Schwannoma of the tongue: two case reports and review of the literature

Neurilemmoma of Tongue in A Young Female: A Case Report

Neurilemmomas are benign, slowly growing tumors originating from Schwann cells in peripheral nerves. The precise cause is unclear. They commonly occur in the head and neck region (25-48% of cases) and rarely in the oral cavity (1%). While lingual schwannomas can develop at any age, they are most frequently seen between the ages of 30 and 60 years. In this case, a 19-year-old female was diagnosed with a lingual schwannoma. She had experienced painless swelling along the left side of her tongue for two years. The examination revealed a non-tender, soft to firm, 2x1 cm lump on the left side of the tongue, covered by healthy mucosa, with no signs of cervical lymph node enlargement. The lesion was completely excised under local anesthesia for histopathological evaluation. Histological examination revealed spindle cells with slender, undulating nuclei in Antoni A and B regions. The prominent nuclear palisading feature typical of schwannomas was evident.

Schwannoma (neurilemmoma) of tongue: A rare case presentation and review of literature

It seems that schwannomas of the tongue base originate from branches of the glossopharyngeal, vagus, or hypoglossal nerves. Additionally, complete trans-oral surgical excision is an efficient method to remove them.

Incidental Finding of a Tongue Schwannoma Mimicking Local Recurrence of Squamous Cell Carcinoma on a Systematic Follow-up 18F-FDG PET/CT

ABSTRACT

Schwannomas are usually benign, rare, and slow-growing nerve sheath tumor composed of Schwann cells. They develop in the head and neck area in approximately 25% to 40% of cases, of which 1% in the oral cavity, where the tongue remains the preferred site. Malignant transformation occurs in approximately 8% to 10% cases. We report a unique case of a histologically proven FDG-avid schwannoma of the left mobile portion of the tongue, showing an 18F-FDG avidity on PET/CT, which was a false-positive result for local recurrence in a patient followed for squamous cell carcinoma.

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 7 months.

A Large Intraoral Sublingual Schwannoma in a Pediatric Patient: A Case Report

INTRODUCTION

Schwannoma is a benign neoplasm that arises from Schwannoma cells found in the peripheral nerve sheath. It's a frequent neoplasm in the head and neck area, but it's exceedingly unusual to find it in the mouth. It's a rare occurrence in the oral cavity of the pediatric age group.

CASE REPORT

We present a 12-year-old kid who has had a smooth, firm, and non-tender mass in the sublingual region for the past year. The mass was removed completely using a transoral technique. The diagnosis of sublingual schwannoma was confirmed by histopathological and immunohistochemical testing.

CONCLUSION

Schwannomas are typically benign and have a good prognosis with a low risk of malignant change. It should be used as a differential diagnostic for sublingual diseases such as ranula and salivary gland lesions. In the case of lingual schwannoma, surgical removal of the tumor is the preferred therapy. The transoral method is the most popular treatment option for sublingual schwannoma.

Pediatric schwannoma of the tongue: A case report and review of literature

BACKGROUND

Neurogenic tumors account for about ten percent of all tumors of childhood, and benign tumor originating from Schwann cells is rare in peripheral nerves. Schwannoma of the tongue is quite rare in children.

CASE SUMMARY

We present the case of an 8-year-old male with schwannoma in the anterolateral tongue. The mass was slow-growing for one year with no pain and discomfort. He underwent transoral mass excision under general anesthesia. Gross examination revealed a smooth surfaced, 17 mm × 14 mm × 7 mm sized, encapsulated nodule with a clear resection margin. Schwannoma of the tongue was confirmed by the pathological exam. He reported no motor or sensory change, such as dysgeusia or paresthesia, or phonation difficulty during postoperative 12 mo follow-up.

CONCLUSION

Schwannoma of the tongue is a rare benign neoplasm in childhood. If a painless firm mass is encountered in the tongue of a child, solid tumors like schwannoma should be considered in the differential diagnosis.

