1
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Liao JY, Lee HS, Kang BH. Nasal Cavity Schwannoma-A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2024; 103:19-24. [PMID: 34318692 DOI: 10.1177/01455613211034598] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Schwannomas are rare slow-growing benign tumors arising from Schwann cells lining the nerve sheaths. Head and neck schwannomas account for about one-third of all cases, and only 4% of them arise from the sinonasal tract. Its diagnosis is based on histology and immunohistochemistry. Complete surgical excision is the most recommended treatment option, and endoscopic surgery has been widely performed in recent years. In this study, we presented a case of a 55-year-old female with schwannoma arising from the lateral wall of the nasal cavity, causing epistaxis and rhinorrhea. The patient underwent endoscopic excision with prompt resolution of symptoms. The reported cases of nasal cavity schwannoma were reviewed and summarized for educational purposes.
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Affiliation(s)
- Jyun-Yi Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Bor-Hwang Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
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2
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Roy S, Mehta A, Muraleedharan M, Virk RS. Sinonasal schwannoma masquerading as an IgG4-related nasal mass. BMJ Case Rep 2023; 16:e255135. [PMID: 37973538 PMCID: PMC10660653 DOI: 10.1136/bcr-2023-255135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
An elderly (8th decade) diabetic patient presented with insidious, painless protrusion of the right eye for 1 month, associated with nasal congestion. Past history included healed serous chorioretinopathy in the right eye (>30 years back) and recently diagnosed (1 year prior) autoimmune IgG4-related pancreatitis for which he was on long-term corticosteroids. On nasal endoscopic examination, a well circumscribed mass was found in the right nasal cavity.Keeping in mind the systemic diagnosis, the sinonasal mass was suspected to be a IgG4-related disease. An endoscopic biopsy was performed and revealed a surprise diagnosis of grade 1 nasal schwannoma.
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Affiliation(s)
- Shrimoyee Roy
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mehta
- Grewal Eye Institute, Chandigarh, Chandigarh, India
| | - Manjul Muraleedharan
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh Virk
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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3
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Liu Y, Zhao X, Yu D. A Rare Instance of Pterygopalatine Fossa Tumor With Hearing Loss as the Main Complaint. J Craniofac Surg 2023; 34:624-625. [PMID: 35949024 DOI: 10.1097/scs.0000000000008914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Pterygopalatine schwannomas are rare tumors which usually cause the symptoms of the traffic area by the tumors in the pterygopalatine fossa which is difficult to resection. This paper presents 1 rare case of pterygopalatine fossa tumor with hearing loss as the main complaint treated by total resection through the endoscopic endonasal approach.
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Affiliation(s)
- Yue Liu
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin, China
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4
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Roy R, Patel B, Gahlot GPS. An Extensive Unilateral Nasal Mass: Septal Schwannoma-Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:1540-1543. [PMID: 36452653 PMCID: PMC9702375 DOI: 10.1007/s12070-021-02635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022] Open
Abstract
Schwannomas are benign peripheral nerve sheath tumours that arise from the Schwann cells of the myelinated nerve and may occur throughout the body. Paranasal schwannomas are uncommon lesions, representing less than 4% of all head and neck schwannomas and nasal septal schwannomas are very rare. Here we report a rare case of sinonasal schwannoma in a 46-year-old male who presented with a history of progressive nasal blockage of 3 years duration. The mass was removed by endoscopic approach without any postoperative complication. The rarity of diagnosis was aided by immune histopathology (IHC) of the tissue to confirm the disease.
