Schwannoma of the nasal cavity

Nasal Cavity Schwannoma-A Case Report and Review of the Literature

Schwannomas are rare slow-growing benign tumors arising from Schwann cells lining the nerve sheaths. Head and neck schwannomas account for about one-third of all cases, and only 4% of them arise from the sinonasal tract. Its diagnosis is based on histology and immunohistochemistry. Complete surgical excision is the most recommended treatment option, and endoscopic surgery has been widely performed in recent years. In this study, we presented a case of a 55-year-old female with schwannoma arising from the lateral wall of the nasal cavity, causing epistaxis and rhinorrhea. The patient underwent endoscopic excision with prompt resolution of symptoms. The reported cases of nasal cavity schwannoma were reviewed and summarized for educational purposes.

Endoscopic Endonasal Approach for the Treatment of Benign Schwannoma of the Sinonasal Tract and Pterygopalatine Fossa

Schwannomas are tumors that rarely involve the sinonasal tract or the pterygopalatine fossa. Three cases of benign schwannomas originating in the nasal cavity, the nasal-ethmoid, and the pterygopalatine fossa are reported. Surgical treatment is considered the treatment of choice to achieve long-term success. In this study, the effectiveness of the endoscopic endonasal approach is outlined for the diagnosis and treatment of these benign tumors.

Schwannomas of the Nose and Paranasal Sinuses

Schwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusual location for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician will be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immuno-chemistry in the diagnosis and treatment of these tumors will be discussed.

Schwannoma of the Nasal Cavity

Schwannomas are benign peripheral nerve sheath tumors that occur throughout the body. They may present as either solitary or multiple masses. They rarely occur in the nasal cavity. The diagnosis is often made only after histologic examination. Because these lesions are radioresistant, the preferred treatment is complete surgical excision. We present a new case of a schwannoma of the nasal cavity.

Schwannoma of the Retropharyngeal Space

We report a rare case of schwannoma arising from the retropharyngeal space. A 24-year-old man presented a 2-month-history of a foreign body sensation in the throat and gradually progressing dysphagia when he swallowed solids and liquids. The patient had no odynophagia, fever, or blood in his saliva. Computed tomographic scans and magnetic resonance images revealed a well-defined and oval mass, measuring about 40 mm x 20 mm in size, in the retropharyngeal space. Because the tumor existed in the retropharyngeal space and was the adequate size, the patient underwent trans-oral resection under the direct laryngoscope without the need for skin incision. On the basis of the histological findings, the tumor was diagnosed as a schwannoma. It was mostly composed of spindle cells arranged in short bundles and fascicles, with focal palisading of the nuclei. The neoplasm arising from the retropharyngeal space is quite rare, because of few anatomical structures in the space. The post-operative course was uneventful, and the patient is currently free from disease 30 months after surgery. Diagnosis, clinical behavior, and treatment of retropharyngeal schwannoma are reviewed from perusal of the literature. When schwannomas are located in the pharynx, they may cause foreign body sensation or dysphagia. Therefore, when a foreign body sensation in the larynx is present, a thorough diagnostic procedure should be performed to evaluate the morphology of the upper aerodigestive tract.

Naso-ethmoid schwannoma with intracranial extension: case report

Intranasal schwannomas are rare lesions, specially when they present with an intracranial extension. The fifth case in the medical literature of a naso-ethmoid schwannoma with extension into the anterior cranial fossa is presented. The magnetic resonance findings and the details of the combined intracranial / transfacial operative approach used are described. The possible origin and the clinical characteristics of this rare lesion are reviewed.

Extended frontal approach with bilateral orbitofrontoethmoidal osteotomies for removal of a giant extracranial schwannoma in the nasopharynx, sphenoid sinus, and parapharyngeal space

BACKGROUND

Although parapharyngeal schwannomas are not uncommon, schwannomas of the nasopharynx and paranasal sinuses are rare lesions. In the absence of intracranial extension, they are usually removed with transantral, lateral rhinotomy or more complex transfacial approaches.

CASE DESCRIPTION

We report a 24-year-old patient with a giant benign schwannoma involving the superior parapharyngeal space, pterygopalatine fossa, nasopharynx, and sphenoid sinus with erosion into the clivus that was removed with an extended frontal approach including bilateral orbitofrontoethmoidal osteotomies.

CONCLUSION

The advantages of the extended subfrontal over more standard transfacial approaches for lesions in this location include the early dissection of critical neural structures, preserving cosmetics and facilitating management of an inadvertent cerebrospinal fluid leak.

Solitary neurofibroma of the inferior nasal turbinate

We present a case of neurofibroma of the nasal inferior turbinate operated under endoscopic control. A 29 year-old female reported progressive left-side nasal obstruction over the past year. Endoscopic examination revealed a mass arising from the left inferior turbinate. Evaluation of multiple sections of the mass by hematoxylin and eosin, S-100 protein and neuron specific enolasa stains showed the tumor to be a neurofibroma.