Focused ultrasound ablation of a large canine oral tumor achieves efficient tumor remission: a case report

Purpose: Oral cancers are one of the commonly diagnosed tumors worldwide in human and veterinary patients. Most oral cancers are surgically resected; however, obtaining an adequate margin of safety in patients without compromising their quality of life is often challenging. Herein, we investigated the ability of non-invasive focused ultrasound (FUS) to thermally ablate a biopsy confirmed canine oral cancer. Materials and Methods: A male canine patient with a large neurilemmoma (schwannoma) mass on the left maxilla, with evidence of thinning and loss of alveolar bone and pressure necrosis, was treated with FUS ablation instead of the traditional maxillectomy procedure. FUS ablations were performed in three sessions over three weeks. Tumor remission was determined with computed tomography and histopathological examination of the treated site. Additionally, the anti-tumor immune effects of FUS were assessed by flow cytometry analysis of blood and tumor samples. Results: Complete tumor remission was noted at the treated site. Treatment related adverse events were primarily thermal burns of the buccal mucosa, which were managed with periodic hyperbaric oxygen therapy and surgical coverage of the underlying exposed bones with gingival flaps. Enhanced proliferation of adaptive immunity cells (e.g., T-cells) was observed in tumor and blood samples. Conclusion: Our limited investigation in a canine oral cancer patient suggests that FUS may avoid the need for large-scale resection of bony tissues, thus potentially improving quality of life.

A fast-growing schwannoma of the tongue in a 15-year-old Iranian male: Review of literature and case report

Schwannoma can be included in the list of differential diagnoses of tongue masses but seems to be a rare finding in the Iranian population. The current case was presented as an exophytic nodular sessile mass which was growing fast.

Schwannoma of the Lower Lip: A Case Report of an Unusual Presentation

Schwannoma is a benign neoplasm that originates from the neural sheath of Schwann cells. Although extracranial schwannomas are commonly observed in the head and neck region, only 1% are found in the intraoral cavity. This article describes the first case in the Eastern Mediterranean region of a lower lip schwannoma in a 17-year-old male patient.

Schwannoma of the Base of the Tongue: A Case Report of a Rare Disease and Review of Literatures

BACKGROUND

Schwannoma is a benign nerve sheath tumor. It was first identified by Virchow in 1908. These tumors can emerge from any nerve covered with a Schwann cell sheath, including the cranial nerves (with the exception of the optic and olfactory nerves), the spinal nerves, and the autonomous nervous system (Harada H, Omura K and Maeda A, 2001). Case Presentation. A 28-year-old male farmer presented with a swelling at the right side of the base of tongue extending into the oral tongue. It was identified incidentally by his newly married wife while he was yawning. It was asymptomatic. The patient had no difficulty in chewing, swallowing, or phonation and also no sensory or taste abnormalities. The tongue movements were normal.

CONCLUSIONS

Diagnosis of schwannoma should be considered for a smooth, painless, firm swelling in the tongue. A schwannoma of the tongue may grow large enough before producing any symptom. Around 25-40% of schwannoma happen within the head and neck region, and among these, 1-12% occurs in the oral cavity, most regularly the tongue or mouth floor. Schwannoma of the tongue does not show any age or sex predisposition. It usually presents as a painless lump in the tongue, but when it grows larger than 3.0 cm, it may produce dysphagia, pain, or discomfort and change in the quality of voice. Here, we report a case of large (4 cm × 3 cm) asymptomatic schwannoma of the tongue in a 28-year-old male patient and review the literature available during the last 61 years.

Schwannoma of head-and-neck region: A clinical chameleon - Report of two cases occurring at rare sites with unusual clinical manifestations

Schwannomas are rare benign encapsulated neoplasms that usually do not arise in the nasal and oral cavities. Only about 25% of the schwannomas are located in the head-and-neck region. The preoperative diagnosis of schwannomas in the head-and-neck region is difficult, as they present with varied clinical manifestations and have nonspecific radiological findings, which can lead to a diagnostic dilemma. We report two cases of schwannomas, one in the nasal cavity and the other in the tongue, that were considered to be an infective lesion and malignant lesion respectively on clinical evaluation. The biopsy and subsequent histopathological examination led to the diagnosis of schwannoma. It is important to be aware of the unusual clinical manifestations of schwannomas and keep it in the differential diagnoses, even at relatively uncommon sites such as the nasal and oral cavities. Lesions that are suspected to be infectious lesions or malignant lesions on clinical and/or radiological evaluation can also be schwannomas. Unnecessary diagnostic evaluations and radical therapeutic measures can be avoided with early diagnosis.

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 82 years (mean 34 years; median 29 years). 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.

