Diagnostic challenges of an unusually large schwannoma of the mandible: Report of a case

A Case Report with Current Updates and Immunohistochemistry Features of Intraosseous Schwannoma

Schwannomas are benign peripheral nerve sheath neoplasms that grow slowly and arise from Schwann cells. Here we report a case of an intraosseous schwannoma, with recent updates of molecular characterization and immunohistochemical data, affecting the left mandibular ramus featuring multilocular well-defined radiolucency making it difficult to diagnose.

Intraosseous schwannoma of the mandible: new case series, literature update, and proposal of a classification

Intraosseous schwannoma of the mandible is rare, with diagnostic and therapeutic challenges. The aims of this study were to report new cases of intraosseous schwannoma of the mandible and to propose a clinical classification, providing suggestions for treatment methods. The cases of 13 patients treated at the authors' hospital and 86 cases reported previously in the literature were reviewed. The most common clinical feature was facial swelling (60/93). The rate of cortical thinning or expansion was 44.8% (43/96); widening of the inferior alveolar nerve canal on radiographs was observed in 15 patients.

Gnathic Schwannomas: A Report of Two Cases and Systematic Review of the Literature

BACKGROUND

The intraosseous schwannoma (IS) is a benign peripheral nerve sheath tumor postulated to arise de novo or from nerve fibers in preexisting nutrient canals. ISs are uncommon and comprise less than 1% of neoplasms originating in bone. We herein present two cases of mandibular schwannomas-the first case was a 66-year-old female with a four-month history of pain and pressure associated with an anterior mandibular radiolucency, and the second case was an asymptomatic 12-year-old female with separate radiolucencies of her mandibular symphysis and right posterior mandible. Incisional biopsies of all three lesions showed a benign spindle cell neoplasm with histologic features of a schwannoma; the tumor cells were strongly reactive for S-100. The patients underwent complete enucleation of their lesions and are without evidence of disease at ten months and five years, respectively.

METHODS

A systematic review was undertaken to evaluate the diagnostic features, treatment, and patient outcomes of gnathic schwannomas.

RESULTS

A total of 93 cases were identified with the following demographic findings: predominance in females (57%); average age of occurrence of 37.3 years (8 to 77 years); mean size of 3.6 cm; and involvement of the mandibular body (37.6%), mandibular body and ramus (18.3%), and anterior mandible (18.3%). The predominant clinical sign was swelling (69.9%), and the most common radiographic presentation was a radiolucency (94.6%) with well-defined borders (72%).

CONCLUSION

All cases were treated surgically, with an average follow-up interval of 22.9 months and a recurrence rate of 5.4.