Schwannoma

Acoustic neuroma: An investigation of associations between tumor size and diagnostic delays, facial

August 27, 2014     Marc Olshan, MD, MBA; Visish M. Srinivasan, MD; Tre Landrum, DO; Robert T. Sataloff, MD, DMA, FACS
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Abstract

We conducted a retrospective case review to ascertain the clinical characteristics associated with acoustic neuromas and their treatment. Our study population was made up of 96 patients-41 men and 55 women, aged 17 to 84 years (mean: 54)-who had undergone treatment for acoustic neuromas and for whom necessary data were available. We compiled data on presenting symptoms, the interval from symptom onset to diagnosis, tumor size at diagnosis, facial weakness, the interval from diagnosis to surgery, the type of surgical approach, and surgical complications. Our primary goals were to determine if tumor size was correlated to (1) the interval from symptom onset to diagnosis, (2) the degree of preoperative facial weakness, and (3) surgical complications. We also sought to document various other clinical characteristics of these cases. The mean interval from the first symptom to diagnosis was 4.5 years; the time to diagnosis did not correlate with tumor size. Nor was tumor size correlated with the degree of preoperative facial weakness as determined by facial electroneurography. Surgical complications occurred in 15 of the 67 patients who underwent surgery (22.4%), and they did correlate with tumor size. The most common complications were postoperative facial weakness (13.4% of operated patients), cerebrospinal fluid leak (6.0%), and infection (3.0%). Since tumors typically grow about 2 mm per year and since larger tumors are associated with more severe symptoms and surgical complications, we expected that the time to diagnosis would correlate with tumor size, but we found no significant association.

Nasal vestibule schwannoma: Report of a rare case

June 8, 2014     Ismail Fadzilah, MSurg(ORL-HNS); Husain Salina, MSurg(ORL-HNS); Baharudin Khairuzzana, MSurg(ORL-HNS); Omar Rahmat, MSurg(ORL-HNS); SHA Primuharsa Putra, MSurg(ORL-HNS)
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Abstract

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 x 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.

Laryngeal schwannoma presenting as a pedunculated mass in the glottis

March 18, 2014     Hideki Nakagawa, MD; Naoyuki Kohno, MD; Toshiyuki Kusuyama, MD; Hiroyuki Fukuda, MD
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This is the first case of laryngeal schwannoma that presented as a pedunculated tumor arising from the true vocal fold.

Schwannoma of the nasal septum: An unusual finding

March 18, 2014     Shruti Dhingra, MS, DNB; Jaimanti Bakshi, MS, DNB; Satyawati Mohindra, MS, DNB
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Abstract

Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient-a 28-year-old woman-waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

Pediatric cervical sympathetic chain schwannoma with Horner syndrome: A rare case presentation

March 18, 2014     Sanjeev Bhagat, MS; Saurabh Varshney, MS; Sampan S. Bist, MS; and Nitin Gupta, MS
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Abstract

Schwannomas are rare, benign, slowly growing neurogenic tumors that originate in peripheral, spinal, or cranial nerves other than the optic and olfactory nerves. In the head and neck, these tumors usually arise from the vagus nerve and the cervical sympathetic chain in the parapharyngeal space. Cervical sympathetic chain schwannomas represent a rare subgroup of schwannomas; fewer than 60 cases have been reported in the literature. These tumors are rarely seen in children and adolescents. Because patients typically present with an asymptomatic neck mass and vague complaints, clinical suspicion is important in making the diagnosis. Neural deficits at presentation are uncommon. The presence of features of Horner syndrome before excision is very rare, having been previously reported in only 10 cases of cervical sympathetic chain schwannoma. We report an extremely rare case of a cervical sympathetic chain schwannoma in a child who presented with Horner syndrome. The lesion was successfully excised.

Delayed recovery of speech discrimination after fractionated stereotactic radiotherapy for vestibular schwannoma in neurofibromatosis 2

February 12, 2014     Michael Hoa, MD; Eric P. Wilkinson, MD; and William H. Slattery III, MD
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Abstract

Hearing loss commonly occurs after radiation therapy for an acoustic neuroma, and it is highly unusual for hearing to return after a prolonged period of time. We report the case of a 12-year-old boy with neurofibromatosis 2 who underwent fractionated stereotactic radiotherapy for the treatment of a left-sided vestibular schwannoma. Following treatment, he demonstrated an elevation of pure-tone audiometric thresholds and a sudden decrease in speech discrimination score (SDS) to 0%. However, 20 months postoperatively, his SDS suddenly and spontaneously rose to 92%, although there was no improvement in his speech reception threshold. We discuss the possible reasons for the unusual outcome in this patient.

Intrapharyngeal schwannoma in a pediatric patient

June 11, 2013     Nader Nassif, MD; Mariaelisabetta Cottelli, MD; Davide Farina, MD; and Marco Berlucchi, MD
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Abstract

Schwannomas are benign peripheral nerve neoplasms that arise from Schwann cells. They usually occur in the adult population. The most common site in the head and neck region is the parapharyngeal space. Intrapharyngeal schwannomas are extremely rare, and those that have been reported all occurred in adults. We report what to the best of our knowledge is the first case of an intrapharyngeal schwannoma in a pediatric patient. The patient, a 15-year-old boy, was treated successfully with surgical excision.

Absent stapedial reflex: Otosclerosis or middle ear tumor?

February 25, 2013     Deb Biswas, FRCS-ORL, MS-ORL, MRCS, DOHNS; Ranjit K. Mal, FRCS
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Abstract

We present an unusual case in which a patient diagnosed as having otosclerosis on the basis of clinical and audiologic findings actually had a middle ear facial nerve schwannoma. To the best of our knowledge, this is the first reported case in English literature in which a facial nerve schwannoma presented with conductive deafness of gradual onset and absent stapedial reflex with a normally functioning facial nerve. We also include a review of the literature.

Laryngeal schwannoma excised under direct laryngoscopy: Case report

April 30, 2012     Iosif Vital, MD; Dan M. Fliss, MD; Jacob T. Cohen, MD
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Abstract

Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO2 laser, and preservation of the mucosal lining of the larynx was achieved.

A purely intracanalicular cochlear schwannoma presenting with progressive hearing loss

October 26, 2011     Hüseyin Işıldak, MD, Metin Ibrahimov, MD, Mehmet Yilmaz, MD, Ozgun Enver, MD, and Sait Albayram, MD
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Abstract

Schwannomas arising from the cochlear nerve and confined to the internal auditory canal are rare. Clinically, a cochlear schwannoma can cause a progressive hearing loss. We report the case of a 56-year-old woman with a cochlear schwannoma that manifested as a slowly progressive hearing loss. The lesion was diagnosed by gadolinium-enhanced 3-Tesla magnetic resonance imaging.

Schwannoma of the palatine tonsil

September 20, 2011     Neena Chaudhary, MS, Deepak Gupta, MS, and V. Natesh, MS
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Abstract

Schwannomas can originate in any peripheral, autonomic, or cranial nerve except the olfactory and optic nerves. Between 25 and 48% of all schwannomas have been reported to arise in the head and neck, with the acoustic nerve being the most common site of origin there. Schwannomas of the palatine tonsil are rare; as far as we know, only 6 such cases have been previously reported in the literature; 5 of these 6 occurred in adults and the other in an adolescent. We report a new case in a 42-year-old woman, which was diagnosed on the basis of histopathology.

Vagal Schwannoma

September 20, 2011     Regan W.J. Bergmark, BA, David P. Guo, BS, Harrison W. Lin, MD, William C. Faquin, MD, PhD, Geoffrey S. Young, MD, and Keith G. Saxon, MD
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