Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study

Intraosseous benign peripheral nerve sheath tumor of the jaws: report of 4 new cases and a comprehensive literature review

Benign peripheral nerve sheath tumors (BPNSTs) are a vast, common, heterogeneous group of lesions that are often diagnostically challenging. The head and neck region is recognized as the second most common location for these lesions, especially the tongue. However, BPNSTs occurring centrally within the jaw bones are exceedingly rare. To date, approximately 161 cases of intraosseous BPNSTs have been reported in the jaws. This group mainly includes the relatively more common neurofibromas and schwannomas, and the less common perineuriomas and hybrid forms. Unlike soft tissues, schwannomas are the most common BPNSTs occurring within the jaws, followed by neurofibromas and perineuriomas. These neoplasms can present as a well-defined unilocular lesion or as an ill-defined multilocular image, resembling several types of benign and malignant lesions of odontogenic origin. The aim of the current study was to report 4 new cases of intraosseous BPNSTs and a comprehensive literature review.

Oral granular cell tumors: an analysis of the clinical and histopathologic features of 126 tumors

OBJECTIVE

To characterize the clinical and histologic features of oral granular cell tumors (GCTs).

STUDY DESIGN

A retrospective search of the archives of our diagnostic oral pathology service was performed for GCTs diagnosed between 1989 and 2023. A total of 126 tumors in 122 patients were retrieved.

RESULTS

There was a female predilection with a female-to-male ratio of 2.3:1. The age range was 5-73 years (mean = 33.3). The most commonly involved site was the tongue (81.0%), followed by the lips (7.9%). Most GCTs were pink, but many lesions appeared yellow or white. Histologically, most GCTs were sessile masses comprised of sheets or nodules of tumor cells. Uncommonly, GCTs were pedunculated (3.2%), papillary (2.4%), ulcerated (3.2%), or desmoplastic (11.1%). Pseudoepitheliomatous hyperplasia, histologically mimicking squamous cell carcinoma, was present in 25.4% of tumors. While 65.9% of GCTs demonstrated positive surgical margins, only 3 tumors recurred.

CONCLUSIONS

To the best of our knowledge, this is the largest series of oral GCTs with a comprehensive analysis of the clinical and histologic features. It is important for clinicians and pathologists to be aware of the spectrum of features observed in GCTs in order to avoid erroneous classification as malignancy.

Epidemiological, Clinical, and Histopathological Features of the Head and Neck Region Schwannomas-Our Experience in the Western Part of Romania with Surgical Insights

INTRODUCTION

Schwannomas are benign solitary, slow-growing, encapsulated, asymptomatic tumors arising from Schwann's sheath of nervous fibers.

OBJECTIVES

The current paper presents all the cases diagnosed with different types of schwannomas in the head and neck region between January 2009 and December 2023 in the Western part of Romania. In this period, ten cases of schwannoma were identified.

MATERIALS AND METHODS

The pathological exams were performed at the Department of Pathology using morphological Hematoxylin-Eosin staining. In addition, immunohistochemical reactions were used in order to confirm the diagnosis.

RESULTS

Demographic and clinical data, imaging features, surgical approach, and morphological and immunohistochemical aspects are presented. The results also display an impressive clinical picture of a gigantic ancient schwannoma.

CONCLUSIONS

This retrospective study describes our experience with head and neck schwannomas, the diagnostic methods available, the surgical decisions, and the histopathological aspects while analyzing the data and reviewing the published specialized literature in the English language.

Oral granular cell tumor: a collaborative clinicopathological study of 61 cases

BACKGROUND

Granular Cell Tumor (GCT) is an uncommon benign lesion in the oral cavity whose pathogenesis remains poorly understood. Due to their infrequent occurrence and similarity to other oral lesions, they are often forgotten during the initial clinical diagnosis. Therefore, understanding its prevalence, clinical and pathological characteristics is crucial for an accurate diagnosis and adequate management.

METHODS

All cases diagnosed as GCTs in six Brazilian and Argentinian oral diagnostic centers were re-evaluated by HE staining, and clinical, demographic, and histopathological data were collected and evaluated.

