A 32 year-old Malay lady presented with a swelling over the dorsal surface of her right thumb for 6 months. The swelling was non-tender, smooth surfaced, mobile and nonfluctuating with no bony involvement. The provisional diagnosis was ganglion cyst. Excisional biopsy did not show features of ganglion cyst as it appeared to be wellencapsulated, multi-lobulated and yellowish in colour. Histopathological examination showed that it was a schwannoma. Schwannomas are relatively rare benign tumours which are frequently misdiagnosed. In this case, it was misdiagnosed both as a ganglion and a lipoma.
Schwannomas are benign tumors. A series of three unusual cases involving the head and neck region at the Department of ENT, Hospital Ipoh from July 2004 to June 2005 is presented. The first case was a pedunculated schwannoma of the tongue base. The second was a schwannoma of the cervical sympathetic chain who developed a transient Horner's Syndrome upon fine needle aspiration cytology. The third case was a bilobed cervical vagal schwannoma which developed immediate vocal cord palsy postoperatively which was evident at six months follow-up. All tumors were removed surgically.
Facial nerve schwannomas are rare benign tumors. The tumor can arise anywhere along the course of the facial nerve. The most common presentation for this tumor is a slowly progressive facial nerve paralysis. Sensorineural hearing loss (SNHL) and tinnitus are later symptoms. The symptoms and signs depend on the site of tumor along the nerve. We report three cases of facial nerve schwannomas with different clinical presentations. Appropriate management of a facial nerve schwannoma should be based on the site and extent of the tumor and status of the nerve function.
A few series of parapharyngeal space tumours have been reported earlier but recently not many series have been published in English literature. It is rare for any medical center, let alone an individual surgeon, to develop sufficient experience in evaluating these tumours. We present our experience in the treatment of 41 cases of parapharyngeal tumours from January 1992 to December 2001. FNAC, ultrasound and CT scan of the presenting mass was done in most of the patients as the main pre-operative work-up. The strategic location and extension of the tumour may occasionally alter the surgical approach for tumour excision.
The case of a 10-year-old girl is presented who had a slow-growing, painless swelling on the left side of the tongue since six months. This was associated with disturbances in mastication and phonation. Examination revealed a 5 cm x 4 cm. globular smooth, mobile mass on left side of the tongue. There was no neurological deficit and no neck nodes palpable. She underwent excision of the mass under general anaesthesia. Complete enucleation with primary closure was carried out. The patient had an uneventful postoperative recovery and histological evaluation was consistent with schwannoma. The patient was recurrence free after one year.
Schwannomas are benign tumours arising from neurilemmal cells which forms the myelin sheath of peripheral nerves. It usually occurs in the head, but may be found in the brachial plexus and sciatic nerve. Common peroneal nerve schwannoma are rare. We report a case of a middle age gentleman who presented with pain and swelling over the right popliteal fossa with associated right radicular pain of the anterolateral leg and weakness of ankle dorsiflexion. Examination revealed a 3x2 cm lump behind the posterolateral aspect of the right knee with positiveTinel’s sign upon tapping of the lump, sensory deficit over the anterolateral aspect of the leg and the ankle dorsiflexors had a muscle power of grade 3. Magnetic resonance imaging (MRI) of the right leg revealed a well circumscribed, oval lesion located along the pathway of the common peroneal nerve homogenously hypointense on T1-weighted images and heterogeneously hyperintense on T2 weighted images compared to the muscles. The lesion was not surpressed on fat suppression sequences. Intra-operatively, we noted that the schwannoma was in continuity with the common peroneal nerve. The patient underwent excision of the schwannoma. Post operatively, the pain reduced remarkably but patient suffers from numbness and right foot drop as a complication of the tumour. This case highlights the rarity of common peroneal nerve schwannoma which presents with neuropathic symptoms complicated with right foot drop.
Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.
Schwannoma (neurilemoma) is a benign, slow-growing tumor of the nerve sheath. These tumors are rarely found in the female genitalia and to date only 1 case of clitoral schwannoma has been reported in a young girl. We report here the second case of schwannoma of the clitoris.
Neurofibromatosis type 2 usually presents with bilateral acoustic schwannomas. We highlight the rare presentation of neurofibromatosis initially involving third nerve. A 23-year-old Malay female presented with left eye drooping of the upper lid and limitation of upward movement for 8 years. It was associated with right-sided body weakness, change in voice, and hearing disturbance in the right ear for the past 2 years. On examination, there was mild ptosis and limitation of movement superiorly in the left eye. Both eyes had posterior subcapsular cataract. Fundoscopy showed generalised optic disc swelling in both eyes. She also had palsy of the right vocal cord, as well as the third and eighth nerve. There was wasting of the distal muscles of her right hand, with right-sided decreased muscle power. Pedunculated cutaneous lesions were noted over her body and scalp. MRI revealed bilateral acoustic and trigeminal schwannomas with multiple extra-axial lesions and intradural extramedullary nodules. Patient was diagnosed with neurofibromatosis type 2 and planned for craniotomy and tumour debulking, but she declined treatment. Neurofibromatosis type 2 may uncommonly present with isolated ophthalmoplegia, so a thorough physical examination and a high index of suspicion are required to avoid missing this condition.