Oral neural tumors: Clinicopathologic analysis of 157 cases and review of the literature

Background

Oral neural tumors (ONTs) are rare lesions and represent reactive or neoplastic proliferations of nerve sheath cells. The purpose of the present study is to report the clinical, demographic and histopathologic features of 157 ONTs diagnosed in a single Oral Pathology Department and review the pertinent literature.

Material and Methods

157 cases of ONTs diagnosed during a 44-year period were retrospectively collected and the diagnosis was reconfirmed by studying representative haematoxylin and eosin stained tissue sections. The patients’ gender and age, as well as the main clinical features of the lesions, were retrieved from the biopsy submission forms.

Results

The 157 ONTs represented approximately 0.4% of 35,590 biopsies accessioned during the study period. They affected 71 male and 86 female patients with a mean age of 38.4±18.8 years. They mainly appeared as asymptomatic nodules of normal or white colour on the tongue, lip mucosa and hard palate. The most common ONT was granular cell tumour (38.9%) followed by neurofibroma (19.7%), schwannoma (15.9%), traumatic neuroma (15.9%), palisaded encapsulated neuroma (8.3%) and nerve sheath myxoma (1.3%).

Conclusions

This study confirmed the rarity of ONTs. Their clinical characteristics mimic other oral lesions; thus, microscopic examination is the only mean to arrive at a definitive diagnosis.

Key words:Oral neural tumors; oral neural neoplasms; neurofibroma; oral neurofibroma; schwannoma; oral schwannoma; neurilemmoma; oral neurilemmoma; granular cell tumor; oral granular cell tumor; traumatic neuroma; oral traumatic neuroma; palisaded encapsulated neuroma; oral palisaded encapsulated neuroma.

Trans-oral, Carbon Dioxide-Assisted Excision of an Unusual Schwannoma of the Tongue Base: Case Report and Review of the Literature

Introduction  Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO ₂ ) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds.

Objective  We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO ₂ -assisted excision. We also provide a review of the available literature, in English language, on humans.

Data synthesis  The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma . Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases.

Conclusion  We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO ₂ laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.

Surgical management of extracranial nerve sheath tumours in a tertiary care center

Objective

Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures.

Methods

It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. The retrospective clinical data, diagnostic procedures, surgical approaches and their complications are analyzed after 12 months of surgery.

Results

Total 13 patients, 7 were females and 6 were males. Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients). Transcervical excision of the tumour was performed in 7 patients. Six needed combined surgical approach for the excision of the tumours. Neurovascular injury was detected in 3 patients, and one patient had recurrent disease during the follow-up period.

Conclusions

Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure. Although the transcervical approach is commonly practiced for the majority of the tumours, combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.

Ancient Schwannoma: A Rare Intramural Intra-lingual Lesion

Ancient schwannoma is an uncommon schwannoma variant which is a benign tumour of Schwann cell origin. It is relatively a rare tumour (25%) in the head and neck region. It is encapsulated and well demarcated from the surrounding tissues. A 35 years old patient in this case presented with painless swelling of the tongue. Trans-oral excision of the intramural lesion was performed. Histopathological and immuno-histochemistry confirmed the diagnosis of schwannoma. This case is of interest on account of the complexity of its diagnosis and the atypical site, that is, intra-mural, of appearance of a schwannoma.

Comprehensive Analyses of Intraoral Benign and Malignant Nerve Sheath Tumors: The Rare Disease Entities Revisited

INTRODUCTION

Intraoral benign and malignant nerve sheath tumors (BNST and MNST) are rare tumors with non-specific clinical presentations and represent diagnostic and therapeutic challenges. Current knowledge regarding their demographic, clinicopathological features and treatments remains fragmented.

MATERIALS AND METHODS

The original data about patients diagnosed as intraoral BNST and MNST were retrieved from our disease registry (2005-2017). Comprehensive reviews of English and Chinese literature were performed to collect and analyze the epidemiological, clinicopathological data and treatment outcomes about those published cases.

RESULTS

Thirty-four intraoral BNSTs were found at our institution in the past 13 years. Literature reviews identified 354 intraoral BNSTs in 223 articles and 60 intraoral MNSTs in 50 articles. Most intraoral BNSTs and MNSTs were presented in the second to fifth decade of life. Males outnumbered females in MNSTs, while BNSTs displayed a slight female preponderance. The common sites for intraoral BNSTs were parapharyngeal space followed by tongue, whereas mandible was the most common site for MNSTs. Most intraoral BNSTs were presented as slow-growing, painless mass or swelling, while MNSTs usually appeared as painful and invasive mass with discomfort. Surgical excision was preferred for intraoral BNSTs with excellent prognosis. Complete resection was indicated for intraoral MNST with dismal prognosis as evidenced by much recurrence, metastasis, and death.