RESULTS

The series comprised 45 female (73.8%) and 16 male (26.2%), with a 2.8:1 female-to-male ratio and a mean age of 35.3 ± 16.9 years (range: 7-77 years). Most cases occurred on the tongue (n = 49; 81.6%) and presented clinically as asymptomatic papules or nodules (n = 50; 89.3%) with a normochromic (n = 25; 45.5%) or yellowish (n = 11; 20.0%) coloration and sizes ranging from 0.2 to 3.0 cm (mean ± SD: 1.40 ± 0.75 cm). Morphologically, most tumors were characterized by a poorly delimited proliferation (n = 52; 88.1%) of cells typically rounded to polygonal containing abundant, eosinophilic, finely granular cytoplasm. Pustulo-ovoid bodies of Milian were identified in all lesions (n = 61; 100%). Entrapment of skeletal striated muscle (n = 44; 72.1%) and nerve fibers (n = 42; 68.9%) were common findings. Pseudoepitheliomatous hyperplasia (PEH) was observed in 23 cases (39.0%). In only 27.7% of cases (n = 13) there was agreement between the clinical and histopathological diagnosis. Outcome information was available from 16 patients (26.2%), with clinical follow-up ranging from 4 to 36 months (mean 13.3 months), and none developed local recurrence.

CONCLUSIONS

The clinical and histopathological features of GCTs were consistent with those described in previous studies. In general, these lesions have a predilection for the lateral region of the tongue in adult women. It is essential to consider GCTs in the differential diagnosis of yellow or normochromic papules and nodules in the oral cavity. Histopathological evaluation is essential for the definitive diagnosis and the prognosis is excellent.

Lingual nerve revisited-A comprehensive review Part II: Surgery and radiology

The lingual nerve (LN) is a branch of the mandibular division of the fifth cranial nerve, the trigeminal nerve, arising in the infratemporal fossa. It provides sensory fibers to the mucous membranes of the floor of the mouth, the lingual gingiva, and the anterior two-thirds of the tongue. Although the LN should rarely be encountered during routine and basic oral surgical procedures in daily dental practice, its anatomical location occasionally poses the risk of iatrogenic injury. The purpose of this section is to consider this potential LN injury risk and to educate readers about the anatomy of this nerve and how to treat it.

Ancient Schwannoma: Case Report of an Unusual Entity in an Unusual Oral Location

BACKGROUND Schwannoma is an uncommon benign tumor that develops from Schwann cells in the peripheral nervous system; 25-50% of such tumors occur in the head and neck. A rare variety of schwannoma, known as an ancient schwannoma, exhibits calcification, cystic degeneration, hemorrhage, myxoid stroma, pleomorphism, and nuclear hyperchromatism. Such characteristics may contribute to this tumor being incorrectly diagnosed as malignant. Almost all reported intra-oral ancient schwannomas behave innocuously. CASE REPORT A 20-year-old man presented to the oral surgery clinic with a right facial swelling that began a few months before. CT and MRI were performed and showed a well-defined cystic lesion anterior to the right masseter muscle, located in the subcutaneous area and measuring 28×24×20 mm. No extension to the surrounding tissues nor any other similar lesions were seen. Microscopic examination revealed an encapsulated nodular mass with cystic cavities, hemorrhage, and variably distributed myxoid and hyalinized stroma. The tumor demonstrated 2 distinct cell distributions: hypercellular areas (Antoni A) and myxoid hypocellular areas (Antoni B). Focal areas in high-power magnification showed atypical cells with hyperchromatic and pleomorphic nuclei. The tumor cells showed diffuse positivity for S-100 in IHC. The diagnosis of ancient schwannoma was made. At 1-year follow-up, there was no evidence of nerve injury or recurrence. CONCLUSIONS One more case of oral ancient schwannoma is added to the literature. This is the first reported in Saudi Arabia. It is prudent to be familiar with the degenerative and cytologic alterations of ancient schwannoma, as this may limit the likelihood of misdiagnosis and unnecessary treatment of this benign tumor, with an excellent prognosis.

An update on oral peripheral nerve sheath tumors

Peripheral nerve sheath tumors (PNSTs) are defined as type of sarcomas that develops in cells which forms a protective sheath (covering) around the peripheral nerve, i.e., the cells of myelin sheath. Nerve tumors are of neuroectodermal in origin as it was composed of small rounded ectodermal cells that affect exclusively soft tissues. PNSTs are most common neoplasm with classic clinicopathological features, but they are diagnostically challenging. They consist of wide spectrum of tumors ranging from benign tumors to malignant nerve sheath tumors and its prevalent in oral tissues. Diagnosis of PNSTs are quite hectic but made possible by histopathology and immunohistological markers.

Analysis of Clinical, Radiographic, and Treatment Profile of 10 Cases of Neurogenic Tumors and Tumor-Like Lesions of the Oral and Maxillofacial Region: An Observational Study

Background:

Soft tissues of the head and neck areas are a very frequent site of occurrence of certain benign tumors of the peripheral nerve sheath, especially the neurofibromas. Hence, the present study was conducted for assessing clinical, radiographic, and treatment profile of 10 cases of neurogenic tumors and tumor-like lesions of the oral and maxillofacial region.

