Schwannoma of the larynx: a case report

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.

Extracranial Head and Neck Schwannomas: Our Experience

Schwannomas are benign neoplasms of the peripheral nerves originating in the Schwann cells. They are rare and usually solitary, with clearly delimited capsules. They occur in the head and neck region in only 25 % of the cases, and may be associated with Von Recklinghausen's disease. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time and histopathology is the gold standard for diagnosis. The present study retrospectively analysed data of 4 patients with schwannomas and reviewed the literature on the subject. Retrospective study at ENT & Head and Neck Surgery Department of Navodaya Medical College, Raichur. Data of 4 patients between 2008 and 2014 were reviewed. The sites of cervical schwannomas and the intraoperative, histopathological and postoperative clinical status of these cases were studied. Diagnostic methods, type of surgery and associated nerve of origin (NOO) were evaluated. The patients' age ranged from 18 to 50 years. None of them had type I neurofibromatosis or Von Recklinghausen's disease. The nerves affected included the brachial plexus, vagus nerve, sympathetic chain and lingual nerve. The nerve of origin was identified based on intra-operative findings and post-operative neurological deficits. Tumour was removed by debulk operation with the preservation of NOO method. Schwannomas are generally benign, and rarely recur. An accurate preoperative workup with the identification of NOO is very important not only for a correct diagnosis, but also for surgical planning and informing the patient about the possible complications.

Trauma-induced schwannoma of the recurrent laryngeal nerve after thyroidectomy

Laryngeal schwannomas are rare, benign tumors, most often arising from the superior laryngeal nerve. We describe a case of a 68-year-old female with a laryngeal schwannoma of the recurrent laryngeal nerve after traumatic injury. We postulate that trauma to the recurrent laryngeal nerve during thyroidectomy or thyroplasty incited growth of a nerve sheath tumor. This is the first reported case of a trauma-induced schwannoma of the recurrent laryngeal nerve and second case of a recurrent laryngeal nerve schwannoma. Although rare, this case demonstrates that these tumors should be considered during workup of vocal cord paresis after surgery or failed thyroplasty. Laryngoscope, 126:1408-1410, 2016.

Schwannoma of the arythenoid

Schwannoma is a benign encapsulated tumor that originates from the Schwann cells lining nerve fibers outside the central nervous system. We report a rare case of schwannoma that arose from the left arythenoid cartilage The patient underwent excision of the mass through microlaryngeal endoscopic procedure. No recurrence was observed during follow-up.

Hidden diagnosis in the subglottic larynx: schwannoma mimicking as bronchial asthma

Schwannomas are rare neurogenic tumors derived from the schwann cells. Their laryngeal location is uncommon and the diagnosis is difficult. We report a case of a 17-year-old female who presented with symptoms of intermittent breathlessness mimicking acute attacks of bronchial asthma and resulted in delayed diagnosis, which lead to upper airway obstruction and an emergency tracheostomy. Computed tomography (CT) of neck revealed a soft-tissue mass within the subglottic region. Surgical excision of the growth was done by laryngofissure technique. Histopathological examination of the tumor revealed it to be a schawanoma. The subglottic occurrence of schwannoma is very rare. Case history and detailed clinical examination are important and will guide for relevant investigations and help to reach at a definitive diagnosis.

Schwannomas in the head and neck: retrospective analysis of 21 patients and review of the literature

CONTEXT AND OBJECTIVE

Schwannomas are benign neoplasms of the peripheral nerves originating in the Schwann cells. According to their cellularity, they can be subdivided into Antoni A or Antoni B types. They are rare and usually solitary, with clearly delimited capsules. They occur in the head and neck region in only 25% of the cases, and may be associated with Von Recklinghausen's disease. The present study retrospectively analyzed some data on this disease in the head and neck region and reviewed the literature on the subject.

DESIGN AND SETTING

Retrospective study at Head and Neck Service, Universidade Estadual de Campinas.

METHODS

Data on 21 patients between 1980 and 2003 were reviewed. The sites of cervical schwannomas and the intraoperative, histopathological and postoperative clinical status of these cases were studied. Diagnostic methods, type of surgery and association with neurofibromatosis were evaluated.

RESULTS

The patients' ages ranged from 16 to 72 years. Four patients had a positive past history of type I neurofibromatosis or Von Recklinghausen's disease. The nerves affected included the brachial and cervical plexuses, vagus nerve, sympathetic chain and lingual or recurrent laryngeal nerve. The nerve of origin was not identified in six cases. Tumor enucleation was performed in 16 patients; the other five required more extensive surgery.

CONCLUSION

Schwannomas and neurofibromas both derive from Schwann cells, but are different entities. They are solitary lesions, except in Von Recklinghausen's disease. They are generally benign, and rarely recur. The recommended surgical treatment is tumor enucleation.

Neurinoma laríngeo: a propósito de un caso

Neuromas or Schwannomas are extremely rare among tumors of the larynx. They are Schwann cell tumors that can be difficult to distinguish from neurofibromas. They present usually as supraglottic masses, since they may arise from the internal branch of the superior laryngeal nerve. Nuclear magnetic resonance imaging is the best diagnostic technique, conferring a high degree of suspicion. We present an exceptional case of a laryngeal neuroma, with a very long evolution, a large tumor volume, dyspnea and vocal cord fixation, with complete resolution through an external approach following surgical removal. The difficulties encountered with its pathological and clinical diagnosis are discussed as well as a review of the literature.

Asphyxial death caused by a laryngeal schwannoma: a case report

Neurogenic tumours of the larynx are unusual, with approximately 115 cases reported in the literature to date. Most of these lesions are benign, solitary submucosal nodules which present with hoarseness and are amenable to surgical resection. We present a case of a large pedunculated schwannoma arising in the aryepiglottic fold associated with sudden asphyxial death in an otherwise healthy young female.