Schwannomas of the nasal cavity and paranasal sinuses are quite rare, especially in the nasal vestibule. We report the case of a 61-year-old woman who presented with a 2-month history of progressively worsening right-sided epistaxis and nasal blockage. Rigid nasoendoscopy showed a mobile, smooth, globular mass occupying the right nasal vestibule. The mass arose from the lateral nasal wall and impinged on the anterior part of the middle turbinate posteriorly. Computed tomography of the paranasal sinuses showed a 3.8 × 1.7-cm enhancing mass in the right nostril. The mass obliterated the nasal cavity and caused mild deviation of the septum. The preoperative histopathologic examination showed positivity for vimentin and S-100 protein, suggesting a diagnosis of schwannoma. The patient underwent an intranasal laser-assisted excision biopsy. The histopathologic examination confirmed the diagnosis of schwannoma. Postoperative recovery was uneventful, and no recurrence was seen in the follow-up period.
A case of metastatic malignant schwannoma of the right orbit is presented here. Although the patient had disseminated disease, it was the eye problems which were striking and most symptomatic.
The orbital lesion was at first thought to be the primary tumour until a history of an excised right wrist mass was probed into and the histology traced.
This report is written as malignant schwannoma is an uncommon tumour. The difficulty in diagnosing malignant schwannoma is mentioned. The importance of diagnosis of an orbital metastatic lesion is also pointed out as this is often misdiagnosed.
Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon, biologically aggressive soft tissue sarcomas of neural origin that poses tremendous challenges to effective therapy. MPNSTs are among the most challenging mesenchymal malignancies to treat with poor prognosis. They usually affect young and middle-aged adults, tend toward early metastasis, and often demonstrate resistance to chemotherapy. We present a case of a 23-year-old female who initially presented with the right temporal swelling for 1 month associated with constitutional symptom which progressively worsening. The right craniotomy and excision biopsy were done with histopathological examination results suggestive of MPNST. Thorax-abdominal-pelvic computed tomography and magnetic resonance imaging further revealed multiple metastatic lesions involving spine, retroperitoneal, pelvic, chest wall, and lungs. This case illustrates the typical presentation of MPNST with its known poorly outcome.
Schwannoma in the head and neck region is very rare. The tumour occurring in the intraparotid facial nerve is even rarer. A patient presenting with a parotid swelling with facial nerve paralysis is not pathognomonic of a facial nerve schwannoma. However it may occur because enlargement of the parotid, by any kind of tumour especially a malignant one can cause facial nerve paralysis. We report a case of an intraparotid facial nerve schwannoma, in a patient who presented with parotid enlargement and facial nerve paralysis.
Introduction: Rectal schwannoma is a rare gastrointestinal mesenchymal tumour with only a few numbers of cases has been reported. It is predominant in the stomach and small bowel, but uncommon in the colon and rectum. Case description: A 74-year-old man presented with features masquerading as low rectal malignancy with a malignant looking pedunculated polyp measuring 10 x 8 cm on colonoscopy. Punch biopsy revealed a diagnosis of benign tumour of schwannoma. After failure of multiple attempts of endoscopic resection, a decision of transanal excision was made. The histopathological assessment was consistent with the preoperative diagnosis and supported by immu-nohistochemistry of S-100 protein. His postoperative recovery was uneventful as he was discharged on the following day. There is no evidence of tumour recurrence on follow up. Conclusion: A huge tumour of the rectum is not always malignant. However, patient with features of low rectal tumour warrants an immediate referral to the surgical team as this non-communicable disease is a public health concern. Preoperative diagnosis is paramount for a necessary surgical intervention.
Schwannomas are solitary, benign tumors arising from the nerve sheaths. They are frequently reported in the thorax predominantly in the posterior mediastinum, but are rarely seen to arise from the brachial plexus. Schwannomas are well demarcated lesions with a slow insidious growth. Presented is a case of a large brachial plexus schwannoma, masking as a cystic lesion in the lateral neck. The patient presented with concerns of a cystic mass progressively increasing in size over a period of four years, initially symptomless, but later caused numbness and tingling sensation over his right forearm, tip of right thumb and index finger. Following histological confirmation via fine needle aspiration and magnetic resonance imaging, the patient underwent surgical excision where by the tumor was dissected from its attachment to the nerve sheath. The patient recovered well, and by the third day post operatively, his neurological symptoms resolved completely. Upon follow up in clinic 1-week post-surgery, the scar had healed well, and his numbness or tingling sensation remained in abeyance. This case illustrates that a schwannoma may present insidiously as a cystic lesion and its possible origin may arise from the brachial plexus.
Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma. The current views are that schwannomas arise from the progenitor of the schwann cell. Whereas the neurofibroma series probably arise from a mesenchymal origin closer to a fibroblast. We report on six cases of nerve sheath tumour that occur in the spinal and paraspinal region that presented to us over a 5 year period.