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

A rare case of upper lip schwannoma: A case report with analysis of the histological, immunohistochemical and pathogenesis aspects

INTRODUCTION AND IMPORTANCE

Schwannoma, a benign tumor originating from Schwann cells, is a rare case found intraorally. The tongue, palate and buccal mucosa are the most common sites of intraoral Schwannoma while it is very rarely found on the lips. Previous studies reported only twelve cases of Schwannoma on the upper lip. The etiology of Schwannoma is unknown, but in some literature, Schwannoma occurs due to a defect in the NF2 gene. Management of Schwannoma is excision of the capsule. The prognosis is good, and the recurrency is low. This article reports a rare case of upper lip Schwannoma in adolescent and its management with its histological, immunohistochemical and pathogenesis aspects.

CASE PRESENTATION

A 16-years old female presented a painless, semi-solid, mobile lump on the upper lip measuring of approximately 1.5 × 3 cm that had similar color with the surrounding tissue. The lump appeared 7 years ago.

CLINICAL DISCUSSION

Excision of the capsule and margins of the tumor. Histopathological examination showed a unique feature of Schwannoma, the Verocay bodies. Subsequent immunohistochemical examination of S100 protein showed a classic type of Schwannoma.

CONCLUSION

Upper lip schwannoma is a very rare tumor, and this type of tumor cannot be distinguished from other benign soft tissue tumors based on clinical findings. Immunohistochemical results are in accordance with the Histopathological results for the final diagnosis of Schwannoma. Schwannoma can be used as a differential diagnosis in cases of lumps on the lips with sessile, similar color like surrounding tissue, painless, and movable features.

Lymphangioma of the Lower Lip-A Diagnostic Dilemma: Report of a Rare Case with a Brief Literature Review

Hamartomas are tumor-like deformities typified by cellular propagation indigenous to the original site, although they display growth arrest without the possibility for further growth. Various hamartomatous oral lesions include hemangiomas, lymphangiomas, nevi, odontomas, Cherubism, etc. Lymphangiomas are benign, developmental hamartomatous entities typified by abnormal proliferation of lymphatic vessels. They are usually congenital, and more than 90% of cases occur by 2 years of age, with a rare occurrence in adults. They have a site affinity for the head and neck, and oral lesions are relatively uncommon. The dorsum of the tongue is the commonest oral site of predilection; however, the lip is a rare site of involvement. Hereby, we present an uncommon case of lymphangioma of the lower lip in a 45-year-old male patient, who reported to our hospital with an asymptomatic lower lip submucosal mass present for the last 3 years. Our case is unique as it occurred on the lower lip of a 45-year-old male. A detailed history and clinical evaluation, ultrasonography, and histopathology confirmed the diagnosis of lymphangioma.

Unusual Lower Lip Swelling: A Rare Case of Lip Schwannoma

Schwannoma (neurilemmoma) is a benign neoplasm that arises from the nerve sheath's Schwann cells. Between 25% and 40% of all schwannomas are discovered in the soft tissues of the head and neck area, but they are infrequently detected in the oral cavity, with the lips being the most unusual site of involvement. Peripheral nerves in the intraoral cavity originate only 1% of schwannomas despite the fact that lips and oral cavity are heavily innervated anatomical areas. Schwannomas are more common in people between the third and fifth decades of life, and there is no predilection based on gender or race. Here, we report a case of lip schwannomas in a 22-year-old female. The lesion was affecting her lower lip and growing steadily for the past two years. The mass measured 1.5 x 1 cm, involving the lower lip with surface telangiectasia. The patient underwent surgical removal of the lower lip mass, and the mass was sent for histopathological correlation that showed completely excised encapsulated schwannoma with free margins. The patient did not have any postoperative complications and was discharged home on the same day. The patient was followed up in the outpatient clinics, and she made full recovery and was pleased with the outcome.

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.

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.

Lower Lip Plexiform Schwannoma: Report of a Rare Case and a Literature Review

Plexiform schwannoma is an uncommon benign neoplasm of the neural sheath characterized grossly and microscopically by multinodular growth. It is typically presented as a mobile, solitary, smooth-surfaced, and nontender mass. Histologically, schwannomas are classified into the following seven types: classical (Verocay), plexiform, cellular, cranial nerve, melanotic, degenerated (ancient), and granular cell schwannomas. In spite of the fact that plexiform schwannoma commonly occurs in the head-and-neck region, the involvement of the lip is considered to be extremely rare. Herein, we present the case of a 16-year-old boy with the schwannoma on the lower lip excised without any recurrence at 9 months after surgery.

Clinical features and management of schwannoma affecting the upper and lower lips

Head and neck schwannomas comprise 25-40% of all schwannomas, with presentation on the lips as the rarest and most surgically complicated site for perioral tumors. A systematic literature review was conducted to include 21 cases of patients with schwannoma of the upper or lower lips. The majority of patients presented with a single, painless, well-encapsulated nodule on the upper or lower lips. The nodules were consistently slow-growing, with an average 29.3 months from symptom onset to clinical presentation. Most cases were complicated by profound cosmetic disfigurement as well as dysphagia, dysarthria, snoring, and/or sleep apnea. Overall, histological analysis was consistent with classic schwannoma, and all cases were treated via complete surgical excision, and for malignant tumors, additional therapy was utilized. All but four cases achieved full remission by final follow-up. Recurrence rate for benign lip schwannomas was 5.3%, which is remarkably different from the standard recurrence rate of 8-24% for benign peripheral schwannomas. Additionally, the proportion of malignant tumors was greater for lip schwannomas than other schwannomas. Lip schwannomas demonstrate different characteristics than schwannomas from other locations on the body, and these remarkable differences highlight significant implications for clinical practice. Complete excision is the primary mode of treatment with overall excellent postoperative prognosis and rare instances of recurrence. Given the rarity of this tumor, this review of available cases serves to comprehensively describe clinical presentation and surgical treatment approaches to upper and lower lip schwannomas.