Neurofibroma of the Lingual Nerve: A Case Report

Endoscopic Endonasal Surgery to Resect a Solitary Trigeminal Neurofibroma Involving the Infratemporal Fossa: A Case Report

Trigeminal neurofibromas are rarely reported, and even rarer when involving the infratemporal fossa. We describe the case of a 58-year-old man incidentally found through magnetic resonance imaging to have a tumor situated mainly in the infratemporal fossa. The tumor derived from the third branch of the trigeminal nerve and was totally removed by endoscopic endonasal surgery. Final pathology confirmed a diagnosis of neurofibroma. The patient had no intraoperative or postoperative complications except for numbness of the face. During the 6 years of follow-up, there has been no tumor progress or recurrence. We consider that endoscopic endonasal surgery is feasible in treating trigeminal neurofibromas involving the infratemporal fossa.

Subchronic toxicity and genotoxicity studies of Hericium erinaceus β-glucan extract preparation

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β-Glucan from Hericium erinaceus was investigated for subchronic toxicity and mutagenicity.

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In the subchronic study, The No-Observed-Adverse-Effect Level (NOAEL) for Hericium erinaceus β-glucan was 2000 mg/kg bw/day.

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In mutagenicity studies, Hericium erinaceus β-glucan did not reveal genotoxic effects.

The medicinal effects of Hericium erinaceus have been long documented in scientific studies of Eastern traditional medicine. It is widely consumed, because of its nutritional qualities and perceived health benefits. Also, it is rich in β-glucans, which has been shown to have immunomodulating and antitumor effects. The objective of the present study was to investigate adverse effects, if any, of β-glucan extract preparation from H. erinaceus in subchronic toxicity and genotoxicity studies. The conduct of these studies was in compliance with Good Laboratory Practice (GLP) and test guidelines established by the Organization for Economic Cooperation and Development (OECD). In the subchronic toxicity study, Sprague Dawley rats (12/sex/group) were administered (gavage) H. erinaceus β-glucan extract preparation at dose levels of 0, 500, 1000 and 2000 mg/kg body weight (bw)/day for 90 days. Treatment with H. erinaceus β-glucan extract preparation did not result in any toxicologically significant treatment-related changes in clinical observations, ophthalmic examinations, body weights, body weight gains, feed consumption, and organ weights. Clinical pathology including hematology, serum chemistry, urinalysisand terminal necropsy (gross or histopathology findings) did not reveal any treatment-related adverse effects. The results of genotoxicity studies as evaluated by gene mutations in Salmonella typhimurium, in vitro chromosome aberrations and in vivo micronucleus test in mice did not reveal any genotoxicity of H. erinaceus β-glucan extract preparation. Based on the subchronic study, the no observed-adverse-effect level (NOAEL) for H. erinaceus β-glucan extract preparation was determined as 2000 mg/kg bw/day, the highest dose tested.

Unusual presentation of submandibular lingual nerve sheath tumour as sublingual stone

A 60-year-old woman was referred to the otolaryngologist for 18 months of left-sided tongue pain and taste changes. Surgeon-performed ultrasound of the submandibular region revealed a hyperechoic mass. Wharton's duct was dilated proximally and the submandibular gland demonstrated normal vascularity. While these findings were highly suspicious for submandibular gland sialolith, an in-office attempt at sialolithotomy suggested an alternate process or mass. After imaging failed to further elucidate an aetiology, surgical exploration revealed a well-circumscribed submandibular mass associated with the lingual nerve. The mass was removed en-bloc and pathology revealed a schwannoma of the lingual nerve.

Solitary neurofibroma of the floor of the mouth: rare localization at lingual nerve with intraoral excision

Background

Neurofibromas (NF) are benign tumors of the peripheral nerves that are composed of Schwann cells, perineural-like cells and fibroblasts. The differential diagnosis for a solitary intraneural variant of neurofibroma arising in the floor of the mouth is broad and includes a submandibular gland neoplasm and adenopathy, among others. The intraoral approach is the best choice for a medium-sized lesion.

