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

Extracranial Head and Neck Schwannomas: A Single Centre Retrospective Experience of 97 Cases

Introduction

Schwannomas are rare benign neurogenic tumours. About 25-45% of extracranial schwannomas are found in the head and neck region. In the head and neck, they can arise from various cranial, peripheral and autonomic nerves. Due to this, they have varied clinical presentations.

Material and Methods

This retrospective cohort includes 97 patients diagnosed with extra cranial head and neck schwannoma, and operated in the Otolaryngology and Head & Neck Surgery department, from 2013 to 2022. The parameters observed were the age and gender distribution, location, nerve of origin, size, pressure symptoms, cranial palsies, post-operative symptoms, recurrence and complications. The data were collected from the institute's electronic records.

Results

The median age of the study population was 36 years; among them, 51 were men and 46 were women. The most common tumour location was parapharynx. The patients had varied head and neck symptoms, of which 23.7% had nerve paresis at presentation. Transcervical surgical approaches was most used. New onset cranial nerve paresis immediately post-surgery was noted in 22.7%. Recurrence was noted in 2% of cases.

Conclusions

Extra cranial schwannomas are uncommon neoplasms and have varied presentations. Comprehensive evaluation with appropriate imaging should be done in all cases. Though benign, patients can present with nerve paresis. Recurrence is uncommon after complete resection.

Sinonasal Schwannoma: A Case Report

Schwannomas are benign tumours of the peripheral nerve sheath that can develop anywhere in the body. In the nasal cavity, they hardly ever happen. Lesions known as paranasal schwannomas make up fewer than 4% of all head and neck schwannomas. Here, we present a case of sinonasal schwannoma in a 24-year-old male who had been experiencing nasal obstruction and loss of sense of smell for the previous 2 years. The lump was successfully removed without any postoperative complications.

Vestibular Schwannoma in a paediatric case-A rare entity

Neurilemmoma, also known as Schwannoma, is a benign, slow-growing, encapsulated neoplasm that arises from Schwann cells of the peripheral nerve sheath. Although it is extremely rare, it affects the head and neck region in roughly 25-45% of all cases. Intraorally, the tongue is the most common site and is rarely involves vestibular mucosa. Here, we report a rare case of Schwannoma of vestibular mucosa in a 13-year-old girl and contribute a review to the current literature. Clinically, based on age, site, and appearance, a diagnosis of a benign tumour such as lipoma, fibroma, neurofibroma, and benign lesions of salivary glands was made. An excisional biopsy showed solely Antoni type A tissue with central acellular eosinophilic Verocay bodies surrounded by spindle-shaped neurilemma cells arranged compactly with wavy, twisted nuclei arranged in a palisaded manner. The patient was recurrence-free after 6 months. Hence, this case is of interest due to its rarity in terms of age, site, and histopathology (Antoni type A neurilemmoma) for a presumed initial diagnosis. Here, we also hypothesize regarding the type of growth pattern in the earlier diagnosed cases.

A Rare Case of Schwannoma of the Right Greater Palatine Nerve in a 17-Year-Old Female Patient

Schwannomas are not uncommon in the maxillofacial region; however, those with intraoral localization and, in particular, the hard palate are among the least frequently described. In the current case report, we present a 17-year-old girl with a histologically verified schwannoma of the hard palate on the right, originating from the right greater palatine nerve. In her case, despite the lysis of the palatine bone from the tumor compression, the disease is asymptomatic, causing only a weak sensation of local discomfort. The lesion was removed surgically under general anesthesia and the resulting defect of the palatal mucosa was compensated by plastic reconstruction with a lingual mucosal flap on a posterior feeding base. The recovery period was uneventful.

Oral palisaded encapsulated neuroma; a diagnosis seldom suspected clinically

Key Clinical Message

Palisaded encapsulated neuroma (PEN) is generally seen in the head and neck area as an asymptomatic nodule with the same color as the surrounding skin and rarely occurs in the oral cavity. The exact etiology of PEN is not known, but there is evidence supporting the role of trauma as its etiological factor.

Abstract

Palisaded encapsulated neuroma (PEN) is one of the benign nerve sheath tumors of Schwann cell origin, which is commonly found in the skin of the head and neck area, and rarely occurs in the oral cavity. Its exact etiology is unknown, but there is evidence that supports the role of trauma as an etiological factor. Here we present a case of PEN in the hard palate of a 30-year-old patient and review the differential diagnoses of these nerve sheath tumors of the oral cavity.

