Neurilemmoma involving the maxillary sinus: a case report

Maxillary schwannoma - A case report of a rare tumor

Schwannoma or neurilemmoma is a neurogenic tumor. Intraoral schwannoma is rare and intraosseous schwannoma involving maxilla is even rare. We present one such rare case of maxillary sinus schwannoma extending to the nasal cavity, infratemporal fossa in a 22-year-old male. Wide excision of the lesion with subtotal maxillectomy of the right side was done using Weber–Fergusson approach. The patient made a good postoperative recovery. The relevant literature on the presentation, radiology, and management of schwannoma of maxillary sinus is discussed.

Maxillary neurilemmoma-Rarest of the rare tumour: Report of 2 cases

INTRODUCTION

Intraoral neurilemmomas (schwannoma) are rare, even rarer are intraosseous ones, and the rarest are the maxillary neurilemmomas. Going by the literature only 5 cases of maxillary neurilemomas are reported till now. Neurilemmomas are benign tumours of nerve sheath origin. Approximately 30% arise in head and neck region, of these 1–12% arise intraorally mainly involving tongue.

PRESENTATION OF CASE

Here we report two cases of maxillary neurilemmoma, one in a 9 year old girl and second one in a 27 year old female, both involving the lateral surface of maxilla on right side. Both the patients presented with a long standing history of swelling which was increasing gradually. 9-Year-old girl also had 1 lesion in the temporal region on right side and the 27-year-old patient had associated erosion of the soft palate. Diagnosis was made on the basis of histopathology and immunohistochemistry.

DISCUSSION

Neurilemmomas are slow growing benign tumour of the nerve sheath origin arising from the Schwann cells. Their aetiology is not known. Most common complaint is that of a gradually increasing swelling followed by pain and paresthesias. Surgery remains the treatment of choice with close follow up.

CONCLUSION

Maxillary neurilemmomas are rarest of the rare tumour which closely mimic benign odontogenic cysts and tumours, and should be kept in the differential diagnosis of these lesions. Knowledge of the radiologic and clinical behaviour of these tumours is extremely important for prompt diagnosis and treatment.

Intraosseous schwannoma of the mandible

Schwannomas (neurilemmomas) are slow-growing, benign neoplasms derived from schwann cells, the sheath cells that cover myelinated nerve fibers. These tumors most commonly arise in the soft tissues of the head and neck, as well as on the flexor surfaces of the upper and lower extremities. Intraoral lesions are uncommon, however, and intraosseous schwannomas are even rarer. In the Mayo Clinic series of 11,087 primary bone tumors, 14 cases of intraosseous schwannoma were identified, accounting for less than 1% of these benign primary bone tumors. The most common site of occurrence is the mandible, a characteristic traditionally attributed to the long intraosseous path of the inferior alveolar nerve. In this article, we describe an additional case occurring in the mandible of a 15-year-old boy.

Schwannoma of the nasal tip: diagnosis and treatment

BACKGROUND

Schwannoma is a neurogenic neoplasm rarely found in the sinonasal tract. It is a benign tumor arising from the sheath of myelinated nerve fibers that may occur in any part of the body. Its diagnosis and treatment can pose certain challenges.

METHODS

A 35-year-old woman presented to the senior surgeon with a nasal tip tumor that had been developing for almost 10 years. Ultrasound showed edema of the nose because of multiple solid nodes. The computed tomography (CT) scan did not show invasion of the bony framework around the tumor (maxilla, septum, nasal bones). Magnetic resonance imaging (MRI) showed a deviation of the septum and well-defined round nodes at the nasal tip with a thick layer of skin around them. Resection of the tumor was performed using open rhinoplasty.

RESULTS

The limits of the excision were free of tumor, and histologic analysis of the tumor showed the characteristics of a schwannoma. At this writing, 2 years postoperatively, the patient is free of recurrence.

CONCLUSION

Schwannoma of the nasal tip is a benign tumor that gradually causes aesthetic and functional disorders. Radiologic examinations can assist in its diagnosis. The treatment is surgical excision and histologic analysis of the specimen.

A schwannoma in the nasal septum

Schwannomas of the sinonasal tract are very rare neoplasms. We present the case of a schwannoma developing in the nasal septum. The patient was a 51-year-old woman with the complaint of unilateral nasal obstruction. We completely removed this tumor by an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

Schwannoma of vagus nerve masquerading as a parotid tumour

A post-auricular swelling is the most common presentation of a parotid tumour, the majority of which are benign neoplasms like pleomorphic adenoma. This case report discusses a post-styloid parapharyngeal space tumour presenting as a post-auricular mass which, on initial clinical and cytological examination, was diagnosed as pleomorphic adenoma. A cross-sectional radiological examination revealed the true location of the mass, which was histopathologically confirmed to be a vagal schwannoma. A radiological differential diagnosis is also discussed.

Factors in the pathogenesis of tumors of the sphenoid and maxillary sinuses: a comparative study

OBJECTIVES/HYPOTHESIS

To explain the processes that lead to the development of tumors in the maxillary and sphenoid sinuses.

STUDY DESIGN

A 32-year review of the world's literature on neoplasms of these two sinuses and a randomized case-controlled study comparing the normal mucosal architecture of the maxillary to the sphenoid sinus.

METHODS

Analysis of a 32-year world literature review reporting series of cases of maxillary and sphenoid sinus tumors. Tumors were classified by histological type and separated into subgroups if an individual incidence rate was reported. Histomorphometry of normal maxillary and sphenoid sinus mucosa was performed in 14 randomly selected patients (10 sphenoid and 4 maxillary specimens). Specimens were fixed in 10% formalin, embedded in paraffin, and stained with periodic acid-Schiff (PAS) and hematoxylin. Histomorphometric analysis was performed with a Zeiss Axioscope light microscope (Carl Zeiss Inc., Thornwood, NY) mounted with a Hamamatsu (Hamamatsu Photonics, Tokyo, Japan) color-chilled 3 charge coupled device digital camera. The images were captured on a 17-inch Sony (Sony Corp., Tokyo, Japan) multiscan monitor and analyzed with a Samba 4000 Image Analysis Program (Samba Corp., Los Angeles, CA). Five random areas were selected from strips of epithelium removed from each sinus, and goblet and basal cell measurements were made at magnifications x 100 and x 400.

RESULTS

The literature review revealed that the number and variety of tumors in the maxillary sinus are much greater than those in the sphenoid. The incidence of metastatic lesions to each sinus is approximately equal. No recognized pattern of spread from any particular organ system could be determined. On histomorphometric study there were no statistically significant differences between the sinuses in the concentration of goblet cells, basal cells, or seromucinous glands.

CONCLUSIONS

Factors involved in the pathogenesis of tumors of the maxillary and sphenoid sinuses include differences in nasal physiology, embryology, morphology, and topography. There are no significant histological differences in the epithelium and submucous glands between the two sinuses to explain the dissimilar formation of neoplasms.

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 neurinoma: case report and review of literature

We report a rare case of nasal neurinoma. The patient was a 21-year-old man, who complained of nasal obstruction. The tumor was successfully excised, and was found to be a benign Schwannoma (neurinoma). The patient had an uneventful course with no signs of recurrence. Reports in the world literatures of neurinomas in the nasal cavity and the paranasal sinuses are reviewed.

Central schwannoma of the maxilla

A case of schwannoma in the maxilla associated with the nasopalatine nerve of a 9-year-old boy is reported. The diagnosis is supported by an immunohistochemical demonstration of S-100 protein within the tumor cells. The patient is free of disease 6 years after tumor removal.