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Affiliation(s)
- Ravi Roy
- Department of ENT-HNS, Army Hospital Research and Referral, New Delhi, India
| | - Bhaumik Patel
- Department of ENT-HNS, Army Hospital Research and Referral, New Delhi, India
| | - Gaurav Pratap Singh Gahlot
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital Research and Referral, New Delhi, India
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5
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Tanjararak K, Tangbumrungtham N, Plumworasawat S, Roongpuvapaht B. Schwannoma Arising in Nasopharynx: A Case Report and Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:911-917. [PMID: 36452824 PMCID: PMC9702495 DOI: 10.1007/s12070-020-02000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
Schwannoma in paranasal sinus has been known as a rare tumor in this origin. This study reports on primary schwannoma arising in the nasopharynx, which is an uncommon location. A 36-year-old female presented with nasal obstruction for one month. Physical examination revealed a nasopharyngeal mass totally occluding bilateral posterior choanae and extended downward to the oropharynx. Magnetic resonance image showed heterogeneous enhancing mass at the nasopharynx extending inferiorly to the oropharynx. The tumor was excised via endoscopic combined trans-nasal/trans-oral approach under general anesthesia. The pathologic diagnosis was consistent with schwannoma. The tumor was successfully excised with en-block resection and the patient was discharged the next day after the operation, without any postoperative complications. There was no tumor recurrence at 12-months follow-up. Schwannoma primarily arising in the nasopharynx is uncommon. Minimally-invasive surgery via the endoscopic approach can be applied for tumor removal with fewer complications and reduced risk of morbidity.
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Affiliation(s)
- Kangsadarn Tanjararak
- Department of Otolaryngology Head & Neck Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Navarat Tangbumrungtham
- Department of Otolaryngology Head & Neck Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Sirithep Plumworasawat
- Department of Pathology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Boonsam Roongpuvapaht
- Department of Otolaryngology Head & Neck Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400 Thailand
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6
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Lee CW, Grammatopoulou V, Bagwan I, Sunkaraneni V. Schwannoma of the sinonasal tract: case report with review of the literature. Ann R Coll Surg Engl 2021; 103:e216-e222. [PMID: 34019433 DOI: 10.1308/rcsann.2020.7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Schwannomas of the sinonasal tract are rare, accounting for <4% of head and neck schwannomas. We report the case of a 61-year-old male who presented with unilateral nasal symptoms. Examination and imaging revealed a unilateral polyp at the level of the middle turbinate, with an initial biopsy suggestive of an inflammatory polyp. Due to the persistence of the patient's symptoms and his polyp despite medical therapy, endoscopic nasal polypectomy was performed. The histology surprisingly showed a schwannoma. No further interventions were carried out, and the patient remains disease-free 6 months postoperatively. A review of the literature comprising 60 cases is included. An optimal clinical approach to the investigation and management of schwannomas of the sinonasal tract is subsequently discussed.
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Affiliation(s)
- C W Lee
- Royal Surrey County Hospital, UK
| | | | - I Bagwan
- Royal Surrey County Hospital, UK
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7
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He X, Wang Y. Neurilemmoma of the Nasal Cavity and Paranasal Sinuses. EAR, NOSE & THROAT JOURNAL 2021:1455613211007947. [PMID: 33951978 DOI: 10.1177/01455613211007947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Neurilemmoma in the nasal cavity and paranasal sinuses is very rare. The study aimed to improve the understanding of neurilemmoma in the nasal cavity and paranasal sinuses. MATERIALS AND METHODS The clinical data of 10 patients with neurilemmoma in the nasal cavity and paranasal sinuses treated from January 2014 to June 2019 in our hospital were retrospectively studied. RESULTS There were 6 females and 4 males patients in our study. The mean age was 49.5 years (range 37-77 years), and the most common clinical symptom was unilateral nasal obstruction. The site of tumor included the nasal cavity, maxillary sinus, ethmoid sinus, and sphenoid sinus. There were 2 cases with malignant neurilemmoma. Nine patients underwent functional endoscopic sinus surgery (FESS); however, 1 patient underwent FESS combined with the lateral rhinotomy for complete resection of the tumor. Two patients with malignant neurilemmoma received postoperative radiotherapy. The mean follow-up was 3.82 years (range 2-7 years). There were no incidences of tumor recurrence during the study period. CONCLUSIONS Neurilemmoma in the nasal cavity and paranasal sinuses is a mainly benign tumor. Complete surgical excision by FESS is the only treatment option for neurilemmoma in the nasal cavity and paranasal sinuses; while malignant neurilemmoma needs postoperative radiotherapy.
