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Annam CS, Das S, Iyer A, Bakshi SS. Laryngeal schwannoma masquerading as malignancy. BMJ Case Rep 2024; 17:e260258. [PMID: 39013626 DOI: 10.1136/bcr-2024-260258] [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: 07/18/2024] Open
Abstract
Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes of throat pain. The Hopkins examination showed right vocal fold irregularity with fullness in the right ventricle. The contrast-enhanced CT neck revealed an ill-defined lesion with contrast uptake extending into the paraglottic region with no neck node involvement. Considering the clinical presentation of hoarseness, throat pain and globus with imaging revealing contrast enhancement of lesion, direct laryngoscopy and biopsy were planned to rule out malignancy. Intraoperatively, a well-defined submucosal capsulated swelling became apparent after incision and dissection of the mucosa over the right vocal fold. A complete excision of the swelling was done with microlaryngeal instruments without tracheostomy. The histopathological report was suggestive of schwannoma. The literature review discusses clinical presentation, location, imaging features and management strategy.
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Affiliation(s)
- Chandra Shekhar Annam
- All India Institute of Medical Sciences - Mangalagiri, Guntur, Andhra Pradesh, India
| | - Soumyajit Das
- All India Institute of Medical Sciences - Mangalagiri, Guntur, Andhra Pradesh, India
| | - Aishwari Iyer
- All India Institute of Medical Sciences - Mangalagiri, Guntur, Andhra Pradesh, India
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Zheng Y, Lou L, Zhao Y. Laryngeal schwannoma: A case report and literature review. EAR, NOSE & THROAT JOURNAL 2022:1455613221075225. [PMID: 35098768 DOI: 10.1177/01455613221075225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Laryngeal schwannomas are rare benign neurogenic tumors of the larynx. They cannot be detected in the early stages because disease onset is asymptomatic. This case of laryngeal schwannoma provided a reference for clinical diagnosis and treatment strategy. A 24-year-old man presented with a 3-year history of hoarseness and sore throat for 6 months. Laryngoscopy and computed tomography showed submucosal bulging of the right ventricular fold in the right paraglottic space. The patient underwent tracheotomy first, followed by laryngotomy. The edema of the laryngeal mucosa was significantly alleviated, with normal movement of the bilateral vocal cords on the 10th day after surgery. The tracheal tube was removed at the time of discharge. The hoarseness had disappeared at the end of the first month after surgery. The effective treatment of laryngeal schwannoma involves complete resection with surgery while protecting the integrity of the larynx and restoring laryngeal function. The indication for surgery should be strictly controlled to avoid damage to the mucosa and structures of the larynx.
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Affiliation(s)
- Yongbo Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Lin Lou
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
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El Fakiri MM, Rochdi Y, Abdala FZ, Nouri H, Raji A. Voluminous Laryngeal Schwannoma Treated with Endoscopic Laser Approach. Turk Arch Otorhinolaryngol 2020; 58:52-55. [PMID: 32313896 DOI: 10.5152/tao.2020.4547] [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] [Received: 06/25/2019] [Accepted: 12/06/2019] [Indexed: 11/22/2022] Open
Abstract
Laryngeal schwannomas are rare benign encapsulated neurogenic tumors that represent less than 1.5% of all benign laryngeal tumors. We report a case of voluminous laryngeal schwannoma that was incidentally found during endotracheal intubation for thyroidectomy in a 43-year-old woman with clinical findings, features of radiologic and histopathologic examinations. The tumor was removed by CO2 laser during microlaryngoscopy. In this case report, we present a challenging approach that can be used in diagnosis and treatment of laryngeal schwannomas. Complete removal of the tumor should be considered as the initial approach to minimize morbidity.
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Affiliation(s)
- Mohamed Mehdi El Fakiri
- Department of Anatomy, Ibn Zohr University, School of Medicine and Pharmacy, Agadir, Morocco.,Department of Otorhinolaryngology, Mohammed VI University Hospital Center, Marrakesh, Morocco
| | - Youssef Rochdi
- Department of Head and Neck Surgery, Cadi Ayyad University, School of Medicine and Pharmacy, Marrakesh, Morocco.,Department of Otorhinolaryngology, Mohammed VI University Hospital Center, Marrakesh, Morocco
| | - Fatima-Zahra Abdala
- Department of Head and Neck Surgery, Cadi Ayyad University, School of Medicine and Pharmacy, Marrakesh, Morocco.,Department of Otorhinolaryngology, Mohammed VI University Hospital Center, Marrakesh, Morocco
| | - Hassan Nouri
- Department of Head and Neck Surgery, Cadi Ayyad University, School of Medicine and Pharmacy, Marrakesh, Morocco.,Department of Otorhinolaryngology, Mohammed VI University Hospital Center, Marrakesh, Morocco
| | - Abdelaziz Raji
- Department of Head and Neck Surgery, Cadi Ayyad University, School of Medicine and Pharmacy, Marrakesh, Morocco.,Department of Otorhinolaryngology, Mohammed VI University Hospital Center, Marrakesh, Morocco
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Abstract
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.
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Wong BLK, Bathala S, Grant D. Laryngeal schwannoma: a systematic review. Eur Arch Otorhinolaryngol 2016; 274:25-34. [PMID: 27020268 DOI: 10.1007/s00405-016-4013-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/23/2016] [Indexed: 11/26/2022]
Abstract
A large proportion of schwannomas are found in the head and neck region. Schwannoma located within the larynx however is uncommon. The characteristic features, clinical presentations, treatment and the outcomes of patients with laryngeal schwannoma are therefore not clearly understood. The aim of this comprehensive review is to compile, analyze and present the details to develop a consensus and augment the available literature on laryngeal schwannoma. A comprehensive literature search on laryngeal schwannoma was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index using MeSH words. A total of 55 patients were reviewed in this study. 40.7 % of the tumours arose from the aryepiglottic fold or arytenoids. Other areas where tumours were found included the false cord, true vocal cord, epiglottis, subglottis, piriform sinus and the post cricoid area. 64.9 % patients presented with dysphonia. Others typically present with multiple symptoms related to the mass effect and location of the tumour. All patients were managed surgically with different techniques and approaches. Majority of patients were alive with no residual disease. There were five recurrences and no mortality to date. Schwannoma within the larynx can present with a variety of symptoms. Surgical excision remained as the treatment of choice with good overall prognosis.
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Affiliation(s)
- Billy L K Wong
- Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
| | - S Bathala
- Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - D Grant
- Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
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Markou K, Dova S, Poulios C, Karkos P. Laryngeal schwannoma as an acute airway presentation. BMJ Case Rep 2016; 2016:bcr-2016-214682. [PMID: 26969364 DOI: 10.1136/bcr-2016-214682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A schwannoma is a neurogenic tumour arising from nerve sheaths. Between 25% and 45% of schwannomas occur in the head and neck region. Schwannomas of the larynx are extremely rare. They usually occur in women during the fourth and fifth decades of life. We present a case of a laryngeal schwannoma in a 76-year-old patient with acute stridor, hoarseness and dysphagia. Laryngeal conservation surgery was performed without the need for a tracheostomy. One year later, the patient remains symptom-free with no evidence of recurrence. Clinical presentation, diagnosis and management are discussed and the literature is reviewed.
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Affiliation(s)
- Konstantinos Markou
- Otolaryngology Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Stamatia Dova
- Otolaryngology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Poulios
- Histopathology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Petros Karkos
- Otolaryngology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
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