Laryngeal Schwannoma Triggered Life-threatening Acute Airway Obstruction- A Rare Case Report with Review of Literature

Schwannoma in larynx is a rare presentaion. Laryngeal schwannomas are characterstically slow growing benign tumour usually arising from false cord and aryepiglottic fold with globus sensation being the most common presentation. Seldom it can present as stridor which need immediate intervention for survival of the patient. We present a case of 53 year female who presented with stridor at emergency and emergency tracheostomy was done. This patient had a history of dysphagia to solid food, hoarseness of voice and symptoms of aspirations. 70 degree rigid endoscopy and CEMRI of neck was performed to see the extent of the laryngeal lesion causing stridor. Tumor was excised completely by external transcervical approach. Histopathological reports suggested this tumor as schwannoma. Large obstructive laryngeal schwannoma though a unusual presentation but with immediate tracheostomy, proper diagnostic work up and precise surgical approach can give excellent recovery and post operative outcome for the patient.

Small biopsies in the head and neck: Bone and soft tissue

Bone and soft tissue lesions in the head and neck encompass not only a broad morphologic spectrum but also significant inherent clinicopathologic overlap. Epidemiology, radiology, and location - similar to the diagnostic assessment in other sites - are especially important considerations in the context of an established mesenchymal proliferation. Herein, the approach towards diagnosis is stratified by morphology (spindle, sarcomatoid, epithelioid, round cell), cellular lineage (fibroblastic, nerve sheath, rhabdomyogenic), and tumor grade (benign, low- to high-grade malignant) as the basis of further immunohistochemical or molecular investigation.

Top 10 Significant Spindled Head and Neck Lesions to Scrutinze

BACKGROUND

Spindled lesions are a challenging area in head and neck pathology. This is particularly true in the sinonasal tract, where several uncommon entities with both unique and overlapping morphologic, immunophenotypic, and/or molecular features can occur.

METHODS

Review.

RESULTS

The clinicopathologic characteristics of biphenotypic sinonasal sarcoma and nine important differential diagnostic considerations with one or more overlapping feature are summarized to establish a practical framework for approaching spindled lesions of the sinonasal tract.

CONCLUSION

Morphologic evaluation is central to the work up of sinonasal spindle cell lesions-in particular, cellular morphology, tumor architecture and growth pattern, and the presence of admixed epithelial elements - however, focused immunohistochemical analysis of neural, myogenic, rhabdomyoblastic, epithelial, and/or melanocytic marker expression and/or ancillary tests for tumor-specific molecular alterations may be necessary for definitive diagnosis.

Ga-68 DOTATATE PET/CT in the Evaluation of Paragangliomas and Other Indeterminate Lesions in the Head and Neck

Background and Purpose

Paragangliomas (PGLs) are rare neuroendocrine tumors with imaging features that can overlap with other entities. This study hypothesizes that given overexpression of somatostatin receptor (SSTR) 2, PGLs can be differentiated on Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT) from other benign or malignant lesions.

Materials and Methods

Ninety-six patients with known tumors of the head and neck who underwent Ga-68 DOTATATE PET/CT from May 2017 to December 2021 were retrospectively reviewed from a single institution. Of these, 43 patients had histopathological confirmation and 66 positive lesions were discovered on PET/CT. For each lesion, the SUV max, the SUV lesion to liver ratio, and the SUV lesion to spleen ratio were analyzed.

Results

PGLs (n = 37) showed the most intense uptake, and the mean of SUVmax was 69.3 (range 3.7-225.9). Metastatic PGL and metastasis from other neuroendocrine tumors (n = 13) demonstrated intermediate uptake, the mean of SUVmax was 15.16 (range 2.3-40.3). Meningiomas (n = 3) had intermediate uptake, and the mean of SUVmax was 12.37 (range 2.5-19.4). One patient with esthesioneuroblastoma had 5 lesions in the head and neck, and the mean of SUVmax was 18.9 (range 6.9-49.4). Schwannomas (n = 4) had very low uptake, and the mean of SUVmax was 1.75 (range 1.1-2.2). Other rare cases with low uptake included 1 each of osteosarcoma, acinic cell carcinoma, ectopic thyroid tissue, and plasmacytoma, and the mean of SUVmax was 4.75 (range 2.3-6.1).