CONCLUSION

Intraoral BNST and MNST are rare diseases which should not be ignored when intraoral painless or painful mass/swelling is found. Surgical excision is indicated for intraoral BNST with favorable outcomes. However, further investigations are warranted to optimize the treatment for intraoral MNST to improve its prognosis.

Plexiform Schwannoma of the Tongue in a Pediatric Patient with Neurofibromatosis Type 2: A Case Report and Review of Literature

Introduction

Plexiform schwannoma is a rare variant of schwannoma that accounts for only 5% of all schwannomas. Herein, we present a rare case of plexiform schwannoma of the tongue in a pediatric patient with neurofibromatosis type 2 (NF2).

Case Presentation

A 13-year-old female presented with a growing left-sided tongue mass. The patient has a past medical history of NF2. The tongue mass was excised and histopathological examination revealed a spindle cell tumor with multinodular growth pattern, with Verocay bodies' formation. Tumor cells were strongly positive for S-100 protein and negative for smooth muscle actin (SMA), and EMA highlighted perineural fibroblasts surrounding tumor nodules. These findings were diagnostic of plexiform schwannoma.

Conclusion

Plexiform schwannoma of the tongue is an extremely rare tumor seen in patients with NF2. Clinical examination and histopathological evaluation are important for diagnosis of plexiform schwannoma.

Anterior Midline Glossotomy Approach for Large Schwannoma of the Tongue: Case Report

Schwannoma corresponds to a benign neurogenic tumor, derived from neural crest cells. It accounts for approximately 5% of all benign soft tissue tumors. These are the most common cause of peripheral nerve neoplasms of the oral cavity and oropharynx representing 1%. Isolated or solitary neurofibromas of the oral cavity usually involve the tongue or the labial mucosa. They appear as soft, painless, slow-growing masses that are tender to depression or palpation. The case of a 40-year-old woman is studied because of the presence of painless swelling, slow, and progressive growth of the oral language. Complete removal of the lesion was performed and primary closure was performed. It had a satisfactory evolution, maintaining adequate sensory and sensory mobility and innervation.

Palatal schwannoma in a young female patient: report of a case and review of the literature

BACKGROUND

A few cases of oral schwannomas in paediatric patients have appeared in the literature so far; however, there are no studies focusing solely on paediatric oral schwannomas. The aim of this study is to report a case of palatal schwannoma in a young female patient and review the pertinent literature on oral schwannomas in paediatric patients.

CASE REPORT

A 12-year-old girl presented with a growing swelling of 2 weeks duration on the hard palate. With a provisional diagnosis of a salivary gland neoplasm an incisional biopsy was performed under local anesthesia and the histologic examination disclosed an Antony A type schwannoma.

TREATMENT

Complete surgical resection of the lesion was performed under local anaesthesia through a palatal mucosa incision and paraffin gauze was sutured on the surgical area for protection during secondary healing. The bone underlying the tumor was normal. The postoperative period was uneventful and 2 weeks after excision the gauze were removed.

FOLLOW-UP

There have been no signs of recurrence during a 18-month follow up period.

CONCLUSION

A palatal swelling in a child or adolescent may represent a neoplasm, such as a schwannoma and requires careful clinical and radiographic evaluation of the dentition.

Schwannoma of the tongue: a case report with review of literature

BACKGROUND

Schwannomas (or neurilemmomas) of the tongue are benign, usually solitary, encapsulated masses derived from Schwann cells. Clinical evidence indicates that schwannoma is painless and slow growing. In general, schwannoma is treated by surgical excision. Here, we describe a case of schwannoma of the tongue, include a review of the literature from 1955 to 2016, and provide data on age, gender, location, presenting symptoms, size, and treatment methods.

CASE PRESENTATION

A 71-year-old female patient presented with a swelling at the base of the tongue of unknown duration. Magnetic resonance images (MRI) showed a large well-circumscribed solid mass and no significant lymph node enlargement. The mass was excised without removing overlying mucosa.

