Clinical Features and Surgical Treatment of Schwannoma Affecting the Base of the Tongue: A Systematic Review

Tongue Base Schwannoma Presenting With Dyspnea

Schwannoma is a benign nerve sheath tumor arising from Schwann cells. Its exact etiology remains known. Tongue base schwannoma is a remarkably rare form of schwannoma. Although it often presents with dysphagia and swelling, it may cause obstructive airway problems as its size increases. Since it affects all age groups, its differential diagnosis typically includes congenital, infectious masses, and benign/malignant neoplasia of vascular and mesenchymal origin. In this study, the authors report on a 43-year-old patient with tongue base schwannoma, and the authors also review the cases reported in the literature over the last 60 years in terms of mass size, primary presenting complaint, and surgical techniques preferred in the studies.

Recurrent Ulnar Nerve Schwannoma in the Cubital Tunnel Elbow: A Rare Presentation and Surgical Management

Schwannoma is a benign tumor arising from Schwann cells of peripheral nerves. Although recurrence is rare, this case report highlights a unique instance of recurrent ulnar nerve schwannoma in a 76-year-old construction worker, emphasizing the complexities of surgical management. The patient presented to our orthopedic clinic with persistent pain and tingling in the medial aspect of his left forearm and hand for the past two years. His medical history included bilateral ulnar nerve schwannoma excision at the cubital tunnel level 20 years prior. Examination revealed a firm, non-tender swelling measuring 5 × 5 cm on the medial side of the left distal arm, with neurological assessment indicating reduced sensation in the little finger and medial half of the ring finger, as well as intrinsic hand muscle weakness. His preoperative Disabilities of the Arm, Shoulder, and Hand (DASH) score was 65, reflecting substantial functional limitations. Preoperative nerve conduction studies confirmed ulnar nerve damage, and MRI indicated a tumor originating from the left ulnar nerve. Given the tumor's increasing size, surgical excision was done. The procedure involved careful dissection around the elbow to isolate the ulnar nerve, significantly affected by fibrosis from prior surgeries. We performed macro neurolysis, which decompresses larger segments of the nerve, and micro neurolysis, which allows for precise intervention on specific segments, to effectively address the challenges presented by the scar tissue. Anterior transposition of the ulnar nerve was conducted to place it in an unscarred area, reducing compression and promoting nerve function. The postoperative biopsy confirmed a benign schwannoma characterized by localized Antoni A and Antoni B areas. Six months post surgery, the patient reported complete resolution of symptoms, with grip strength improving to approximately 95% of normal and a postoperative DASH score of 25. Follow-up assessments showed enhanced nerve function, with no signs of tumor recurrence over two years. This case underscores the challenges of managing recurrent ulnar nerve schwannoma and emphasizes the critical role of surgical intervention in preserving nerve function and improving patient outcomes. The successful management of this recurrence highlights the importance of meticulous surgical technique and thorough follow-up in ensuring long-term patient well-being.

Transoral diode laser-assisted resection of a tongue base schwannoma

Schwannomas are benign peripheral nerve sheath tumours with a low risk of malignant transformation. About 25%-40% are in the head and neck region with the posterior third of the tongue being a rather rare site of its growth, and a lesion at this site is understandably difficult to approach and treat. Being benign and encapsulated, surgical excision is in the mainstay of treatment. Symptoms can range from a globus pharyngeus and dysphagia to airway compromise depending on the size and site. Traditionally, a paramedian lip split approach with paramedian mandibulotomy and mandible swing may be used. However, some recent reports of the use of carbon dioxide laser and robotic surgery for tongue base lesions are seen in the literature. Our case report is a unique addition to the management strategies for such tongue base lesions as we employed diode 980 nm laser using a minimally invasive transoral approach with a successful outcome.

Transoral surgery with Thunderbeat© for hemangioma of the tongue base: A novel procedure. Case report

INTRODUCTION

Hemangiomas are the most common benign tumors of the head-neck region in children and mainly affect the face, oral mucosa, lips, and tongue. The base of tongue is an extremely rare site of involvement. The incidence is higher in women and occur more frequently in infants and childhood.

PRESENTATION OF CASE

We present a rare case of cavernous hemangioma of the base of tongue in a 70-year-old male patient surgically removed by Transoral Ultrasonic Surgery (TOUSS). 1-year follow up didn't show sign of recurrence.

DISCUSSION

Hemangiomas are benign proliferations of endothelial cells common in the head and neck. The etiology is uncertain: an imbalance in angiogenesis related to substances such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (BFGF) with uncontrolled proliferation of vascular elements is proposed. It can be asymptomatic or, when affecting the tongue, lead to difficulty swallowing, pain, bleeding and dyspnea.

