Schwannoma

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.

Syndromes after resection of a cervical schwannoma

September 20, 2011     Michael J. Boros, MD and Stephen T. Wysong, MD, FACS
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Abstract

Cervical schwannomas are rare, as fewer than 250 cases have been reported in the literature. The preferred method of removing a schwannoma is enucleation. Complications of schwannoma excision include Horner syndrome, first-bite syndrome, and Pourfour du Petit syndrome. These complications are usually transient and in most cases do not require treatment. Pourfour du Petit syndrome, which is the converse of Horner syndrome, occurs with stimulation of the sympathetic cervical chain. We report a case of cervical schwannoma in a 44-year-old woman who developed signs suggestive of both Horner syndrome and Pourfour du Petit syndrome following excision of the lesion. We discuss the diagnostic workup, surgical treatment, and likely sequelae of this pathology.

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

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.

Bilateral multicanal benign paroxysmal positional vertigo coexisting with a vestibular schwannoma: Case report

January 1, 2011     Selmin Karatayli-Ozgursoy, MD, Greta C. Stamper, AuD, Larry B. Lundy, MD, and David A. Zapala, PhD
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Abstract

We describe a rarely encountered case of coexisting bilateral multicanal benign paroxysmal positional vertigo (BPPV) and vestibular schwannoma in a 56-year-old woman. The patient had presented with a 10-year history of dizziness and imbalance, and her vestibular findings were perplexing. We decided on a working diagnosis of BPPV and began treatment. After several months of canalith repositioning maneuvers had failed to resolve her symptoms, we obtained magnetic resonance imaging, which revealed the presence of the vestibular schwannoma. This case serves as a reminder of the importance of differentiating between central and peripheral vestibular disorders, as well as central and anterior canal BPPV-induced down-beating nystagmus in order to establish the correct diagnosis and initiate appropriate treatment.

Nasal tip schwannoma

August 31, 2010     Michele P. Morrison, DO

A unique case of a sublingual-space schwannoma arising from the mylohyoid nerve

June 30, 2010     Kavita Malhotra Pattani, MD, Kevin Dowden, MD, and Cherie-Ann O. Nathan, MD, FACS
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Abstract

We describe a unique case of a sublingual-space schwannoma presenting as a painless, 3 x 2-cm enlarging mass in the oral cavity of a 63-year-old man. Computed tomography demonstrated a distinct, well-encapsulated mass in the right side of the floor of the mouth. Findings on fine-needle aspiration cytology were consistent with a pleomorphic adenoma. Transoral excision was performed. Intraoperatively, the mass appeared to involve the nerve to the mylohyoid muscle. Upon removal, the gross tumor measured 4.4 x 3.5 x 2.5 cm. On microscopic examination, the spindle-cell neoplasm was found to be consistent with a schwannoma. Schwannomas of the sublingual space are exceedingly rare. Moreover, to the best of our knowledge, this case represents the first published occurrence of a schwannoma that arose from the mylohyoid nerve.

Solitary nasal schwannoma clinically presenting as an angiofibroma of the nasopharynx

June 30, 2010     S.C. Gupta, MS, Jain Sachin, MS, Saxena Savyasachi, MS, Jaiswal Ritesh, MBBS, Garg Neha, MBBS, and Himanshu P. Singh, MBBS
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Abstract

Benign schwannomas of the nasal cavity are rare. When they do occur, their clinical presentation is variable, and some are fairly vascular. We report the case of a 17-year-old boy who presented with epistaxis associated with a unilateral nasal mass that extended into the nasopharynx. The tumor was removed via a transpalatal approach. In most such cases, a clinical diagnosis of angiofibroma is made. In this case, however, histopathologic examination identified the lesion as a schwannoma.

An asymptomatic schwannoma of the nasal septum: Report of a unique case

December 1, 2009     Fabio Pagella, MD, Georgios Giourgos, MD, Elina Matti, MD, and Andrea Colombo, MD
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Abstract

Schwannomas of the nasal septum are extremely rare, and therefore their diagnosis and treatment can pose certain challenges. We describe the case of an incidentally discovered schwannoma of the nasal septum that was unique in that the lesion was completely asymptomatic. In view of our finding, we believe that routine examinations of both nasal fossae should be considered during routine diagnostic laryngeal flexible endoscopy.

Columellar schwannoma

September 30, 2009     Taylor Tidmore, MD, Karen H. Calhoun, MD, Scot Hirschi, MD, and Ronald Miick, MD
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Abstract

Schwannomas of the nose or paranasal sinuses are very rare. In fact, only 19 cases of schwannoma of the nasal septum have been reported in the otolaryngology literature. In all of those cases, only the cartilaginous or bony septum was involved. To the best of our knowledge, no case of soft-tissue involvement of the columella has been documented until now. We report a case of a columellar schwannoma in a 57-year-old white man. The mass was easily palpated on physical examination, and it was removed surgically. We summarize this case and discuss the incidence, general characteristics, radiographic findings, pathology, and treatment of schwannomas.

Intraparotid facial nerve schwannoma: Clinician beware

July 31, 2009     Neil Tanna, MD, MBA, Philip E. Zapanta, MD, Leela Lavasani, MD, and Nader Sadeghi, MD
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Abstract

Intraparotid facial nerve schwannomas are rare neoplasms that are challenging to diagnose and manage. Many patients present with a painless, palpable facial mass. The presence of facial paralysis is variable. Imaging studies and fine-needle aspiration cytology are not always helpful in preoperative diagnosis. With early diagnosis of facial nerve schwannoma, management of the patient can be planned and, ultimately, facial nerve function optimized. By reviewing the literature and 2 cases from a series of patients seen in our practice, we provide insight into the current diagnosis and treatment of a rare pathology.

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