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Affiliation(s)
- Xindi He
- Department of Rhinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Rhinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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8
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Zeng J, Liu L, Li J, Huang Q, Pi L, Jin K. MRI features of different types of sinonasan rhabdomyosarcomas: a series of eleven cases. Dentomaxillofac Radiol 2021; 50:20210030. [PMID: 33835837 DOI: 10.1259/dmfr.20210030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively analyze magnetic resonance imaging (MRI) features of various pathological subtypes of sinonasal rhabdomyosarcoma (RMS) and explore correlations between imaging features and pathological subtypes. METHODS In total, 11 cases with embryonal, alveolar or pleomorphic sinonasal RMSs, confirmed by surgical pathology, were selected. Their characteristics and distinctive imaging features were analysed, and the correlation between pathology and imaging features was explored. RESULTS Bone destruction was observed in all 11 cases with RMS. Expansive growth was predominant in three alveolar and three embryonal RMS cases, and creeping growth was predominant in two alveolar, two embryonal and one pleomorphic RMS cases. Signs of residual mucosa were observed in all 11 cases, and 10 cases showed involvement of multiple sinus cavities and orbital cavities. All cases exhibited mild-to-intermediate enhancement. CONCLUSION Sinonasal RMSs have the following characteristic MRI features: ethmoid sinuses and middle nasal conchae are the prevalent sites; lesions are mainly of mild enhancement; tumours exhibit signs of residual mucosa, mild-to-intermediate enhancement and frequent orbital involvement; bone invasion and bone destruction are frequently observed; and haematogenous metastasis is not as common as lymphatic metastasis. RMSs of various pathological subtypes were not significantly distinct by imaging.
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Affiliation(s)
- Junjie Zeng
- Department of Radiology, Hunan Children's Hospital, Changsha, China
| | - Lan Liu
- Department of Radiology, NanChang University cancer hospital, Nanchang, China
| | - Jiayong Li
- Department of Radiology, People's Hospital of Heyuan City, Heyuan, China
| | - Qiling Huang
- Department of Radiology, People's Hospital of Heyuan City, Heyuan, China
| | - Leiming Pi
- Department of Radiology, People's Hospital of Heyuan City, Heyuan, China
| | - Ke Jin
- Department of Radiology, Hunan Children's Hospital, Changsha, China
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9
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Ajiya A, Bello-Muhammad N. Encapsulated Sinonasal Schwannoma Mimicking an Antrochoanal Polyp. Niger Med J 2019; 60:326-329. [PMID: 32180664 PMCID: PMC7053271 DOI: 10.4103/nmj.nmj_104_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
Extracranial schwannomas are uncommon neoplasms of the sinonasal tract arising from peripheral nerve shealth. Mostly acapsulated on histology, but few cases of encapsulated schwannomas have been reported. Its symptoms are nonspecific and initial clinical diagnosis is frequently missed. We report a 13-year-old boy with a huge, encapsulated sinonasal schwannoma initially thought to be an antrochoanal polyp. Computed tomography scan demonstrated a huge irregularly shaped mildly enhancing isodense mass in the right nasal cavity with lateral extension to the ipsilateral maxillary sinus, superior extension into the ethmoids and frontal sinuses and posteriorly into the nasopharynx. The tumour was completely excised via a lateral rhinotomy and patient is still on follow-up.
