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Lopez J, Hamill EB, Burnstine M. Orbital schwannoma management: a case report, literature review, and potential paradigm shift. Orbit 2022; 41:15-27. [PMID: 33397169 DOI: 10.1080/01676830.2020.1858431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To present a case of orbital schwannoma and assess the literature on treatment modalities. METHODS A MEDLINE literature search for cases of orbital schwannomas was performed using the PubMed search tool using the search terms "orbital schwannoma" and "orbital neurilemmoma." Papers were included if they were peer-reviewed, published in English, discussed management, and included the search terms. Each article was rated using the scale developed by the British Centre for Evidence-Based Medicine. In addition, we present a case report of an orbital schwannoma. RESULTS A total of 428 articles were found. 102 met the criteria for inclusion. Only two articles met Level 1 evidence and 16 were important to the clinical care process. We report a case of a biopsy-proven orbital schwannoma managed conservatively with observation over a 4-year period due to risk of cosmetic disfigurement with tumor removal. There has been no change in tumor size and no associated complications during follow up. CONCLUSIONS There is a paucity of data on the natural history of orbital schwannomas. Based on our review of the literature, we recommend observation for asymptomatic or minimally symptomatic orbital schwannomas with minimal growth over an extended period of time. For rapidly growing tumors or large tumors affecting key structures causing visual loss, diplopia, aesthetic disfigurement, or patient discomfort, a more aggressive approach may be necessary.
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Affiliation(s)
- Jennifer Lopez
- Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Eric B Hamill
- Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
- Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine, University of Southern Califonrnia, Los Angeles, CA, USA
| | - Michael Burnstine
- Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
- Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine, University of Southern Califonrnia, Los Angeles, CA, USA
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2
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Affiliation(s)
- Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Ribeiro SFT, Queirós T, Amorim JM, Ferreira AM, Sales-Sanz M. An Unusual Differential Diagnosis of Orbital Cavernous Hemangioma: Ancient Schwannoma. Case Rep Ophthalmol 2017. [PMID: 28626414 PMCID: PMC5471764 DOI: 10.1159/000473697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Schwannomas are rare lesions of the orbit that can be confused with cavernous hemangioma on imaging studies. We report the case of an 84-year-old woman with a 9-year history of a tumoral lesion in the inferolateral left orbit. The imaging studies did not reveal specific characteristics, only bone remodeling due to the long evolution of the tumor. The patient underwent complete excision of the tumor by anterior orbitotomy via the inferior conjunctival fornix. The histopathological examination revealed an ancient schwannoma, a variant of schwannoma with uncommon histological features. The follow-up was uneventful. The present case emphasizes the importance of considering neural tumors in the differential diagnosis of orbital masses with bone changes and degenerative alterations such as hemorrhagic areas, cysts, and/or calcifications.
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Affiliation(s)
- Sara Filipa Teixeira Ribeiro
- Orbit and Oculoplastic Surgery Unit, Ophthalmology Department, Hospital de Braga, School of Health Sciences, University of Minho, Braga, Portugal.,Ophthalmology Department, Hospital Lusíadas, Porto, Portugal
| | - Tatiana Queirós
- Orbit and Oculoplastic Surgery Unit, Ophthalmology Department, Hospital de Braga, School of Health Sciences, University of Minho, Braga, Portugal
| | - José M Amorim
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Ana M Ferreira
- Pathologic Anatomy Department, Hospital de Braga, Braga, Portugal
| | - Marco Sales-Sanz
- Orbit and Oculoplastic Surgery Unit, Ophthalmology Department, Hospital Universitario Rámon y Cajal, IRYCIS, Oculoplastic Surgery Unit, Novovision, Madrid, Spain
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4
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Orbital peripheral nerve sheath tumors. Surv Ophthalmol 2017; 62:43-57. [DOI: 10.1016/j.survophthal.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023]
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5
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Kulkarni AS, Anjum S, Kokandakar HR, Bindu RS, Awargaonkar A. Ancient schwannoma of the orbit. Oman J Ophthalmol 2014; 7:66-8. [PMID: 25136229 PMCID: PMC4134548 DOI: 10.4103/0974-620x.137146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The ancient schwannoma is a rare variant of a neurilemoma with a course typical of a slow-growing benign neoplasm. Histologically, it can be confused with a malignant mesenchymal tumor because of increased cellularity, nuclear pleomorphism, and hyperchromatism. Despite the degree of nuclear atypia, mitotic figures are absent. We describe the clinical and histopathologic features of an ancient schwannoma of the orbit. A need for early removal of such tumors is recommended to prevent complications.