Materials and Methods:

Data records of a total of 10 patients who were diagnosed with tumors of neurogenic origin were enrolled in the present study. Data files were analyzed over a time period of 2 years, and complete clinical and radiographic details were evaluated. All the patients in which incomplete information was present in the record files were excluded from the present study. The assessment of the histopathologic reports was done, and final diagnosis was recorded separately in the master chart.

Results:

Neurofibroma was the diagnosis in two cases. In another set of two cases, final diagnosis of traumatic neuroma was achieved. A single case Schwannoma of mandible depicting multilocular radiolucency was present. Granular cell tumor was present in three cases. It was present clinically in the form of swelling, ulcerative nodule, and nodular growth in the three respective cases. Surgical excision was carried out in all the cases, and follow-up records did not depict any case of recurrence of complication posttreatment.

Conclusion:

Neurogenic tumors of oral and maxillafacial region are a rare phenomenon and mainly present in the form of benign neoplasm. However, careful recognition and diagnosis of these lesions are necessary to rule any possible malignant changes.

Palisaded encapsulated neuroma in tongue - A commonly misdiagnosed peripheral nerve sheath tumor

Palisaded encapsulated (solitary circumscribed) neuromas are benign neural tumors, rarely found in oral mucosa. This case reports a 24-year-old man that presented a unique soft nodule at the left side of the tongue. An excisional biopsy was performed under local anesthesia and histopathological examination of the surgical specimen revealed a well circumscribed mass composed of spindled Schwann cells, often aligned and fasciculated, forming occasional nodules embedded in a fibrous stroma. Histopathological analysis showed the presence of positive cells for S-100, EMA, CD57, and collagen IV. Based on clinical and microscopical features, the diagnosis established was of palisaded encapsulated neuroma. This case report aims to discuss the differential diagnosis among palisaded encapsulated neuroma and the other neural tumors that affect the oral mucosa.

Acute coronary syndrome: Uncommon presentation of multiple endocrine neoplasia

INTRODUCTION

Myocardial infarction is usually due to thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable atherosclerosis plaque. There is also the acute myocardial infarction with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction with non-obstructive coronary arteries (MINOCA) such as Takotsubo, myocarditis and catecholamine induced cardiomyopathy. Pheochromocytoma is one of the causes of MINOCA. This association is rare but it may delay diagnosis and must be known in order to provide the best chance at early detection. This work has been reported in the line with the SCARE criteria.

PRESENTATION OF THE CASE

We report a case of a 49 year-old man, admitted to our department for a recurrence of myocardial infarction with angiographically normal coronary arteries. During his hospitalization the patient complained of intestinal haemorrhage. The abdominal Computed tomographic scan revealed bilateral adrenal mass. The diagnosis of pheochromocytoma was made and confirmed by a high level of normetanephirnes and metanephrines.

DISCUSSION

The coexistence of multiple endocrine neoplasia type 2 and myocardial infarction appears to be a rare association rather than a coincidence.

CONCLUSION

In this case we highlight the importance of thorough history taking and investigation for the determining the aetiology of MINOCA. As a reversible cause of myocardial dysfunction, catecholamine-induced cardiomyopathy can occur as a feature of multiple endocrine neoplasia. The prognosis depends greatly on early diagnosis and prompt medical and surgical treatment, which are unfortunately often delayed because of the challenging diagnosis in many cases.

Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview

Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease.

Benign connective and soft-tissue neoplasms of the oral and maxillofacial region: Cross-sectional study of 1066 histopathological specimens

BACKGROUND

Benign connective and soft-tissue neoplasms (CSTNs) are unusual in the head and neck region. The aim of the present study was to evaluate the demographic and clinicopathological features of these neoplasms.

METHODS

A cross-sectional study was conducted of cases diagnosed as benign CSTNs, with data collected from biopsy records. The chi-square test was used. A p-value <0.05 was considered indicative of statistical significance.

RESULTS

Among the 38 119 specimens, 1066 (2.79%) were benign CSTNs: 369 fibroblastic/myofibroblastic, 250 adipocytic, 179 vascular, 130 neural, 94 osseous/cartilaginous, 19 muscular, and two fibrohistiocytic. Most patients were female (62.8%) and white-skinned (45.8%). Mean age was 42 years. The tongue (25.2%) was the most affected site for extraosseous neoplasms.

