with an incidental peripancreatic mass measuring 3.5 × 3.7 cm found on abdominal computed tomography (CT). The patient underwent complete enucleation of the mass at our hospital. Pathological analysis of the excised specimen showed spindle shaped cells. Immunohistochemical staining was positive for S100 protein expression, confirming the definitive diagnosis of peripancreatic schwannoma. The patient's postoperative course was uneventful.DiscussionSchwannoma is a commonly benign, encapsulated, and slowly growing tumor arising from myelin producing cells of peripheral nerves. A schwannoma presenting within or adjacent to solid abdominal viscera, such as the pancreas, may be challenging to diagnose preoperatively as it may mimic other lesions. Radiological appearance of schwannoma may be nonspecific and definitive diagnosis is reliant upon pathological analysis. The use of endoscopic ultrasound (EUS) with fine needle aspiration (FNA) may assist the clinician in preoperative diagnosis, however these interventions are not widely available. Accurate preoperative diagnosis of a peripancreatic schwannoma is of high importance as it may preclude unnecessary pancreatectomy or radical resection.ConclusionAlthough rare, schwannoma should be part of the differential diagnosis of a cystic or solid appearing mass within or surrounding the pancreas. Total resection carries an excellent prognosis with little to no documented recurrence.

Large benign schwannoma of the greater omentum with synchronous cervical cancer: A case report.

Introduction and importanceSchwannomas are uncommon tumors of the omentum with only 16 reported cases originating from the greater omentum in the literature. We report for the first time a synchronous presentation of an omental schwannoma and cervical cancer.Case presentationA 37-year-old female presented with an abdominal mass and heavy vaginal bleeding. An 11.5 × 14.6 × 16.6 cm complex omental mass and 5.4 × 6.2 × 4.4 cm lobulated heterogeneous cervical mass were noted on CT-scan. Wide excision of the complex mass and radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection was performed. The final biopsy revealed benign omental schwannoma and poorly differentiated cervical adenocarcinoma.Clinical discussionSchwannomas originating from the greater omentum are less common than in the lesser omentum due to the paucity of nervous tissue in the former. They can undergo malignant transformation and the most common presentation is abdominal pain/discomfort. Larger tumors may cause catastrophic bleeding. Prompt surgery should be offered and wide local excision with sufficient margins be performed when there is suspicion of malignancy. Schwannomas presenting with multiple or synchronous lesions are commonly associated with neurofibromatosis type 2, schwannomatosis, and Carney's complex. Whether this co-occurrence is simply incidental or has a causal relationship remains to be established.ConclusionBenign schwannoma of the greater omentum is rare and only requires complete tumor excision. However, surgeons should be aware that synchronous presentation of cervical cancer is possible and that thorough examination of both sites should be undertaken when either primary tumor presents.

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management.

Introduction The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. Objective The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. Patients and Methods A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. Results From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms ( p < 0.001). Presentation with hydrocephalus was associated with larger tumor size ( p < 0.001) as well as concomitant visual symptoms and papilledema ( p < 0.001). Patients with visual symptoms presented at a younger age ( p = 0.002) and with larger tumors ( p < 0.001). Conclusion This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.

Unusual Presentation of a Giant Schwannoma of Left Lateral Border of Tongue: A Rare Case Report.

Schwannoma is a benign, encapsulated, slow-growing and generally solitary tumour that arise from Schwann cells of the peripheral nerve sheath. Approximately 1-12% occur intraorally with the tongue being one of the site. We report a case of schwannoma of the tongue in a 33-year-old male patient. It presented as a slow growing mass of the tongue. We did the surgical excision of the tumour with the help of CO2 laser, and the patient is in follow-up and is asymptomatic from the last 7months.