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Affiliation(s)
- Anjali S Kulkarni
- Department of Pathology, Government Medical College, Aurangabad, Maharashtra, India
| | - Shaziya Anjum
- Department of Pathology, Government Medical College, Aurangabad, Maharashtra, India
| | - Hemant R Kokandakar
- Department of Pathology, Government Medical College, Aurangabad, Maharashtra, India
| | - Rajan S Bindu
- Department of Pathology, Government Medical College, Aurangabad, Maharashtra, India
| | - Amarnath Awargaonkar
- Department of Opthalmology, Government Medical College, Aurangabad, Maharashtra, India
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6
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A patient with swelling of the eyelid: ancient schwannoma of the supraorbital nerve (2010:6b). Eur Radiol 2010; 20:2301-4. [PMID: 20680630 DOI: 10.1007/s00330-009-1659-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 10/17/2009] [Indexed: 10/19/2022]
Abstract
We present a case of swelling of the eyelid and supraorbital anesthesia caused by an intraorbital tumor. The differential diagnosis based on imaging consisted of aneurysmal bone cyst, schwannoma, neurofibroma, dermoid cyst, and cavernous hemangioma. The surgical and pathological diagnosis was an ancient schwannoma of the orbit, a rare entity.
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8
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9
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Sales-Sanz M, Sanz-Lopez A, Romero JAC. Bilateral Simultaneous Ancient Schwannomas of the Orbit. Ophthalmic Plast Reconstr Surg 2007; 23:68-9. [PMID: 17237700 DOI: 10.1097/iop.0b013e31802d97dd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An unusual case of purely cystic bilateral ancient schwannomas of the orbit is reported. Complete ophthalmologic examination and CT was performed. Diagnosis was established by excisional biopsy of both tumors, including clinicopathologic study. Histologic examination showed a bilateral purely cystic ancient schwannoma. This case underlines the importance of considering neural tumors, including schwannomas, in the differential diagnosis of both cystic and bilateral orbital tumors. As far as we know, no other case has been previously reported.
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10
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Abstract
"Ancient schwannomas" of the mouth floor are rare, benign neoplasms derived from the nerve sheath of peripheral nerves. They show many degenerative changes such as necrosis and vascular thrombosis. Ancient schwannomas show histopathological features, such as degenerative changes and atypical nuclei, and may easily be confused with malignant neoplasms. B-scan sonography for the mouth floor and MRT imaging may be helpful in differential diagnosis. Here, we report on a patient with ancient schwannoma of the floor of the mouth.
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Affiliation(s)
- T Zehlicke
- Abteilung für Hals-, Nasen-, Ohrenheilkunde, Kopf-, Halschirurgie, Bundeswehrkrankenhaus Hamburg.
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11
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Bayindir T, Kalcioglu MT, Kizilay A, Karadag N, Akarcay M. Ancient schwannoma of the parotid gland: a case report and review of the literature. J Craniomaxillofac Surg 2005; 34:38-42. [PMID: 16343919 DOI: 10.1016/j.jcms.2005.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2005] [Accepted: 08/16/2005] [Indexed: 11/19/2022] Open
Abstract
Schwannomas are encapsulated benign tumours arising from nerve sheath cells, of which ancient schwannoma is one of five variants. Since the first description, only a few ancient schwannomas have been reported in different locations in the head and neck region. In the parotid gland, this tumour is very rare. In this report, a 41-year-old female patient with an ancient schwannoma of the parotid gland is presented and the data of this patient compared with other (comparable) cases described in the literature.