CONCLUSIONS

The authors report a case of lingual schwannoma that was completely removed intraorally without preoperative biopsy. No sign or symptoms of recurrence were observed at 12 months postoperatively.

Schwannoma of the tongue-A common tumour in a rare location: A case report

Schwannoma is a benign tumour that arises from Schwann cells of the peripheral nerve sheath, and is a common tumour of the head and neck. However, intraoral location is very uncommon (only 1% of all head and neck schwannomas). We report a rare case of lingual schwannoma in a 20-year-old male patient who presented with a small, slow-growing mass over the right lateral border of the tongue with 1 year of evolution and that became recently ulcerated. The patient underwent MRI examination and complete surgical excision. Histopathological and immunohistochemical examination confirmed the diagnosis.

Intraoral ancient schwannoma: A systematic review of the case reports

Intraoral ancient schwannoma is a rare type of oral schwannoma, which is encapsulated and well demarcated from the surrounding tissues. Ancient schwannomas are associated with conventional features of neurilemmoma; however, they are distinguished from other types of schwannoma due to factors such as the long history, cellular architecture showing hypocellularity, and hyalinized matrices. This systematic review was performed through searching in databases such as PubMed and Google Scholar using related keywords (intraoral, oral, ancient, schwannoma, and neurilemmoma). Eventually, 26 case reports were systematically reviewed by the researchers. Required data were extracted by one researcher, and all the selected articles were reviewed in full text after screening. This systematic review aimed to determine the most significant influential factors in intraoral ancient schwannoma and evaluate the diagnostic and therapeutic methods in this regard.

Tongue base schwannoma: differential diagnosis and imaging features with a case presentation

Schwannomas are slow growing, encapsulated neoplasms that arise from the nerve sheath. A vast majority of these benign neoplasms occur in the head and neck region, most commonly involving the 8th cranial nerve. Schwannomas arising from the base of tongue are very rare and, thus, can easily escape the list of differential diagnosis for a posterior tongue mass. A systematic approach is recommended for diagnosis of a posterior tongue mass, with neoplastic, infectious, and congenital categories. We report a case of a 24-year-old female, who presented with pressure sensation in the throat. On imaging, she was found to have a mass in the right posterior tongue with follow-up biopsy results yielding a schwannoma. Characteristic imaging features for various possible etiologies of a posterior tongue mass are also discussed.

Schwannoma of the tongue

Schwannoma, neurilemmoma or neurinoma is a rare, benign nerve sheath neoplasm composed of Schwann cells. It is usually solitary, slow growing and asymptomatic. Approximately 1-12% of the tumours occur intraorally with the tongue being the most common location. We report a rare case of lingual schwannoma in a 20-year-old female patient involving the tip of the tongue, which was slow growing and asymptomatic. For diagnosis histopathological examination and also immunohistochemistry testing were carried out to confirm the nature of tissue fragments. The treatment was complete surgical excision.

Schwannoma (Neurilemmoma) on the Base of the Tongue: A Rare Clinical Case

Patient: Female, 20

Final Diagnosis: Schwannoma of the tongue

Symptoms: Dysarthria • dysphagia

Medication: —

Clinical Procedure: Excision of the mass via trans-oral approach

Specialty: Surgery

Head and Neck Schwannomas: 20-Year Experience of a Single Institution Excluding Cutaneous and Acoustic Sites

While head and neck sites comprise the most common location of schwannomas, clinicopathologic data regarding those tumors occurring in non-acoustic and non-cutaneous locations are relatively sparse. In this study, therefore, we sought to examine retrospectively the clinical and pathologic features of head and neck schwannomas excised at our institution over a 20-year period. During this period, we identified a total cohort of 85 patients, which included 36 males (42.4 %) and 49 females with average age of 41.3 years, the majority of which presented asymptomatically with a mass. Localized symptoms were, however, associated with all of the schwannomas that arose in the oral cavity and larynx, while tumors within or adjacent to bone were often associated with neurologic complaints (7 of 15 such tumors [46.7 %]). Clinical follow-up data was available in 86.4 % of all cases and demonstrated no recurrences or mortality. Pathologically, the microscopic features were characteristic of those well-described for schwannomas in other sites, including alternating Antoni A and B areas and the presence of degenerative changes. Tumor encapsulation, however, was variable and was completely absent in schwannomas of the nasal cavity, paranasal sinuses, and larynx. Additionally, a significant minority of the tumors (28.2 %) exhibited foci that resembled neurofibroma. Non-acoustic, non-cutaneous schwannomas of the head and neck appear to have clinicopathologic features similar to their soft tissue counterparts with some subsite variation in presentation and/or microscopic features.