Conclusions

Ga-68 DOTATATE PET/CT can be a useful adjunct in differentiating tumors in the head and neck. PGLs demonstrate the highest uptake. Meningioma, esthesioneuroblastoma, and neuroendocrine tumor metastasis have intermediate uptake. Schwannomas and other rare tumors exhibit low uptake.

High CT Attenuation Values Relative to the Brainstem Predict Fungal Hyphae Within the Sinus

Objectives

There is currently no established objective diagnostic indicator for the differentiation of sinus fungal ball (SFB) from unilateral nonfungal chronic sinusitis (UCRS). This study evaluated whether computed tomography (CT) attenuation values relative to those of the brainstem (relative CT number) are useful for differentiating SFB from UCRS.

Materials and Methods

Consecutive patients who were pathologically diagnosed with SFB or UCRS between 2013 and 2021 were retrospectively identified. The relative CT numbers of region of interest (ROIs) within the sinuses were compared between the two patient groups. Factors with predictive power for differentiating SFBs from UCRSs were identified by uni/multivariable logistic regression analyses.

Results

One hundred and eighty-three patients with unilateral chronic sinusitis were finally analyzed (SFB, 86 cases; UCRS, 97 cases). Regardless of the presence or absence of calcified lesions, the relative CT numbers in SFB were significantly higher than those in UCRS. ROIs showing high relative CT numbers were those where fungal hyphae were present. In the uni/multivariable logistic regression analysis, age (p < 0.001), relative CT number (p < 0.001), and calcification (p = 0.002) had predictive value for distinguishing SFB from UCRS. Within those cases not showing calcification, age (p = 0.004) and relative CT number (p < 0.001) were predictive factors for differentiating SFB from UCRS. A relative CT number >1.5 was significantly associated with SFB (sensitivity, 70%; specificity, 91%), with a significantly larger area under the receiver operating characteristics curve than age.

Conclusions

High relative CT numbers within the sinus are strongly associated with the presence of fungal hyphae, and measurement of relative CT number is a powerful adjunctive diagnostic method for distinguishing between SFB and UCRS.

A Predictable Approach of a Rare and Frequently Misdiagnosed Entity: Laryngeal Nerve Schwannoma

(1) Background: Schwannoma, a mesenchymal neoplasm derived from Schwann cells that line peripheral nerve sheaths, has a challenging diagnosis, due to the non-specific medical history and clinical examination. Nowadays, virtual reality (VR) is increasingly more used for enhancing diagnosis and for preoperative planning of surgical procedures. With VR, the surgeon can interact, before any surgery, with a virtual environment that is completely generated by a computer, offering them a real experience inside a virtual 3D model. (2) Methods and Results: The aim of the present paper was to present a case of surgically removal of a schwannoma, which originated from the fibers of the superior laryngeal nerve, in a predictable and minimally invasive fashion, upon using VR for diagnosis and surgical procedure planning. (3) Conclusions: The current clinical report attracted the attention of including schwannoma in the possible differential diagnosis of a swelling in the anterior cervical region, mainly when a nonspecific radiological appearance is noticed, even with the use of multiple imaging modalities. Virtual reality can increase the predictability and success rate of the surgical procedure, being in the meantime a good tool for communication with the patient.

Update on MR Imaging of Soft Tissue Tumors of Head and Neck

This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.

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.

Retrospective analysis of schwannoma in the oral and maxillofacial region: clinicopathological characteristics and specific pathology of ancient change

Schwannomas are benign tumours that originate from the Schwann cells of the nerve. Despite the frequency of their occurrence in the head and neck, data relating to their clinicopathological features in the region are limited. This study reviews the clinicopathological characteristics and specific pathology of ancient (degenerative) change in 40 cases in the oral and maxillofacial region. Medical records were reviewed of the 40 cases treated at Tokyo Medical and Dental University Hospital Faculty of Dentistry between 2000 and 2020. The most frequently involved site was the tongue, and the average tumour size was 13.2 mm. Degenerative changes were observed in eight cases. All tumours were completely excised through biopsy or local excision, and no recurrence was observed on clinical follow up. Statistical analyses revealed significant associations (p < 0.05) between ancient change and tumour size, and between ancient change and the apparent diffusion coefficient (ADC) value derived from diffusion-weighted magnetic resonance imaging (MRI). Analysis suggests that schwannoma progresses over a long period and subsequently undergoes secondary ancient changes. Pathological events such as cystic formation and haemorrhage that are associated with ancient changes, cause hypocellularity and lead to high ADC values. These values may indicate ancient change and should be considered when distinguishing schwannoma from other lesions.

