Calcification in Schwannoma of the lacrimal gland region

Plexiform Schwannoma of the Eyelid

Plexiform schwannoma of the lacrimal gland of the palpebral lobe has not been previously described. This 41-year-old male presented with a 2-year history of a left upper eyelid mass and associated regional irritation. MRI of the head and orbits confirmed a left superolateral multinodular mass centered on the palpebral lobe of the left lacrimal gland. Excision revealed a schwannoma of the plexiform subtype.

Orbital schwannoma with calcification treated by intracapsular excision: A case report

RATIONALE

Orbital schwannoma is a relatively rare orbital tumor, and calcification of the lesion is rarely found in the orbit. We report a case of orbital schwannoma which was characterized by calcification in the orbital muscle cone, and was cured by intracapsular excision.

PATIENT CONCERNS

A 54-year-old female with a complaint of a mass in the left orbit during a magnetic resonance imaging examination and symptom of dizziness 6 months before, presented with painless exophthalmos and vision decline in the left eye.

DIAGNOSES

According to clinical manifestations, imaging examinations and postoperative immunohistochemical examinations, the diagnosis was orbital schwannoma, with calcification in the muscle cone.

INTERVENTIONS

The patient was treated by intracapsular excision of the left orbit. We removed the intracapsular mass and most part of the cyst wall in order to prevent orbital apex syndrome.

OUTCOMES

The diagnosis of schwannoma with calcification was confirmed finally through histological and immunohistochemical exam. The patient was followed up for 28 months and the orbital CT scan showed that there were no significant lesions found in the orbital muscle cone.

LESSONS

Understanding clinical, imaging diagnostic, and histopathological features of rare orbital schwannoma with calcification will facilitate timely diagnosis and treatment of this condition. The intracapsular excision can help in avoiding complications.

Calcification and ossification in conventional schwannoma: A clinicopathologic study of 32 cases

Calcification and ossification are uncommon in schwannomas; however, when present these findings may cause diagnostic confusion with other mesenchymal tumors which more frequently harbor these features. We sought to better characterize the type and rate of calcification and ossification in schwannomas. Cases of schwannoma diagnosed at our institution from 2005 to 2019 were reviewed to determine the type and amount of calcification and ossification present. Of 2116 total cases of schwannoma reported during the study period, 38 cases harbored calcification or ossification per the pathology report. Thirty-two of the 38 cases had slides available for review, of which 27 (84.3%) showed calcification, nine showed ossification (28.1%), and four (12.5%) cases demonstrated both. Foci of ossification typically occurred adjacent to large vessels. Of the 27 cases showing calcification, coarse dystrophic calcification was seen in 22 cases, psammomatous calcification in nine cases, and combined dystrophic and psammomatous calcification was seen in four cases. Cases with psammomatous calcification predominantly occurred in spinal roots and cerebellopontine angle of a younger age group with almost equal gender distribution. All four cases tested for protein kinase cyclic adenosine monophosphate-dependent type I regulatory subunit alpha immunohistochemical stain demonstrated retained expression. We confirm that calcification and ossification are rare findings in schwannoma. Awareness that these features may be present in these tumors will prevent misdiagnosis and ensure appropriate clinical management.

A new cause of lacrimal gland calcification: Retained metallic foreign bodies

A 49-year-old male presented with a 4 month history of dysaesthesia in the left periorbital region. A CT scan showed a lacrimal gland mass with areas of dense calcification. Biopsies of the left lacrimal gland revealed a silver material with associated chronic granulomatous inflammation and secondary calcification. The histological specimen was sent for X-ray microanalysis. This confirmed the silver material to be aluminium. The metal fragments were subsequently discovered to be from a car aerial, which caused an orbital impaling injury 20 years prior to presentation. This is the first reported case of lacrimal gland calcification secondary to chronic metal foreign body exposure. The case is presented alongside literature reviews of lacrimal gland calcification and associated radiological findings.

Primary intraocular ancient schwannoma: a case report and review of the literature

BACKGROUND

Schwannomas comprise 8% to 10% of all primary intracranial tumors. Primary intraorbital schwannomas are rare, accounting for 1% to 2% of all intracranial tumors. Schwannomas arise from Schwann cells in the myelin sheaths of sensory and cranial nerves.

METHODS

We present the case of a 56-year-old white man blind since 1970 who presented to an outside hospital for a painful right eye. Physicians identified no clinical or radiologic features of neurofibromatosis.

RESULTS

The patient underwent enucleation; the final pathologic diagnosis was ancient schwannoma.