Case presentation

We report a rare case of a solitary neurofibroma of the floor of the mouth in a 31-year-old male. The patient consulted the dental emergency department for acute pain of the left mandible. Systematic clinical examination revealed the presence of a mass in the left mouth floor. The panoramic x-ray was not conclusive and the magnetic resonance imaging (MRI) revealed a well-defined soft tissue lesion with homogenous isosignal intensity on the T1-weighted image, high intensity signal on the T2-weighted image and heterogeneous enhancement following contrast-enhancement on the T1-weighted Fast Sat image. The surgical excision of the soft-tissue neoplasm was accomplished by an intraoral approach. The specimen was sent for histopathologic analysis and Immunohistochemical studies which confirmed the diagnosis of a myxoid predominant intraneural solitary neurofibroma.

Conclusion

The diagnosis of neurofibroma was confirmed by histopathological evaluation and immunohistochemical studies which also excluded other entities in the histopathologic differential diagnosis including schwannoma and a malignant peripheral nerve sheath tumor among other. Localized (solitary) neurofibromas most often occur as sporadic lesions, however; diagnosis of a solitary neurofibroma prompts clinical evaluation to exclude the remote possibility of neurofibromatosis. The purpose of this case report is to raise awareness of the uncommon presentation of neurofibroma and to document the successful management of such a lesion using an intraoral approach.

Comparative transcriptome analysis reveals the genetic basis underlying the biosynthesis of polysaccharides in Hericium erinaceus

BACKGROUND

Hericium erinaceus, also known as lion's mane mushroom, is a widely distributed edible and medicinal fungus in Asian countries. H. erinaceus harbors diverse bioactive metabolites with anticancer, immunomodulating, anti-inflammatory, antimicrobial, antihypertensive, antidiabetic and neuroprotective properties. Although the chemical synthesis processes of these bioactive metabolites are known, the biosynthetic processes remain unknown.

RESULTS

In this study, we obtained the transcriptomes of six H. erinaceus strains using next-generation RNA sequencing and investigated the characteristics of the transcriptomes and biosynthesis of bioactive compounds, especially polysaccharides. The transcriptomes ranged in size from 46.58 to 58.14 Mb, with the number of unigenes ranging from 20,902 to 37,259 across the six H. erinaceus strains. Approximately 60% of the unigenes were successfully annotated by comparing sequences against different databases, including the nonredundant (NR), Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), clusters of orthologous groups for eukaryotic complete genomes (KOG) and Swiss-Prot databases. Most of the transcripts were putatively involved in signal transduction, carbohydrate metabolism, translation, transport and catabolism, and amino acid metabolism. Genes involved in polysaccharide biosynthesis were identified, and these genes encoded phosphoglucomutase (PGM), glucose phosphate isomerase (PGI), UDP-glucose pyrophosphorylase (UGP), glycoside hydrolase family proteins, glycosyltransferase family proteins and other proteins. Moreover, the putative pathway for the intracellular polysaccharide biosynthesis of H. erinaceus was analyzed. Additionally, the open reading frames (ORFs) and simple sequence repeats (SSRs) were predicted from the transcriptome data of the six strains.

CONCLUSIONS

Overall, the present study may facilitate the discovery of polysaccharide biosynthesis processes in H. erinaceus and provide useful information for exploring the secondary metabolites in other members of the Basidiomycetes genus.

Trigeminal neurofibroma in the infratemporal fossa arising from the inferior alveolar nerve: A case report

Solitary neurofibromas arising from cranial nerves are rare, and those arising from the peripheral divisions of the trigeminal nerve are even rarer. Although infratemporal fossa (ITF) masses are challenging to remove, certain approaches are considered feasible for this region. The present study reports a rare case of an ITF neurofibroma arising from the inferior alveolar nerve. The 27-year-old male patient presented with numbness of the right jaw. A radiological examination revealed a large mass occupying the ITF, from the mandible to the foramen ovale, originating from the inferior alveolar nerve in the mandible. The tumor was successfully excised via a transtemporal approach followed by a transoral-retromolar approach. A histological examination confirmed the diagnosis of neurofibroma. The present case demonstrates that a combination of the transtemporal and transoral-retromolar approaches may provide wide access to the ITF region.

Neurofibromas of the Oral Cavity: Clinical Aspects, Treatment, and Outcome

OBJECTIVE

This study aimed to evaluate the efficacy of diode laser for the surgical treatment of neurofibromas (NF), in terms of clinical outcome and therapeutic success.

