Sinonasal Schwannoma: A Rare Sinonasal Neoplasm

Endoscopic Management of Ethmoidal Schwannoma: A Case Report

Schwannomas of sinonasal origin are rare tumours with an incidence as low as 4% and may present with a wide range of clinical features. Due to non-specific endoscopic and radiological findings, diagnosis becomes difficult. We present a case of an ethmoidal schwannoma with nasal and nasopharyngeal extension in an elderly female patient who had a slow course of the long-standing disease. Her main complaints were nasal obstruction, nasal discharge, mouth breathing, snoring and recurrent nasal bleed. Nasal endoscopy showed a pale, firm, polypoidal mass with dilated vessels on the surface which bled on probing. It was a non-enhancing sinonasal mass with scalloping of adjacent paranasal sinuses and erosion of posterior nasal septum on contrast-enhanced computed tomography. Endoscopic excision of the mass was done in toto and histopathology report confirmed it as schwannoma. Long standing sinonasal masses especially in the elderly age group with an indolent medical history should arise suspicion of benign neoplasm especially schwannomas due to their high rate of incidence amongst benign sinonasal neoplasms.

Schwannoma of the sinonasal tract: case report with review of the literature

Schwannomas of the sinonasal tract are rare, accounting for <4% of head and neck schwannomas. We report the case of a 61-year-old male who presented with unilateral nasal symptoms. Examination and imaging revealed a unilateral polyp at the level of the middle turbinate, with an initial biopsy suggestive of an inflammatory polyp. Due to the persistence of the patient's symptoms and his polyp despite medical therapy, endoscopic nasal polypectomy was performed. The histology surprisingly showed a schwannoma. No further interventions were carried out, and the patient remains disease-free 6 months postoperatively. A review of the literature comprising 60 cases is included. An optimal clinical approach to the investigation and management of schwannomas of the sinonasal tract is subsequently discussed.

Encapsulated Sinonasal Schwannoma Mimicking an Antrochoanal Polyp

Extracranial schwannomas are uncommon neoplasms of the sinonasal tract arising from peripheral nerve shealth. Mostly acapsulated on histology, but few cases of encapsulated schwannomas have been reported. Its symptoms are nonspecific and initial clinical diagnosis is frequently missed. We report a 13-year-old boy with a huge, encapsulated sinonasal schwannoma initially thought to be an antrochoanal polyp. Computed tomography scan demonstrated a huge irregularly shaped mildly enhancing isodense mass in the right nasal cavity with lateral extension to the ipsilateral maxillary sinus, superior extension into the ethmoids and frontal sinuses and posteriorly into the nasopharynx. The tumour was completely excised via a lateral rhinotomy and patient is still on follow-up.