Schwannoma

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
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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.

A facial nerve schwannoma masquerading as a vestibular schwannoma

August 31, 2008     Amit Prasai, MRCS, Stephen E.M. Jones, FRCS (ORL-HNS), Justin Cross, MRCP, FRCR, and David A. Moffat, MA, FRCS
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Abstract

Schwannoma of the facial nerve is an extremely rare condition with an incidence far lower than that of vestibular schwannoma. We discuss the case of a woman who had been diagnosed as having vestibular schwannoma and referred to our hospital. Initially, we concurred with the diagnosis, but on reassessment of magnetic resonance imaging scans before surgery, we revised the diagnosis to facial nerve schwannoma. This allowed us to counsel the patient appropriately preoperatively regarding the expected outcome. We discuss the importance of this case and the lessons to be learned from it.

Auditory brainstem response threshold differences in patients with vestibular schwannoma: A new diagnostic index

July 31, 2008     Matthew L. Bush, MD, Raleigh O. Jones, MD, and Jennifer B. Shinn, PhD
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Abstract

Auditory brainstem response (ABR) testing is less sensitive in detecting small vestibular schwannomas than medium-size tumors. Magnetic resonance imaging (MRI) is more sensitive than ABR alone for small and large tumors, but it carries with it increased cost and issues of unavailability and patient discomfort. We conducted a prospective pilot study of 7 patients with untreated MRI-proven, unilateral vestibular schwannoma to determine if we could increase the sensitivity of ABR testing in detecting small tumors. Our method involved the use of a new ABR index that is based on threshold differences. All patients underwent pure-tone audiometry followed by a determination of behavioral threshold and neurodiagnostic threshold ABR in the normal ear, which was used as a control, and in the diseased ear. Analysis of results revealed that all 7 patients had an abnormal ABR threshold difference, and 5 patients displayed abnormal traditional ABR indices. The mean difference between the ABR and behavioral click thresholds was 41.4 dB in the diseased ears (with the ABR threshold being higher than the click threshold) and 15.8 dB in the normal ears. None of the control ears had a threshold difference >30 dB.

Vocal fold paralysis secondary to a jugular foramen schwannoma

September 30, 2007     Enrique Palacios, MD, FACR
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Vocal fold paralysis can be caused by deficits in the superior laryngeal nerve, recurrent laryngeal nerve, or the complete vagal nerve. When it occurs, the radiologist should examine the neck for the presence of a lesion along the course of the vagus nerve (cranial nerve X), which passes through the pars nervosa of the jugular foramen and along the carotid sheath

Transcranial trigeminal schwannoma

August 31, 2007     Daniel H. Coelho, MD; Nilesh Vasan, MD, FRACS
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A 51-year-old man fell while hiking and sustained a mild concussion and a fractured lower leg. Computed tomography (CT) of the head detected no intracranial pathology, but it did incidentallyshow a mass in the right infratemporal fossa. 

Paranasal sinus melanoma masquerading as chronic sinusitis and nasal polyposis

August 31, 2007     Brian Kung, MD; Geoffrey R. Deschenes, BA; William Keane, MD; Mary Cunnane, MD; Marie-Paule Jacob-Ampuero, MD; Marc Rosen, MD
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Abstract
Malignant melanoma of the nose and paranasal sinuses can be a devastating disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. It is an uncommon process, often misdiagnosed both clinically and pathologically. We present the case of an 80-year-old man who had a 2-month history of progressively worsening left-sided epistaxis and nasal obstruction. Radiographic evidence indicated the presence of soft tissue in the left maxillary sinus and nasal cavity resembling massive nasal polyposis and chronic fungal sinusitis. Magnetic resonance imaging was not performed because the patient had a pacemaker. After endoscopic debridement of the soft-tissue mass, frozen-section analysis detected no evidence of tumor. The final pathologic diagnosis was malignant melanoma. Otolaryngologists should be familiar with the difficulties inherent in the diagnosis and management of sinonasal melanomas.
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