High CT values relative to the brainstem differentiate inverted papillomas from nasal polyps

OBJECTIVES

A diagnostic indicator for the differentiation of inverted papillomas (IPs) from inflammatory nasal polyps (NPs) has not been established. This study aimed to evaluate whether CT attenuation values relative to those of the brainstem (relative CT number) could be useful for differentiating IPs from NPs.

MATERIAL AND METHODS

Consecutive patients who were pathologically diagnosed with IP or NP between 2005 and 2019 were retrospectively identified. Relative CT numbers were compared between the two patient groups. The factors with predictive power for differentiating IPs from NPs were identified by univariate and multivariate logistic regression analyses.

RESULTS

One hundred and twenty-two sinonasal masses were finally analysed (IP, 51 cases; NP, 71 cases). Relative CT numbers were significantly higher in IP than in NP (P < 0.001). Univariate logistic regression analysis showed relative CT number, bone erosion and bone thickening to have predictive value for differentiating IPs from NPs (relative CT number, P < 0.001; bone erosion, p = 0.04; bone thickening, P < 0.001). In the multivariate logistic regression analysis, relative CT number and bone thickening had predictive value for distinguishing IP from NP (relative CT number, p < 0.001; bone thickening, p = 0.02). The optimum cut off value calculation from the area under the receiver operating characteristics curve indicated that a relative CT number >1.3 was significantly associated with IP (sensitivity, 72.6%; specificity, 87.3%). Within cases not showing bone thickening, only the relative CT number was a predictive factor for differentiating IPs from NPs in the univariate analysis.

CONCLUSIONS

High relative CT numbers could potentially indicate IP, and their measurement could provide a basis for differentiating IPs from NPs.

Soft palate resection and secondary healing not to impair the velopharyngeal function? - Diagnosis and treatment of an intraoral schwannoma: A case report

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Schwannomas are benign nerve sheath tumors and mostly occur (25–45%) in the head and neck.

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1–12% of schwannomas affect the intraoral area, most frequently the tongue or mouth floor followed by palate, gingiva, vestibule and lips.

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The cure requires full surgical excision with clear margins to prevent a recurrence and malignant transformation, which is considered rare.

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Resection of soft palate tumors can make reconstruction necessary to obtain velopharyngeal function.

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To strive full regeneration and function of the velopharyngeal apparatus, in mucosal and even muscle defects of the soft palate, secondary healing can be the option of choice.

Introduction

Schwannomas are benign lesions arising from the nerve sheath, commonly located in the head and neck. Intraoral schwannomas mostly occur in tongue and lips and are rarely located in the soft palate.

Presentation of case

We describe the diagnostic assessment and treatment of 18-year old male presenting with an intraoral mass on the soft palate.

Discussion

The treatment of choice in peripheral nerve sheath tumors is conservative resection and due to location and impairment, reconstruction. Secondary healing of soft palate defects is rarely described in the literature.

Conclusion

With this case report, we demonstrate the feasibility of secondary healing after resection of a 3,0 × 1,9 × 2,1 cm schwannoma in the soft palate, resulting in no postoperative impairments, especially due to velopharyngeal function in a follow-up period of 2 months.

PD-1/PD-L1 negative schwannoma mimicking obstructive bronchial malignancy: A case report

Schwannomas are homogeneous tumors of schwann cells and occur at peripheral and cranial nerves on the upper limbs, the head and neck area. Rarely, a bronchial schwannoma may appear in the lung and be misdiagnosed as lung neoplasms. Here, we report a 56‐year old woman with a 5.8 × 7.0 × 2.8 cm lesion in her right upper lobe bronchus. The lesion had a maximum standardized uptake value (SUV_max) of 8.5 by 18‐fluorodeoxyglucose positron emission tomography (FDG‐PET). Bronchoscopy showed a mass obstructing the bronchus that bled easily. Despite repeated biopsies, a lung malignancy could not be excluded, and surgical resection was subsequently performed. Pathological examination demonstrated a primary bronchial schwannoma that was positive for molecular markers S‐100 and SOX‐10, negative for immune checkpoint marker PD‐1/PD‐L1 but also demonstrated certain uncommon pathological features. This case highlights the heterogeneity of bronchial masses and the diagnostic challenge for differentiating benign and malignant tumors in the thorax.

Key points

Rare bronchial schwannoma mimics lung malignancy and poses a diagnostic challenge.