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Affiliation(s)
- Abdulrazak Ajiya
- Department of Otorhinolaryngology, AKTH/Bayero University, Kano, Nigeria
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10
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Kotaki S, Gamoh S, Yoshida H, Ikeda C, Tominaga K, Wato M, Ueno Y, Akiyama H, Shimizutani K. Diagnostic usefulness of panoramic imaging of the pterygopalatine fossa: case of a schwannoma causing pterygopalatine fossa expansion. Oral Radiol 2018; 35:321-325. [PMID: 30484211 DOI: 10.1007/s11282-018-0352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
The pterygopalatine fossa is a small area between the posterior wall of the maxillary sinus and the anterior surface of the pterygoid process of the sphenoid bone. The pterygopalatine fossa can be seen clearly on panoramic imaging. We present the case of a 57-year-old man who exhibited right pterygopalatine fossa expansion on panoramic imaging. Computed tomography (CT), magnetic resonance imaging (MRI), and panoramic imaging all showed a tumor at the right pterygopalatine fossa in this patient. CT indicated that the tumor replaced right retromaxillary fat and displaced the posterior wall of the maxillary sinus. On MRI, the tumor showed intermediate signal intensity at the paranasal area on T1-weighted images, and variable intermediate and high signal intensities on fat-suppressed T2-weighted images. It was eventually diagnosed as a schwannoma. Thus, panoramic imaging can be used for disease screening at the posterior border of the maxilla. Our conclusion is based on this report of a patient with a schwannoma at the posterior wall of the maxillary sinus, which panoramic imaging revealed to have pterygopalatine fossa expansion.
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Affiliation(s)
- Shinya Kotaki
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan.
| | - Shoko Gamoh
- Health Promotion Division, Public Health Bureau, Osaka City Government, 1-3-20 Nakanoshima, Kita-ku, Osaka, 530-0005, Japan
| | - Hiroaki Yoshida
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
| | - Chihoko Ikeda
- Department of Oral Pathology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
| | - Kazuya Tominaga
- Department of Oral Pathology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
| | - Masahiro Wato
- Department of Oral Health Sciences, Osaka Dental University (ODU), 1-4-4 Makino Honmachi, Hirakata, Osaka, 573-1144, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, 2-5-1 Hirakata Shinmachi, Hirakata, 573-1010, Japan
| | - Hironori Akiyama
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
| | - Kimishige Shimizutani
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
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11
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Imaging features of sinonasal tumors on positron emission tomography and magnetic resonance imaging including diffusion weighted imaging: A pictorial review. Clin Imaging 2018; 51:217-228. [DOI: 10.1016/j.clinimag.2018.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022]
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12
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Imaging features of benign mass lesions in the nasal cavity and paranasal sinuses according to the 2017 WHO classification. Jpn J Radiol 2018; 36:361-381. [DOI: 10.1007/s11604-018-0739-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/17/2018] [Indexed: 12/11/2022]
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13
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Kumar S, Sayoo C. Sinonasal Schwannoma: A Rare Sinonasal Neoplasm. Indian J Otolaryngol Head Neck Surg 2017; 69:425-427. [PMID: 28929080 DOI: 10.1007/s12070-017-1125-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
Abstract
Neoplasm in sinonasal cavity is dominated by epithelial type. Sinonasal schwannoma is a rare entity represent less than four percent of head and neck schwannoma. Clinically this tumour is commonly misdiagnosed until they are confirmed by histopathological examination. We present a case of schwannoma in sinonasal region with involvement of right side nasal cavity, maxillary sinus and maxillary alveolar process. The tumour was successfully removed by midfacial degloving approach.
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14
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Gupta M, Rao N, Kour C, Kaur I. Septal Schwannoma of the Nose: A Rare Case. Turk Arch Otorhinolaryngol 2017; 55:41-43. [PMID: 29392052 DOI: 10.5152/tao.2017.1929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/03/2016] [Indexed: 11/22/2022] Open
Abstract
A schwannoma is a benign tumor arising from Schwann cells present in the nerve sheath of myelinated nerves.It is rarely seen in the nose and paranasal sinuses, and it very rarely originates from the nasal septum. A 40-year-old female presented to our outpatient department with a gradual onset, progressive, left nasal obstruction since the last 4 years. On performing a local examination, a soft tissue mass occupying the left nasal cavity was seen. Surgery via the external approach was performed; the mass was found to arise from the nasal septum and was totally excised. Histopathologic examination revealed a schwannoma. Nasal septal schwannoma along with review of the literature is a rare entity. It should be considered in the differential diagnosis of benign tumors of the nasal cavity.