A case of a CD56-expressing ectomesenchymal chondromyxoid tumor of the tongue: potential diagnostic usefulness of commonly available CD56 over CD57

Ectomesenchymal chondromyxoid tumors (ECTs) are rare. Only approximately 55 cases have been reported in the English literature. Distinguishing ECTs from soft tissue myoepithelioma (STM) is often difficult owing to morphological and immunohistochemical similarities. Here, we present a case of an ECT arising from the anterior dorsum of the tongue in a 24-year-old woman. Grossly, the tumor was soft, had a myxoid appearance, and measured 8×7×7 mm. Microscopically, it was well-demarcated, lacked a fibrous capsule, and predominantly consisted of short, spindle to ovoid cells in a myxoid background. Vimentin, glial fibrillary acidic protein (GFAP), and S-100 protein were strongly positive on immunohistochemical analysis. While CD56 was moderately immunopositive, cytokeratin (AE1/AE3) and alpha-smooth muscle actin (αSMA) showed focal weak positivity. Thus, the immunohistochemical findings suggested a diverse immunophenotype, indicating mesenchymal (vimentin and αSMA positive), neurogenic (S100, GFAP, and CD56 positive), and epithelial differentiation (cytokeratin positive). This reflected the fact that ECTs probably arise from uncommitted ectomesenchymal cells that have the potential for multilineage differentiation. The immunohistochemical staining pattern observed for ECTs slightly differs from that of STMs. Strongly positive staining for GFAP and weakly positive staining for cytokeratin are observed in ECTs, whereas the opposite is typically observed for STMs. These findings indicated that the patterns of expression on immunohistochemistry differ between ECTs and STMs, although inevitably, there was some overlap. Thus, CD56 expression in the case presented here is noteworthy, and it could potentially become an adjunct diagnostic marker for ECT instead of previously used CD57.

Schwannoma of the tongue in a paediatric patient: a case report and 20-year review

Schwannomas (Neurilemmomas) are benign, encapsulated, slow-growing, and usually solitary tumours originating from Schwann cells of the peripheral nerve sheath with uncertain etiology. Approximately 25-48% of cases are seen in the head and neck region, of which 1% appears in the oral cavity. Lingual schwannoma can affect all age groups with peak incidence between the third and sixth decade. We report a rare case of lingual schwannoma in a 14-year-old girl complaining of asymptomatic swelling over lateral border of tongue since two years. Clinical examination revealed a nodule 1.5 × 1 cm in size, rubbery, nontender, smooth at right lateral border of tongue covered by normal mucosa, with no cervical lymphadenopathy. Excisional biopsy of the lesion was done under local anaesthesia. The histological sections spindle cells with thin wavy nuclei arranged as typical Antoni A (with Verocay bodies) and Antoni B areas. Nuclear palisading distribution (typical of a schwannoma) was readily identifiable. The patient was recurrence-free after one year.

Swelling on lower lip…not always a mucocele !!!

Schwannomas are well characterized uncommon neural neoplasms which may rarely present with variation in clinical manifestation. Oral Schwannomas clinically simulate other lesions like traumatic fibroma, pyogenic granuloma, mucocele and salivary gland lesions. The diagnosis of schwannoma is typically made at the time of surgery following biopsy and surgical resection is the mainstay of treatment with no chances of recurrence as they are well encapsulated. We present a case of schwannoma of lower lip occurring in a 21-year-old female patient.

A discrete swelling of the upper lip: a diagnostic and clinical stepladder

An upper lip swelling can be attributed to multiple etiologies. The clinical presentation and differential diagnosis of an upper lip swelling is described. Histologic examination revealed the presence of a Schwannoma. This rare entity in the upper lip must be considered by the clinician during the evaluation of an upper lip swelling.