This case of bronchial schwannoma, unlike peripheral schwannoma, lacks PD‐L1. Pathological features indicate autonomic nerve origin for pulmonary schwannomas.

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.

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.

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.

Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review

Objective

This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy.

Data Sources

PubMed, Google Scholar, Cochrane, and SCOPUS.

Review Methods

Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied.

Results

The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes.

Conclusions

Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.

Dysphagia caused by giant schwannoma of the supraglottic oropharynx: A case report and review of the literature

Background

Schwannomas are benign, encapsulated, peripheral nerve tumours that arise from the Schwann cell. Approximately 25%–45% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck. However, schwannoma of the supraglottic oropharynx is rare.

Case presentation

We report on a 35-year-old female who complained of progressive dysphagia, from whom a large schwannoma in the supraglottic oropharynx was excised through a transoral approach. No recurrence was seen after one year follow-up.

Conclusion

Although rare, schwannomas do occasionally occur in the supraglottic oropharynx. When dysphagia is present, a thorough diagnostic procedure should be performed to evaluate the morphology and function of the upper aerodigestive tract. MRI is sensitive and specific in the diagnosis of schwannoma. And the best treatment of choice is complete excision with preservation of functions.

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Schwannoma is a benign peripheral nerve tumor that usually presents as a slow growing single lesion.

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Giant schwannoma of the supraglottic oropharynx is rare.

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The main symptom is dysphagia due to the location and mass of the tumor.

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MRI is particularly helpful in delineating schwannoma.

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Surgery is the treatment of choice.

Angioleiomyoma (Vascular Leiomyoma) of the Oral Cavity

A 70-year-old male presented with a slow growing, dome shaped and painless mass of the hard palate. The mass was excised. Histopathological examination confirmed the diagnosis of a angioleiomyoma (vascular leiomyoma). A leiomyoma is an uncommon benign tumor of smooth muscle differentiation. True leiomyomas of the oral cavity are rare and most oral tumors are derived from the smooth muscle of walls of blood vessels. Therefore, they are called vascular leiomyomas or angioleiomyomas. Clinically, they may resemble a myriad other conditions both benign and malignant. A definitive diagnosis depends upon histopathological examination of the biopsied tissue in correlation with the tumor cell immunohistochemistry. Tumors are excised and recurrence is rare. The histopathological findings and differential diagnosis of a case of a palatal angioleiomyoma are discussed.

Sinonasal Schwannoma - A Case Report

Schwannomas are benign peripheral nerve sheath tumours that may occur throughout the body. They rarely occur in the nasal cavity. Paranasal schawannomas are uncommon lesions, representing less than 4% of all head and neck schawannomas. Here we report a case of sinonasal schwannoma in a 35-year-old man who presented with a history of nasal blockage since two years. The mass was removed successfully without any postoperative complication and there was no recurrence within a year of follow up.

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.

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.

Volumetric Growth of Cervical Schwannoma as a Predictor of Surgical Intervention

Objective

Cervical schwannomas are benign tumors that commonly present as asymptomatic masses and are managed with observation, radiation, or surgery. To our knowledge, the rate of volumetric change seen on serial imaging is not currently used to determine surgical candidacy. We assess average growth rates and determine whether growth rate of cervical schwannoma predicts having undergone surgery.

Study Design

Case series with chart review.

Setting

Quaternary academic medical center.

Subjects and Methods

Patients were identified with at least 2 imaging studies and pathologic or imaging characteristics of cervical schwannoma. Volume was calculated with the formula 4/3π xyz, with x, y, and z representing the 3 orthogonal dimensions. Volume and rate of volume change were compared among observed, surgical, and gamma knife groups.

Results

Thirteen patients were identified and divided into subgroups: surgical (n = 5), observation (n = 6), and gamma knife (n = 2). Mean follow-up time was 21 months (range, 1-80 months) and not significantly different among subgroups. The average changes in volume were 3.61 cm3/mo (entire group), –2.75 cm3/mo (observation), 11.97 cm3/mo (surgery), and 1.78 cm3/mo (gamma knife). Average initial volume for the entire group was 124.4 cm3 (range, 5-608 cm3) and 142 cm3 (range 5-613) at follow-up. The surgical group had a statistically significant change in volume ( P = .03). A statistically significant difference in growth rate was seen between the surgical and observation groups ( P = .016) and between the surgical group and all nonsurgical patients ( P = .011).

Conclusions

Rate of tumor growth can be used in the evaluation of patients with cervical schwannoma, and it may predict surgical intervention.