Spinal Intraosseus Schwannoma: A Case Report

Introduction: Schwannomas are the most frequent extramedullary intradural spinal tumors, accounting for approximately 24% of all nerve sheath tumors in adults. In a lower percentage of cases they may be extradural or transdural (1-19%). Intramedullary schwannomas and intraosseous schwannoma are quite rare tumors representing. Case Description: A 74-year-old woman presented intense low back pain for a few months, associated with left cruralgia and dysesthesia spread to both lower limbs. Magnetic resonance and computed tomography examination demonstrated an extramedullary intradural osteolytic lesion located in the posterior part of the vertebral body and pedicles of L1. The patient underwent a first surgery 4 years earlier with complete removal of the tumor but after about two years she had a recurrence. She was then subjected to a new intervention of decompression, removal of the tumor and arthrodesis. The histological findings were compatible with a classical schwannoma characterized by intraosseous growth and multifocal bone infiltration. Conclusion: We reported a rare case of intraosseous schwannoma presenting as a recurrence four years after radical surgical removal of a classic lumbar schwannoma. Only 25 cases of these tumors have been previously reported and none of them as an intraosseous recurrence.

Intraosseous schwannoma of the glenoid: case report and literature review.

Intraosseous schwannomas represent an extremely rare subgroup of schwannomas, accounting for <1% of all primary bone tumors. They mostly occur in the mandible, the maxilla, the sacrum, and they are also seen in long bones. We herein report a rare presentation of an intraosseous schwannoma in the glenoid of a 49-year-old patient. She complained of shoulder pain and was referred to the orthopaedic oncologist after detection of a suspicious lesion on imaging. Biopsy revealed benign spindle cells and immunohistochemistry was positive for S100. Because of the rarity of these intraosseous schwannomas it is important to recognize their radiological and histological features and make a differential diagnosis with other lytic tumors. Only if these characteristics are recognized, correct treatment can be given with definite curettage and bone grafting and correct follow-up with avoidance of unnecessary adjuvant therapy.

Pneumothorax as a Rare Presentation of Bronchial Schwannoma

Tracheobronchial schwannomas are rare diseases. Common signs and symptoms of this tumor include cough, wheezing, and dyspnea. In contrast, pneumothorax is an exceptional presentation. This study reports the first case of bronchial schwannoma presenting with pneumothorax. A 79-year-old woman was diagnosed with pneumothorax by chest radiography. Chest computed tomography unexpectedly revealed a tumor occluding the right main bronchus. Following the pathological diagnosis of bronchial schwannoma, the patient underwent thoracoscopic tumor enucleation. The airway lumens are consequently secured postoperatively. Pneumothorax should be aware of a rare presentation of non-malignant tracheobronchial tumors.

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).

Orbital Schwannoma

Orbital schwannomas are rare neoplasms of the orbit. The presenting symptoms are often nonspecific. Classic imaging characteristics seen on magnetic resonance imaging (MRI) and orbital ultrasound can be useful to help aid in the diagnosis of orbital schwannoma. When diagnosed, the goal of treatment is complete surgical excision. The location of the tumor within the orbit dictates which surgical approach would provide the best exposure. When complete excision is achieved, recurrence rates are very low. This article addresses the etiology, patient population, presentation, natural history, and differential diagnosis of orbital schwannomas. Imaging characteristics and histopathologic subtypes are reviewed. Treatment goals, approaches, and specialties involved in the management of these patients is discussed. Finally, a representative case is presented.

Intratemporal facial nerve schwannomas: multicenter experience of 80 cases.

To provide more data on the clinical presentation and natural evolution of facial nerve schwannomas and to provide guidance for therapeutic decision making. A retrospective case review of eighty patients diagnosed with a facial nerve schwannoma between 1990 and 2018 in ten tertiary referral centers in Europe was performed. Patients' demographics, symptomatology, audiometry, anatomical site (segments involved), size and whenever possible volume measurement were registered. At presentation, transient or persistent facial palsy was the most common symptom, followed by hearing loss. The schwannoma involved more than one segment in the majority of the patients with the geniculate ganglion being most commonly involved. Initial treatment consisted of a wait and scan approach in 67.5%, surgery in 30% and radiation therapy in 2.5% of the patients. Tympanic segment schwannomas caused mainly conductive hearing loss and were more prone to develop facial palsy at follow-up. Internal auditory canal or cerebellopontine angle schwannomas presented with significantly more sensorineural hearing loss. Although modern imaging has improved diagnosis of this tumor, choosing the best treatment modality remains a real challenge. Based on the literature review and current findings, more insights into the clinical course and the management of facial nerve schwannomas are provided.