CONCLUSION

This study had the largest sample of benign oral and maxillofacial CSTNs. Although these tumors have similar clinical features, the characterization and differentiation detailed here may help clinicians with regards to the correct diagnosis.

Palatal Soft Tissue Myxoma in a Patient with Carney Complex

Carney complex (CNC) is a rare, autosomal dominant multiple neoplasia syndrome. Although cutaneous myxomas commonly occur in CNC patients, intraoral myxomas are extremely rare. We present a case of a palatal myxoma in a 21-year-old female patient with CNC, along with a review of the pertinent literature. She presented with a sessile nodule on the hard palate that microscopically showed a multilobulated and highly vascularized myxomatous tissue composed of loosely-arranged spindle, polygonal, and stellate cells, suggestive of myxoid neurofibroma. Six years after the oral lesion was removed, she presented with a growth hormone (GH)-producing pituitary adenoma, a cardiac myxoma, two cutaneous myxomas on the lower abdomen area, and one myxoma in the vaginal mucosa. Therefore, the final diagnosis of the palatal lesion was of a soft tissue myxoma related to CNC. The patient remains on close follow-up, with no recurrences of the palatal myxoma after 7 years.

Tumors of the orofacial zone in children and adolescents (literature review)

Relevance. The relevance of the literature review presented by the authors is due to the diversity and complexity of the differential diagnosis of tumors of the orofacial zone in children and adolescents. Against the background of the absolute predominance of benign neoplasms, about 10-20% falls on the share of malignant neoplasms in this area. In this regard, polyclinic specialists often do not show sufficient oncological alertness, which leads to an unjustified lengthening of the diagnostic period and late diagnosis of malignant neoplasms.

The purpose of the literature review is to discuss the results of studies on the epidemiological, clinical and therapeutic features of the tumor process in the orofacial zone in children and adolescents.

Materials and methods. The searching of publications on the subject of the review were performed in the databases: https://www.ncbi.nlm.nih.gov/, https://elibrary.ru/cit_title_items.asp, https://www.researchgate.net/, https://elibrary.ru/. The authors describe the clinical manifestations of tumors depending on the location of the lesion and histological affiliation. The initial symptoms of both malignant and benign neoplasms are often nonspecific. Prevailing benign neoplasms can only be treated by surgery. Much less often in children and adolescents, malignant neoplasms are also found: squamous cell carcinoma of the oral cavity, Langerhans cell histiocytosis and others, which are treated in accordance with the principles of complex / combined anticancer therapy, including courses to minimize the amount of rehabilitation.

 

Results. Timely diagnosis and prevention of the development of neoplasms in the orofacial area can reduce the severity of morphological and functional disorders in children and adolescents. Despite the use of effective methods of surgical or combination therapy, many need rehabilitation measures.

Conclusions. The optimal position of a pediatrician, therapist, dentist, or surgeon at the stage of tumor diagnosis should be the implementation of oncological alertness, which implies an active approach without long-term "dynamic observation" of patients. Oncological alertness, especially among dentists, will improve the results of antitumor therapy in patients with Orofacial tumors.

Plexiform Schwannoma of the Oral Cavity: Report of Eight Cases and a Review of the Literature

Plexiform schwannoma represents an unusual schwannoma variant, characterized by multinodular growth grossly and/or microscopically. A review of the English-language literature reveals only 28 previously reported cases involving the oral cavity, and herein we present 8 additional cases. Among these 36 patients, the average age at diagnosis was 28 years (range 5 to 62 years), with a female-to-male ratio of 1.4:1. The most frequently involved sites were the tongue (n = 13) and lip (n = 11). Lesion duration prior to presentation averaged 5.3 years (range, 6 weeks to 26 years). The average lesion size was 2.1 cm (range, 0.3 to 16 cm). The typical clinical presentation was a painless mass, although infrequent findings included pain/discomfort, paresthesia, difficulty chewing, and limited buccal mobility. All cases clinically appeared as a solitary mass or localized cluster of tumor nodules, with the exception of one patient who had neurofibromatosis 2 (NF2) and exhibited two distinct nodules on the tongue and buccal mucosa. In addition, extraoral neural neoplasms were evident in four patients, including three with NF2. Typical microscopic findings included multiple well-circumscribed tumor nodules, each surrounded by a perineurium-derived capsule with immunoreactivity for epithelial membrane antigen. The nodules contained characteristically bland and diffusely S-100-positive spindle cells arranged in Antoni A and B patterns; however, modest nuclear pleomorphism was evident in three cases. Most patients (n = 23) were treated by excision or enucleation and curettage, and three patients experienced recurrence. Unlike plexiform neurofibromas, plexiform schwannomas exhibit only a weak association with neurofibromatosis and have no known malignant potential.