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Affiliation(s)
- Manish Gupta
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, India
| | - Naiya Rao
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, India
| | - Chandpreet Kour
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, India
| | - Ivreet Kaur
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, India
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15
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Surapaneni B, Hanly E, Kadakia S, Moscatello A, Kamat A. Endoscopic resection of nasal schwanomma as a diagnostic and therapeutic adjunct in the treatment of a rare disorder: A case report with literature review. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1281713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Bhavishya Surapaneni
- Department of Otolaryngology, University of Southern California, Los Angeles, CA, USA
| | - Elyse Hanly
- Department of Otolaryngology-Head and Neck Surgery, New York Medical College, Valhalla, NY, USA
| | - Sameep Kadakia
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Augustine Moscatello
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Ameet Kamat
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
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16
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Pediatric Isolated Sinonasal Schwannoma: A New Case Report and Literature Review. Case Rep Med 2016; 2016:2786030. [PMID: 27882056 PMCID: PMC5110863 DOI: 10.1155/2016/2786030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/09/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022] Open
Abstract
Schwannomas of the paranasal sinus are uncommon. Less than 4% of schwannomas involve the nasal cavity and paranasal sinuses, even less in the pediatric age group. A case of schwannoma arising in maxillary sinus in a 2.5-year-old Chinese boy is reported. The basis for discussion of this case is the exceptional rarity of sinonasal schwannoma in pediatric patients.
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17
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Abstract
PURPOSE The purpose of the study was to explore the characteristic magnetic resonance imaging (MRI) findings of schwannoma of the sinonasal tract. METHODS Eighteen patients with histopathologically confirmed sinonasal schwannoma underwent conventional MRI, and 12 had dynamic contrast-enhanced MRI studies synchronously. The morphology feature, signal intensity, enhancement degree, and time intensity curve (TIC) pattern of schwannomas were retrospectively analyzed. RESULTS This entity appeared as a well-circumscribed, oval or fusiform soft tissue mass with a mean greatest diameter of 38 mm. Schwannomas exhibited isointense on T1-weighted image in 12 patients and hypointense in 6. On T2-weighted image, the lesions were heterogeneously isointense in 14 patients and hyperintense in 4. The lesions had heterogeneously moderate and marked contrast enhancement in 2 and 16, respectively. The mottled-, island-, and multicyst-like appearance were identified in 3, 4, and 11, respectively. Compared with inverted papilloma and lobular capillary hemangioma, the type I TIC is characteristic of schwannoma. CONCLUSIONS A well-circumscribed mass displaying T2 intermediate signal intensity, marked enhancement, and type I TIC, with cystic changes, strongly suggests the diagnosis of sinonasal schwannoma.
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18
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Karligkiotis A, Turri-Zanoni M, Sica E, Facco C, Freguia S, Mercuri A, Pistochini A, Bignami M, Castelnuovo P. Role of endoscopic surgery in the management of sinonasal and skull base schwannomas. Head Neck 2016; 38 Suppl 1:E2074-82. [PMID: 26876981 DOI: 10.1002/hed.24383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to report our experience with the endoscopic management of sinonasal schwannomas, analyzing the advantages, limitations, and outcomes of the technique. METHODS A retrospective analysis was carried out on 11 patients treated endoscopically between 2000 and 2014 at a single institution. RESULTS Eight patients underwent an exclusive endoscopic endonasal approach, whereas, in 3 patients, an osteoplastic flap was combined because of massive or lateral frontal sinus involvement. The tumor extended into the orbit in 5 cases, and involved the skull base in 5 patients who required a concomitant endoscopic duraplasty. No evidence of disease was observed in 10 patients after a mean follow-up of 90.1 months (range, 14-189 months). One patient was alive with persistence of disease, although asymptomatic. CONCLUSION The endoscopic endonasal approach is a valid alternative for the vast majority of sinonasal schwannomas with minimal morbidity for the patient. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2074-E2082, 2016.