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Affiliation(s)
- Tuba Bayindir
- Department of Otorhinolaryngology, Inonu University, School of Medicine, Turgut Ozal Medical Center, Malatya 44069, Turkey
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Ugokwe K, Nathoo N, Prayson R, Barnett GH. Trigeminal nerve schwannoma with ancient change. Case report and review of the literature. J Neurosurg 2005; 102:1163-5. [PMID: 16028782 DOI: 10.3171/jns.2005.102.6.1163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ancient change in a schwannoma is a histological variant typically found in longstanding tumors. Histologically, the tumor has biphasic features typical of a schwannoma with evidence of degenerative changes that may complicate diagnosis. The authors report on a 23-year-old man with no features of neurofibromatosis who presented with headaches, blurred vision, and ataxic gait. Magnetic resonance imaging demonstrated a rim-enhancing lesion in the cerebellopontine angle with displacement of brainstem structures and no supratentorial hydrocephalus. Using a lateral suboccipital approach together with image guidance and intraoperative neurophysiological monitoring, a gross-total macroscopic excision was performed. At surgery, the tumor was found to arise from the inferior division of the trigeminal nerve. The final histological diagnosis was schwannoma with ancient change. Note that ancient change in schwannomas is a histological variant thought to result from degenerative changes in longstanding tumors. To the authors' knowledge, this is the first independent report of this histological variant in an intracranial schwannoma.
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Affiliation(s)
- Kene Ugokwe
- Brain Tumor Institute, Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Kapur R, Mafee MF, Lamba R, Edward DP. Orbital Schwannoma and Neurofibroma: Role of Imaging. Neuroimaging Clin N Am 2005; 15:159-74. [PMID: 15927866 DOI: 10.1016/j.nic.2005.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Schwannomas are well-circumscribed ovoid masses that most commonly present in the superior orbit. Although it may be difficult to differentiate these benign masses from other orbital tumors on radiologic imaging, the CT and, in particular, the MR imaging characteristics can sometimes point to the diagnosis of a nerve sheath tumor. A definitive diagnosis can be made through correlation with histopathologic findings, however. In most cases, schwannomas have low malignant potential, and with total excision, recurrence is rare.
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Affiliation(s)
- Rashmi Kapur
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, MC 648, 1855 West Taylor Street, Chicago, IL 60612, USA
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Abstract
A 65-year-old woman presented with a 3 month history of right eye discomfort and protrusion. Examination revealed right proptosis with hypoglobus and diplopia in extremes of upgaze. Computed tomographic scanning revealed a large extraconal mass in the superotemporal orbit. The mass was excised through an extended superior skin crease incision. Histopathology revealed a benign tumour of Schwann cell origin showing advanced cystic degeneration, the so-called 'ancient schwannoma'. The authors could find only two previously reported cases of such tumours arising in the orbit.
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Affiliation(s)
- Gregory Moloney
- Department of Ophthalmology, Pacific Laboratory Medicine Services, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Abstract
Primary tumors of the optic nerve (optic nerve sheath meningiomas and optic nerve astrocytomas) are important causes of visual morbidity. They may elude clinical detection and have the potential to be lethal. Their treatment remains controversial but often includes radiation. The optic nerve may be involved secondarily by peripheral nerve tumors in the orbit or by metastatic and infiltrative neoplasms. Optic neuropathy may also develop as a result of treatment of these tumors. Recent contributions to the literature concerning the diagnosis and management of neural orbital tumors are reviewed.
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Affiliation(s)
- W A Cantore
- Department of Ophthalmology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033, USA
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