Multiple endocrine neoplasia type 2B: Frequency of physical stigmata-Results of the GPOH-MET registry

BACKGROUND

Multiple endocrine neoplasia (MEN) 2B is characterized by early development of aggressive medullary thyroid carcinoma (MTC), visible physical stigmata, and associated symptoms. In most cases, de novo mutations are revealed. There are premonitory symptoms and stigmata that enable early diagnosis, before an inoperable MTC develops. The German Society for Paediatric Oncology and Haematology (GPOH)-Malignant Endocrine Tumours (MET) registry maintains records of children with MTC in Germany since 1997.

METHODS

Children with a diagnosis of MTC in MEN 2B recorded in the GPOH-MET study were analyzed retrospectively. Stigmata and symptoms associated with MEN 2B were examined.

RESULTS

From inception through 2017, 24 patients aged 0.2-17.3 years were included. Symptoms affecting the oral/dental (88.0%), musculoskeletal (79.2%), and gastrointestinal (70.8%) systems were recognized most frequently. Gastrointestinal and musculoskeletal symptoms preceded symptoms of MTC. Twelve patients had short stature. Regarding the prevalence of single symptoms, neuromas of the lips and the oral cavity were mentioned most frequently. Five patients died from MTC. Patients diagnosed by tumor symptoms showed more advanced disease than those with disease detected by other means. Children diagnosed via associated stigmata and symptoms or positive family history had significantly improved overall survival (OS) compared to children diagnosed via symptoms of MTC (OS 100% vs 53.3%).

CONCLUSIONS

In children with MEN 2B, oral/dental, musculoskeletal, and gastrointestinal symptoms are most common. If children are diagnosed via associated symptoms and stigmata, OS is improved. Most of the children were diagnosed with growth disturbances; this finding requires verification and ranging in other patient cohorts.

Tongue Schwannoma: A Clinicopathologic Study of 19 Cases

Schwannomas commonly occur in the head and neck but infrequently involve the oral cavity and rarely affect the tongue. The clinical and pathologic features of 19 cases of schwannoma arising in the tongue were analyzed. There were 13 males and 6 females ranging in age from 12 to 82 years (mean 34 years; median 29 years). The majority of tumors presented as an asymptomatic mass localized to the anterior two-thirds of the tongue. Histologically, 18 schwannomas exhibited characteristic Antoni A and B areas with the former pattern predominating. One tumor was composed exclusively of cellular Antoni A tissue and was classified as a cellular schwannoma. Tumor encapsulation was variable with nearly half of the lesions lacking a well-defined fibrous capsule. All were strongly and diffusely positive for S-100 protein. No recurrences were observed on clinical follow-up. Schwannoma of the tongue, although rare, should be separated from other types of lingual nerve sheath proliferations and tumors.

Oral neural tumors: Clinicopathologic analysis of 157 cases and review of the literature

Background

Oral neural tumors (ONTs) are rare lesions and represent reactive or neoplastic proliferations of nerve sheath cells. The purpose of the present study is to report the clinical, demographic and histopathologic features of 157 ONTs diagnosed in a single Oral Pathology Department and review the pertinent literature.

Material and Methods

157 cases of ONTs diagnosed during a 44-year period were retrospectively collected and the diagnosis was reconfirmed by studying representative haematoxylin and eosin stained tissue sections. The patients’ gender and age, as well as the main clinical features of the lesions, were retrieved from the biopsy submission forms.

Results

The 157 ONTs represented approximately 0.4% of 35,590 biopsies accessioned during the study period. They affected 71 male and 86 female patients with a mean age of 38.4±18.8 years. They mainly appeared as asymptomatic nodules of normal or white colour on the tongue, lip mucosa and hard palate. The most common ONT was granular cell tumour (38.9%) followed by neurofibroma (19.7%), schwannoma (15.9%), traumatic neuroma (15.9%), palisaded encapsulated neuroma (8.3%) and nerve sheath myxoma (1.3%).

Conclusions

This study confirmed the rarity of ONTs. Their clinical characteristics mimic other oral lesions; thus, microscopic examination is the only mean to arrive at a definitive diagnosis.

Key words:Oral neural tumors; oral neural neoplasms; neurofibroma; oral neurofibroma; schwannoma; oral schwannoma; neurilemmoma; oral neurilemmoma; granular cell tumor; oral granular cell tumor; traumatic neuroma; oral traumatic neuroma; palisaded encapsulated neuroma; oral palisaded encapsulated neuroma.