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Affiliation(s)
- Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.,Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Eleonora Sica
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Carla Facco
- Division of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Stefania Freguia
- Division of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Anna Mercuri
- Department of Neuroradiology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Pistochini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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19
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Abstract
Schwannoma is a benign neoplasm originating from schwann cells of the peripheral nerve sheath. Although nearly half of all schwannomas involve the head and neck region, nasal and paranasal sinus presentations are very rare in the literature. We present a case of nasal schwannoma originating from the right nasal cavity. A 59-year-old man presented with complaints of progressive right nasal obstruction and headache. Endoscopic examinations revealed a mass that filled the right middle meatus. At first glance, it was not like polyp tissue. Endoscopic sinus surgery was performed under general anesthesia, and the mass was completely removed.
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Wang XY, Yan F, Hao H, Wu JX, Chen QH, Xian JF. Improved performance in differentiating benign from malignant sinonasal tumors using diffusion-weighted combined with dynamic contrast-enhanced magnetic resonance imaging. Chin Med J (Engl) 2015; 128:586-92. [PMID: 25698188 PMCID: PMC4834767 DOI: 10.4103/0366-6999.151649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Differentiating benign from malignant sinonsal lesions is essential for treatment planning as well as determining the patient's prognosis, but the differentiation is often difficult in clinical practice. The study aimed to determine whether the combination of diffusion-weighted (DW) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can improve the performance in differentiating benign from malignant sinonasal tumors. Methods: This retrospective study included 197 consecutive patients with sinonasal tumors (116 malignant tumors and 81 benign tumors). All patients underwent both DW and DCE-MRI in a 3-T magnetic resonance scanner. Two different settings of b values (0,700 and 0,1000 s/mm2) and two different strategies of region of interest (ROI) including whole slice (WS) and partial slice (PS) were used to calculate apparent diffusion coefficients (ADCs). A DW parameter with WS ADCsb0,1000 and two DCE-MRI parameters (time intensity curve [TIC] and time to peak enhancement [Tpeak]) were finally combined to use in differentiating the benign from the malignant tumors in this study. Results: The mean ADCs of malignant sinonasal tumors (WS ADCsb0,1000 = 1.084 × 10−3 mm2/s) were significantly lower than those of benign tumors (WS ADCsb0,1000 = 1.617 × 10−3 mm2/s, P < 0.001). The accuracy using WS ADCsb0,1000 alone was 83.7% in differentiating the benign from the malignant tumors (85.3% sensitivity, 81.2% specificity, 86.4% positive predictive value [PPV], and 79.5% negative predictive value [NPV]). The accuracy using DCE with Tpeak and TIC alone was 72.1% (69.1% sensitivity, 74.1% specificity, 77.5% PPV, and 65.1% NPV). Using DW-MRI parameter was superior than using DCE parameters in differentiation between benign and malignant sinonasal tumors (P < 0.001). The accuracy was 87.3% (90.5% sensitivity, 82.7% specificity, 88.2% PPV, and 85.9% NPV) using DW-MRI combined with DCE-MRI, which was superior than that using DCE-MRI alone or using DW-MRI alone (both P < 0.001) in differentiating the benign from the malignant tumors. Conclusions: Diffusion-weighted combined with DCE-MRI can improve imaging performance in differentiating benign from malignant sinonasal tumors, which has the potential to improve diagnostic accuracy and to provide added value in the management for these tumors.