An Intraparotid Schwannoma Mimicking A Warthin’s Tumour

In this report, we describe the rare presentation of a cystic intraparotid facial nerve schwannoma (IPFNS) in a young female who initially presented with a painful unifocal parotid mass gradually enlarging over 5 years. Preliminary imaging and cytology offered this to be a Warthin’s tumour. Here we describe the limitations of current diagnostic tools in the workup of intraparotid cystic lesions and highlight the importance of keeping rare tumours in mind to optimize pre-­surgical management.

Clinicopathological Presentation and Management of Penile Schwannoma

Patients with penile schwannoma are rare and usually with variant presentations. No evidence-based clinical guideline exists for diagnosis or treatment. To put schwannoma into differential diagnoses of benign soft tissue lesions in the penis is important. To analyze and categorize clinical, histopathological, and radiological presentations and apply possible explanation on several fields of penile schwannoma. We collected the English literature through the PubMed database of the National Library of Medicine up to October 2019. A newly diagnosed case in Chang Gung Memorial Hospital, Taiwan, was also included. This study categorized lesion locations into the penile body or shaft, glans, or penile root, dorsal or ventral. The main outcome measure was to demonstrate clinical, pathological, ultrasonography, and MRI manifestations of penile schwannoma and perform immunohistochemistry staining that has not been performed among penile schwannomas. We collected 40 cases. Data were arranged in tables. Clear descriptions were added on several fields of penile schwannoma in detail in Discussion. Penile schwannomas are mostly located at the penile shaft and dorsum of the penis. Dyspareunia is the most reported complaint for sexual dysfunction. This study is the first study in the world to document the expressions of calretinin, SOX10, glial fibrillary acid protein, D2-40 (podoplanin), and cytokeratin AE1/AE3 in penile schwannoma and claims magnetic resonance imaging and pathologic presentations of penile schwannomas are synonymous with schwannomas from head to toe. The current patient may be the first to present with penile schwannoma with schwannomatosis. Huang LC, Wang HZ, Chu YC, etal. Clinicopathological Presentation and Management of Penile Schwannoma. Sex Med Rev 2020;8:615-621.

Unusual presentation of giant schwannoma in the sciatic nerve

Introduction: Schwannomas are benign, encapsulated, slow-growing, generally solitary tumors originating from Schwann cells in the peripheral nerve heath. Schwannoma of the sciatic nerve is a rare condition and, therefore, little documented in the literature. Case Report: A 77-year-old female patient arrived at the clinic complaining of pain and the appearance of a mass in the middle third of her left thigh. She presented with a well-defined mass, horizontally movable, hyperalgesia to the touch at the site of the mass, and positive Tinel’s sign. Magnetic resonance imaging showed multiple lesions suggestive of neurinomas, with intense nodular enhancement after gadolinium contrast injection, diffuse, in the right thigh and in the middle third of the left thigh. Surgical treatment was proposed by our team, but the patient preferred to continue the outpatient follow-up, because the injury did not interfere in her daily activities. Conclusion: Although schwannoma in the sciatic nerve is rare, it should be considered in the differential diagnosis of patients presenting with conditions that affect this nerve.

Cranial nerve schwannoma - A pictorial essay.

Schwannomas are peripheral nerve sheath tumours arising from cranial, spinal or peripheral nerves. Most of the schwannomas are benign with the rare possibility of malignant transformation. Cranial nerve schwannomas can be seen along the course of any cranial nerve in the intracranial region or head and neck location. Although a majority are solitary sporadic lesions, multiple schwannomas can be seen in syndromes like neurofibromatosis type 2 and rarely in type 1. Since intracranial schwannomas are slow-growing, clinical presentation varies between no symptoms to cranial nerve palsy. Most of the times, the symptoms are due to mass effect over the adjacent structures, foraminal widening, compression of other cranial nerves, denervation injury or hydrocephalus. Familiarity with the course of the cranial nerves, imaging appearances and clinical presentation of schwannomas helps in accurate diagnosis and possible differential diagnosis, especially in uncommon clinical and radiological appearances. In this pictorial review, we illustrate relevant anatomy of cranial nerves, imaging features of schwannomas of most of the cranial nerves, clinical presentation and differential diagnosis.

Thyroid schwannoma presenting by intractable persistent unexplained cough: a case report

Thyroid schwannoma presenting by intractable persistent unexplained cough: a case report