BACKGROUND DATA

The NF is a benign tumor of the peripheral nerve sheath, characterized by the proliferation of Schwann cells, perineural cells, and endoneural fibroblasts. NF may occur as a solitary lesion, or as part of a generalized neurofibromatosis syndrome; much more rarely it occurs in the form of multiple neurofibromas with no associated syndrome. Two distinct variants of neurofibromatosis have been described: types I and II.

METHODS

Ten cases are reported (6 women and 4 men, age range 43-70 years) with smooth, painful, or painless lesions of the oral mucosa. Lesions were completely excised using a diode laser at 980 nm wavelength, average power 2.0 W, in continuous wave mode, with 320 μm optical fibers, for 45 sec average time.

RESULTS

Complete healing occurred within 20 days. There were no adverse effects; patients were carefully followed up and there have been no recurrences after an interval of 3 months to 3 years.

CONCLUSIONS

The results of this diode laser treatment of NF demonstrate good effectiveness of this novel therapy, which may replace conventional surgical procedures.

Effects of amycenone on serum levels of tumor necrosis factor-α, interleukin-10, and depression-like behavior in mice after lipopolysaccharide administration

Accumulating evidence suggests that inflammation plays a role in the pathophysiology of depression and that anti-inflammatory substances have antidepressant effects. Amycenone is obtained from extracts of the Yamabushitake (Hericium erinaceum). The purpose of this study is to examine whether amycenone shows anti-inflammatory and antidepressant effects in an inflammation-induced mouse model of depression. First, we examined the effects of amycenone on the serum levels of the pro-inflammatory cytokine, tumor necrosis factor-α (TNF-α), and the anti-inflammatory cytokine, interleukin-10 (IL-10), after intraperitoneal administration of the bacterial endotoxin lipopolysaccharide (LPS). Oral administration of amycenone (50, 100, or 200mg/kg) markedly blocked an increase in the serum TNF-α levels after a single administration of LPS (0.5mg/kg). Furthermore, amycenone (200mg/kg) markedly increased the serum IL-10 levels by a single administration of LPS (0.5mg/kg). Next, we examined the effects of amycenone on depression-like behaviors in the tail-suspension test (TST) and forced swimming test (FST). Pretreatment with amycenone (200mg/kg) significantly attenuated LPS (0.5mg/kg)-induced increase of the immobility time by the TST and FST, indicating antidepressant effects of amycenone. In addition, oral administration of paroxetine (30mg/kg) showed anti-inflammatory and antidepressant effects in the same model. These findings suggest that amycenone has antidepressant effects in LPS-induced inflammation model of depression. Therefore, amycenone could represent a potential supplement to prevent inflammation-related depression.

Lingual neurofibroma causing dysaesthesia of the tongue

Neurofibroma is a benign tumour derived from the neural sheaths of peripheral nerves and composed of Schwann cells, fibroblast-like cells and intermediate cells. The usual clinical presentation of an oral neurofibroma is swelling. A 62-year-old woman was referred to our department of otorhinolaryngology with irritation and dysaesthesia of the lateral aspect of the tongue. The only finding was a slightly red area from which a biopsy was taken. The macroscopic findings observed by the surgeon were consistent with normal tongue tissue. The histopathological examination showed a small, rounded tumour closely approximated to an invagination of the surface epithelium and with a small lymphatic infiltrate. The tumour was a neurofibroma. A Schwannoma type B was considered but the presence of small nerves and positive neurofilament reaction favoured a neurofibroma. The patient had no other neurofibromas or skin lesions. At a 3-week follow-up visit all symptoms had resolved.

Neurofibroma in the left mandible: a case report

We report a rare case of isolated neurofibroma arising in the left mandible without family history of neurofibromatosis type 1. The tumor was histopathologically analyzed and an immunohistochemical panel comprising S-100 protein was performed. Vim, HMB45, and HHF35 were negative. The tumor cells were fusiform in shape, arranged in a plexiform manner, and grew actively. Features typical of neurofibroma, including an enlarged nerve fascicle composed of elongated nuclei and scant cytoplasmic cells, were identified. Our study suggest that neurofibroma can occur in the jaw as an isolated benign tumor in patients without other features of neurofibromatosis type 1.