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Affiliation(s)
| | | | | | | | | | - Jun-Fang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Capital Medical University, Beijing 100069, China
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Zhou H, Xing G, Gao X, Wang J, Chen F, Lu L, Zhang Y, Chen Z, Qian X. Schwannoma of the Sinonasal Tract and the Pterygopalatine Fossa with or without Intracranial Extension. ORL J Otorhinolaryngol Relat Spec 2015; 77:61-9. [PMID: 25791913 DOI: 10.1159/000374122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 01/06/2015] [Indexed: 11/19/2022]
Abstract
AIMS Compared with those in other head and neck regions, schwannomas in the nasal cavity or paranasal sinuses are rare. The aim of this study was to present the experience of the authors in 11 schwannoma cases of the sinonasal tract and pterygopalatine fossa over a decade. METHODS A retrospective study from 2003 to 2014. RESULTS Three female and 8 male patients from 22 to 61 years of age (mean age 42 years) were admitted. The most common complaints were unilateral nasal congestion. A total of 10 of the patients received surgery, including 6 functional endoscopic sinus surgeries (FESS). The postoperative course was generally uneventful. Among the patients, 10 remained regionally asymptomatic, and there has been no clinical or radiological evidence of recurrence or residual tumor. CONCLUSION Surgical treatment is effective for schwannomas of the sinonasal tract and the pterygopalatine fossa with a low recurrence rate. Conducting CT and MRI (particularly fluid-attenuated inversion recovery) before surgery is mandatory. FESS could become the primary treatment of choice.
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Affiliation(s)
- Han Zhou
- Department of Otorhinolaryngology, Nanjing Drum Tower Hospital, Nanjing, PR China
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23
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Gencarelli J, Rourke R, Ross T, Gravel DH, Purgina B, Jordan D, Agbi C, Kilty SJ. Atypical presentation of sinonasal cellular schwannoma: a nonsolitary mass with osseous, orbital, and intracranial invasion. J Neurol Surg Rep 2014; 75:e144-8. [PMID: 25083375 PMCID: PMC4110123 DOI: 10.1055/s-0034-1376424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/03/2014] [Indexed: 11/24/2022] Open
Abstract
Objective Sinonasal cellular schwannoma represents < 4% of head and neck schwannomas. These benign tumors are typically confined to the nasal cavity or ethmoid sinus. We describe an atypical case of sinonasal cellular schwannoma with diffuse paranasal sinus involvement and both intraorbital and intracranial extension. Results A 62-year-old woman presented with a 6-month history of right orbital proptosis and right-sided headache. Subsequent imaging revealed an invasive paranasal sinus mass extending through the skull base and displacing the right orbit. Preoperative biopsies were not diagnostic but revealed a spindle cell lesion suspicious for malignancy based on lack of encapsulation, infiltration of the sinonasal submucosa, and osseous invasion. The patient underwent open skull base surgery, and pathology confirmed a S100-positive nonencapsulated cellular schwannoma. Conclusion An atypical case of sinonasal cellular schwannoma with intracranial extension is reported. Its presentation is contrary to the common view that these are isolated solitary lesions of the nasoethmoid region. We suggest that sinonasal cellular schwannoma be considered in the differential diagnosis of a poorly defined invasive paranasal sinus mass, particularly following biopsy.
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Affiliation(s)
- John Gencarelli
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan Rourke
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada ; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tracey Ross
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada ; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Denis H Gravel
- The Ottawa Hospital, Ottawa, Ontario, Canada ; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bibianna Purgina
- The Ottawa Hospital, Ottawa, Ontario, Canada ; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Jordan
- The Ottawa Hospital, Ottawa, Ontario, Canada ; Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles Agbi
- The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shaun J Kilty
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada ; The Ottawa Hospital, Ottawa, Ontario, Canada ; The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
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Abstract
Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare and recently recognized mesenchymal tumor with intermediate malignant potential, most of which arises in the soft tissue of the extremities with obvious specificity on histopathology. Here, we report a case of CT findings of PHAT arising from the posterior neck as a 3.4 × 4 × 5-cm mass in a 35-year-old woman. Precontrast CT showed an ill-defined, inhomogenous and oval-shaped mass. On contrast-enhanced CT, the mass appeared well defined except for a very small part, most of which showed marked and heterogenous enhancement, with a maximum CT value of 161 HU, which was almost identical to that of the vessels.
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