Lingual schwannoma: case report and review of the literature

Schwannomas are benign, encapsulated, slow-growing and usually solitary tumours originating from Schwann cells of the peripheral nerve sheath. Approximately 25-40% of cases are seen in the head and neck region, of which 1% in the oral cavity. We report a rare case of lingual schwannoma in a young woman who was treated with complete transoral excision, and also review the literature of the past two decades, analyzing epidemiological and clinical data of the 35 cases reported. Lingual schwannomas generally present as a painless lump with an average size of 2 cm in the fourth decade of life and with no gender predilection. Complete transoral excision can be considered standard treatment for these tumours, with no recurrences documented in the literature.

Ancient Schwannoma of the hard palate. An uncommon case report and review

Schwannoma or neurilemmoma is an infrequent benign tumor in the oral cavity that originates from the Schwann cells on the neural sheath of the peripheral nerves. Schwannomas are frequently located in the soft tissues of head and neck region, but only a 1 to 12% of them are located in the oral cavity. Some histological variants of schwannoma have been described including the cellular, plexiform, epithelioid, ancient, and melanocytic types. The "ancient schwannoma" is an uncommon variant of this tumor that shows specific histological characteristics, and is rare in the oral cavity with less than 15 cases described on the literature. Most of them were located in the tongue or in the floor of the mouth, being the hard palate an extremely rare localization. We present a new clinical case of an ancient schwannoma with a long time of evolution, arising from the nasopalatine nerve, and located in the hard palate of a 35 year old female. We also review the main clinical and histological characteristics of this pathology. Key words:Ancient schwannoma, neurilemmoma, palate, schwannoma.

Lingual schwannoma in pediatric patients

We present the case of a 15-year-old boy who presented to our emergency department because of a soft lesion growing on the back of his tongue. On examination, a vegetant mass on the posteromidline lingual part of the body of the tongue was noticed: it was not painful, even if the boy reported discomfort because of its size; there was no bleeding or signs of infection. The magnetic resonance imaging showed the lesion as trilobated and capsulated, but was not diriment to define a diagnosis; excisional biopsy was performed under general anesthesia, and the mass was identified as a schwannoma. Schwannoma, or neurilemmoma, is a benign tumor originating from Schwann cells of the nerve sheath surrounding peripheral nerves. It is slow-growing, usually solitary, and encapsulated. Intraoral schwannomas are rare and account for 1% of lesions of the head and neck region. There is no sex predilection. The symptoms depend on size and location of the tumor. Recurrence is rare after complete surgical resection. The present study aimed to retrospectively describe our experience with a case of neurilemmoma of the tongue presenting in childhood, the diagnostic methods used, the surgical decision, and the treatment outcome and to analyze the data and review the literature available on this type of tumor. The etiology, clinical presentation, differential diagnosis, and management are discussed.

Intraoral schwannoma--a report of two cases

Schwannomas, also known as neurilemmomas, are uncommon neoplasms, derived from schwann cells. These neoplasms, although rare, should be considered in the differential diagnosis of slow growing tumour masses of the oral cavity. The growth of these tumours sometimes causes displacement and compression of the nerve of origin, giving rise to clinical signs and symptoms. It can develop at any age and there is no sex predilection. Intraorally, the tongue is the most common site followed by the palate, floor of the mouth, buccal mucosa, lips and jaws. Surgical excision is the treatment of choice for schwannomas, with few reports of recurrence or malignant transformation. In this paper, the authors report two cases of patients with intraoral schwannoma, where the preoperative clinical diagnosis was inconclusive and final diagnosis was established based on radiographic and histopathological examination.

Giant plexiform schwannoma of the tongue

We present the case of a 38-year-old woman that presented with a very slowly enlarging mass of the tongue. MRI revealed a large mass originating in the tongue base and extending to the supraglottic space. Biopsy of this tumor confirmed the diagnosis of schwannoma. An endaural approach allowed complete resection of the tumor. Definitive histopathological examination showed a plexiform schwannoma. Schwannoma or neurilemoma represents a benign tumor potentially affecting any nerve. The head and neck region is a relatively common location for schwannomas, but tongue schwannomas are considered to be rare and pose the problem of both clinical and histological differential diagnosis of tongue masses.

Palatal schwannoma in an elderly woman

Schwannoma also known as neurilemmoma is a benign tumour derived from schwann cells and is relatively rare in occurrence. Only 1% of the schwannomas in the head and neck region occur at intra-oral sites. Schwannomas usually occur during the third or fourth decades of life and the tongue is the most common intra-oral site. A case of intra-oral schwannoma in a 70-year-old female in the region of hard palate is described which is extremely rare.