Infantile schwannoma of the maxillary sinus

A rare case of a 5-year-old female with schwannoma of the maxillary sinus is presented. She had complained of painless swelling of the left cheek and hard palate for a duration of one year. Preoperatively, a CT scan strongly suggested it to be a maxillary cyst with an erupted tooth rather than neoplasm. The tumour was completely removed after embolization of the left internal maxillary artery. The tumour was composed of spindle cells in a palisading pattern and intercellular collagenous fibres. Mitotic figures and atypical nuclei were not observed. Immunohistochemically, the majority of the cells were positive for NSE and S-100 protein, whereas GFA and PCNA showed little immunoreaction. The pathological diagnosis was Antony type A of schwannoma arising in the maxillary sinus.

Nasal septal neurinoma

A case of nasal septal neurinoma is presented. The patient was a 71-year-old male who complained of nasal obstruction and epistaxis. Results of the physical examination showed a giant mass filling the nasal cavity and the nasopharynx. A biopsy taken from its tissue surface showed histological features of neurofibroma. The lesion was completely resected with the patient under general anesthesia. The tumor completely occupied the right nasal cavity and the nasopharynx, partially penetrated the nasal septum and extended to the left nasal cavity. After the operation, the final pathological diagnosis was not neurofibroma but neurinoma in which Antoni type A and type B cells were mixed. The postoperative course was uneventful, and no recurrence has been observed to date.

Benign nasal schwannoma

Nerve sheath tumours of the head and neck region mainly involve the eighth cranial nerve with only 4 per cent occurring in the paranasal sinuses. Only 32 cases of benign schwannomas occurring in the paranasal sinuses have been reported. We present a further case, review the current literature, and discuss the clinical details and specific histological features.

Intracranial extension of a naso-ethmoid schwannoma

A rare case of intracranial extension of a naso-ethmoid schwannoma is presented. Its subsequent removal with few sequelae confirmed the benign nature and good prognosis of the disease.

A rare cause of nasal obstruction: a solitary neurofibroma

This case represents a peripheral nerve sheath tumor as a cause of nasal obstruction. Nerve sheath tumors are relatively uncommon; however, most otolaryngologists will encounter them. These tumors develop from cranial and spinal nerve roots and from peripheral nerves. In total, approximately 25% to 44% of nerve sheath tumors occur in the head and neck region. Although the most important are cranial nerve tumors--the majority being acoustic neuromas arising from the vestibular nerve--they may also develop in the nasal cavity.

Nasal schwannoma

A 36-year-old man with a nasal septal mass is presented. The diagnosis of a benign neoplasm arising from peripheral nerve Schwann cells was made by excisional biopsy. A benign nerve sheath tumor may be either a schwannoma or neurofibroma. Schwannomas may be distinguished from neurofibroma by clinical and histologic criteria. Malignant degeneration and intracranial extension may complicate the course of a nasal schwannoma. Complete excision is the preferred therapy.

Neurilemmoma involving the maxillary sinus: a case report

A case is reported of a neurilemmoma arising from the maxillary sinus. Its aetiology, presentation, histology and treatment are discussed.

Nonepithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx. A clinicopathologic study. XII: Schwann cell tumors (neurilemoma, neurofibroma, malignant schwannoma)

Twelve Schwann cell tumors (two neurilemomas, six neurofibromas, and four malignant schwannomas), arising in the nasal cavity, paranasal sinuses or nasopharynx, are described. Schwann cell neoplasms only rarely develop in this area. Clinically, these tumors lead to nonspecific symptoms including nasal obstruction epistaxis, facial pain and swellling, and proptosis, similar to those produced by other neoplasms that involve this area. On radiologic examination, a mass lesion may be identified. Benign Schwann cell tumors may lead to bone erosion, which thus is not necessarily a sign of malignancy. The correct diagnosis of Schwann cell tumor is usually made only when histologic sections are studied. The histologic differentiation between Schwann cell neoplasms and myxomas, fibroblastic tumors, fibrous histiocytomas and fibro-osseous lesions is discussed. Treatment depends upon the type of tumor. Neurilemomas, which usually are encapsulated neoplasms, can be treated by local excision. Neurofibromas may infiltrate extensively, and thus may require an extensive surgical resection; however, functional and cosmetic considerations should be taken into account because neurofibromas, even if incompletely excised, may recur clinically only after many years. Malignant schwannomas tend to be aggressive neoplasms, but because of the anatomy of the area, radical resections leading to complete removal of the tumor cannot always be carried out.

Management of paranasal sinus schwannomas

Schwannomas arising in the nasal cavities and paranasal sinuses are rare entities, with only sporadic cases appearing in the world literature. The lesion most commonly arises in the ethmoid and maxillary sinuses, with two cases having been reported in the sphenoid sinus. There are no reported cases of frontal sinus schwannoma. Four illustrative cases are presented which demonstrate the clinical features. The radiological investigation should include plain films and anteroposterior and lateral polytomography. Computerized tomography appears to be useful in planning surgery. An operative approach is approach is proposed which emphasizes a meticulous and complete removal of the lesion with preservation of adjacent structures and repair of any resultant dural defect.

Peripheral nerve sheath tumors of the paranasal sinuses

Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses. The most commonly involved sinus is the maxillary antrum and the most common histologic type is benign schwannoma. Two new cases of schwannoma occurring in the sphenoid and maxillary sinuses are reported. The clinical pathologic, and radiographic features of these lesions are reviewed.