This study reviewed the epidemiology of brain and spinal tumours in Sarawak from January 2009 till December 2012. The crude incidence of brain tumour in Sarawak was 4.6 per 100,000 population/year with cumulative rate 0.5%. Meningioma was the most common brain tumour (32.3%) and followed by astrocytoma (19.4%). Only brain metastases showed a rising trend and cases were doubled in 4 years. This accounted for 15.4% and lung carcinoma was the commonest primary. Others tumour load were consistent. Primitive neuroectodermal tumour (PNET) and astrocytoma were common in paediatrics (60%). We encountered more primary spinal tumour rather than spinal metastases. Intradural schwannoma was the commonest and frequently located at thoracic level. The current healthcare system in Sarawak enables a more consolidate data collection to reflect accurate brain tumours incidence. This advantage allows subsequent future survival outcome research and benchmarking for healthcare resource planning.
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.
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.
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.
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.
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 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.
Schwannoma of cervical sympathetic chain is a rare cause of neck swelling. We report a 73- year-old male presented with anterior neck triangle swelling mimicking a carotid body tumour. Surgical excision was done, and the histopathological examination reported as ancient schwannoma. We would like to discuss the important differential diagnoses and highlight the possibility of an ancient schwannoma of cervical sympathetic chain masquerading as carotid body tumour. Also, to emphasise the importance of imaging for pre-operative planning and counselling.
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.
Schwannomas are benign slow growing lesions arising from the Schwann cells that ensheath the axons of the peripheral, cranial and autonomic nervous systems. Intracranial schwannomas develop from the facial nerve much more rarely than from the vestibular or trigeminal nerves. Ancient schwannoma is an unusual histological variant of this rare disease. A 48 years old man who had recurrent facial nerve paralysis and right external auditory mass is presented in this case report.
Extracranial schwannomas in the head and neck region are rare neoplasms. The tumours often present as asymptomatic, slowly enlarging lateral neck masses and determination of the nerve origin is not often made until the time of surgery. Preoperative diagnosis maybe aided by imaging studies such as magnetic resonance imaging or computed tomography, while open biopsy is no longer recommended. The accepted treatment for these tumors is surgical resection with preservation of the neural pathway. We report four cases of cervical schwannomas that we encountered at our center during four years of period. The clinical features, diagnosis and origin, management and pathological findings of these benign tumors are discussed.
Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and
presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia,
dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication
of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused
any surgical intervention, conservative management was used.
Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used.
Cystic spinal or ancient schwannoma is a rare form of intradural tumour especially in the conus medullaris region. Due to its indolent behavior and benign course, the diagnosis of schwannoma is always a challenge and the imaging findings can be misleading. Our patient presented with chronic mild sciatica pain without any other neurological symptom. MRI of the spine showed intradural tumour located at the conus medullaris region with nerves compression and was reported as ependymoma. L3-L5 laminectomy and total excision of tumour was performed without any neurological complication. We concluded that ancient schwannoma of the conus medullaris is a rare benign tumour that can present with minimal non-specific neurological symptom that lead to misdiagnosis. Radical tumour excision is safe with an excellent outcome.
Schwannomas are mesenchymal tumors that are characteristically benign and slow growing, which originate from any nerve with Schwann cell sheath. Gastrointestinal schwannomas are rare with distinct morphologic features as compared to schwannomas of soft tissue or central nervous system. A 77-year-old male patient was diagnosed with gastrointestinal stromal tumor based on radiological findings and clinical impression when he presented with worsening abdominal discomfort and pain. He underwent distal gastrectomy however histopathological examination of the tumour revealed schwannoma. This case report presents a rare case of a symptomatic gastric schwannoma, whose definitive diagnosis was established by histopathological and immunohistochemical findings postoperatively.
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.
Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall. One, GISTs are relatively more common than schwannomas in the rectum. Two, schwannomas usually have very little mitoses. Three, rectal GISTs commonly exhibit nuclear palisades. We also discuss the diagnostic, prognostic and therapeutic functions of immunohistochemical and molecular investigations. As the surgical intent for rectal GISTs is for en-bloc excision with wide margins, we surmise that the intraoperative consult should include GIST as a possible differential diagnosis for rectal mesenchymal tumours. In view of the potential for neoadjuvant treatment with imatinib before surgical excision to preserve sphincter function, a multidisciplinary approach is recommended for establishing most effective treatment strategy in these rare complex cases.