CONCLUSION

We describe herein a case of intrascleral schwannoma with ancient changes arising within the globe of the right eye occupying the subretinal space and completely replacing the vitreous body.

Clinico-Radiological Spectrum and Management of Orbital Schwannomas: A Tertiary Care Institute Study

Abstract Purpose: The aim is to study clinical presentations, radiological features and outcome in histopathologically proven orbital schwannomas. Methods: A retrospective and longitudinal study of 16 patients between January 1999 and July 2011 was undertaken by reviewing the appropriate charts. Clinical and radiological data of all orbital schwannomas patients were analyzed. Results: Mean age was 28.18 years (range 8-40 years). Of 16 patients, 10 were males and 6 females. Duration of symptoms was chronic in 15(93%). Chief complaints were proptosis in 10(62.5%), eyelid swelling in 5(31%) and eyelid mass lesion in 2(12.5%). This included a rare case of cystic schwannoma with microphthalmos. Mass was extraconal in 11(69%). Radiological findings varied from solid to cystic, intraconal to extraconal, no enhancement to intense enhancement and presence of calcification. Thirteen (81%) were excised via anterior orbitotomy route while fronto-orbital craniotomy was done in 3(19%). Postoperatively, vision improved or remained stable in 15(94%) and worsened in one (6%). Final visual acuity of 6/6 was achieved in 11(69%), 6/9 in 2, 6/36 in one. Conclusions: Schwannomas may mimic a variety of mass lesions in the orbit because of variable clinical or imaging features and should be considered in the differential diagnosis of all well circumscribed orbital lesions.

A bilobed schwannoma in roof of orbit: a rare case report

In this paper, we report a case of bilobed schwannoma, presented in the roof of orbit arising from supraorbital nerve. A 62-year male presented with a nontender mass in superior part of orbit and eccentric proptosis. Visual acuity and rest of ocular examination were normal. CT scan and MRI orbit revealed an extraconal homogenous bilobed mass, of size 3.5 to 2.5 cms in roof of orbit. Fine needle aspiration cytology was done, which was suggestive of schwannoma a peripheral nerve tumor. Successful surgical excision of intact bilobed schwannoma was done with careful separation and preservation of supraorbital nerve from which it was originated. Postoperative period was uneventful though rare, less than 1%, schwannoma can present as painless mass in the orbit and proptosis. Treatment of choice is surgical excision of intact tumor to prevent recurrence and preservation of peripheral nerve from which it arises.

Sinonasal schwannoma with new bone formation expressing bone morphogenic protein

Schwannoma is a benign tumor that arises from the sheath of myelinated nerve fibers and may occur in any part of the body. Osteogenesis in schwannoma is extremely rare and, to date, new bone formation in sinonasal schwannoma has not yet been reported. Here, we describe the first reported case of sinonasal schwannoma with new bone formation. The tumor was successfully treated by endoscopic sinus surgery, and the patient showed no evidence of recurrence 24 months postoperatively. Immunohistochemically, the tumor expressed bone morphogenic protein 4, indicating a possible role of this protein in the new bone formation in schwannomas.

Schwannomas of the lacrimal gland fossa

PURPOSE

Schwannomas are rare benign nerve sheath tumours that account for 1% of orbital tumours and, although sometimes associated with neurofibromatosis, most occur as isolated lesions and arise from branches of the ciliary or trigeminal nerves.

METHODS

Two rare cases of Schwannoma arising within the lacrimal gland fossa are presented, these tumours being managed with intact surgical excision.

RESULTS

A 66-year-old Caucasian female was referred with 6 months of progressive left painless proptosis and intermittent diplopia. Restriction of left upgaze was associated with 3 mm relative proptosis. On a presumptive preoperative diagnosis of pleomorphic adenoma, the patient underwent a bone-swinging lateral orbitotomy with intact excision of a moderately-firm, lobulated lesion which proved to be a Schwannoma. A 30-year-old White female was referred with a 4-year history of slowly progressive right supratemporal periocular lump. There was 2 mm of right relative proptosis and slight restriction of right extraocular movements. Although lacrimal gland remnants were present at the edge of both specimens, at surgery it was evident that the tumours completely occupied the lacrimal gland fossa and any normal orbital lobe of the lacrimal gland had undergone atrophy.

CONCLUSIONS

Two very rare cases of Schwannoma arising within the lacrimal gland fossa are presented, the tumours causing complete atrophy of the normal orbital lobe of the lacrimal gland.