CONCLUSION

This case report aims to stress that hemangioma should be considered in differential diagnosis in case of richly vascularized tongue base lesion, also in adult population. It would like to highlight the role of transoral ultrasonic surgery (TOUSS), which is able to achieve the same advantages as TORS with lower costs and shorter learning curve.

Schwannoma base of Tongue - Case Report with a Novel Reconstruction Technique

INTRODUCTION

Schwannomas are benign, slow-growing well-encapsulated neoplasms arising from Schwann cells of nerve sheaths. Oral cavity schwannomas are very rare with an incidence less than 1%. The posterior third of the tongue is not frequently involved.

CASE REPORT

We report a rare case of a large tongue base schwannoma in a 44 year old female managed surgically by lateral pharyngotomy approach. A novel reconstruction method involving the use of submental flap is described for the functional reconstruction of the defect.

CONCLUSION

Being a rare tumor, schwannoma should not be missed in the differential diagnosis of tongue base tumors. Complete surgical resection is the treatment of choice with recurrence being very rare.

Peripheral Schwannoma Presenting as a Retro-Malleolar Mass: A Case Report

Schwannomas are rare peripheral nerve tumors that can present with diverse clinical manifestations. They commonly present as solitary, encapsulated masses and can occur in various locations throughout the body. This case report presents a comprehensive analysis of a peripheral schwannoma in a 29-year-old male patient who presented with numbness, pain, and paresthesias on the plantar aspect of the left foot. The symptoms progressively worsened, impacting the patient's daily activities. Physical examination revealed tenderness on the medial aspect of the left foot, along with prolonged episodes of paresthesia and recurrent numbness. Imaging studies confirmed the presence of a retro-malleolar mass, consistent with a peripheral schwannoma. The patient underwent successful surgical excision of the mass, resulting in complete resolution of symptoms. This case emphasizes the importance of considering peripheral schwannomas in the differential diagnosis of patients presenting with foot symptoms and highlights the effectiveness of surgical excision as a treatment modality for these tumors.

Schwannoma (neurilemmoma) of tongue: A rare case presentation and review of literature

It seems that schwannomas of the tongue base originate from branches of the glossopharyngeal, vagus, or hypoglossal nerves. Additionally, complete trans-oral surgical excision is an efficient method to remove them.

Large benign schwannoma of the greater omentum with synchronous cervical cancer: A case report

INTRODUCTION AND IMPORTANCE

Schwannomas are uncommon tumors of the omentum with only 16 reported cases originating from the greater omentum in the literature. We report for the first time a synchronous presentation of an omental schwannoma and cervical cancer.

CASE PRESENTATION

A 37-year-old female presented with an abdominal mass and heavy vaginal bleeding. An 11.5 × 14.6 × 16.6 cm complex omental mass and 5.4 × 6.2 × 4.4 cm lobulated heterogeneous cervical mass were noted on CT-scan. Wide excision of the complex mass and radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection was performed. The final biopsy revealed benign omental schwannoma and poorly differentiated cervical adenocarcinoma.

CLINICAL DISCUSSION

Schwannomas originating from the greater omentum are less common than in the lesser omentum due to the paucity of nervous tissue in the former. They can undergo malignant transformation and the most common presentation is abdominal pain/discomfort. Larger tumors may cause catastrophic bleeding. Prompt surgery should be offered and wide local excision with sufficient margins be performed when there is suspicion of malignancy. Schwannomas presenting with multiple or synchronous lesions are commonly associated with neurofibromatosis type 2, schwannomatosis, and Carney's complex. Whether this co-occurrence is simply incidental or has a causal relationship remains to be established.

CONCLUSION

Benign schwannoma of the greater omentum is rare and only requires complete tumor excision. However, surgeons should be aware that synchronous presentation of cervical cancer is possible and that thorough examination of both sites should be undertaken when either primary tumor presents.

Schwannoma of the Lower Lip: A Case Report of an Unusual Presentation

Schwannoma is a benign neoplasm that originates from the neural sheath of Schwann cells. Although extracranial schwannomas are commonly observed in the head and neck region, only 1% are found in the intraoral cavity. This article describes the first case in the Eastern Mediterranean region of a lower lip schwannoma in a 17-year-old male patient.

Transoral Robotic Surgery in the Management of a Tongue Base Schwannoma

Schwannomas are the most common benign tumors arising from the peripheral nerve sheath, and the intraoral location is very atypical, representing less than 1% of all cases. Surgical excision is the treatment of choice, and a variety of surgical approaches have been described. The authors report the first described case of tongue base schwannoma treated with transoral robotic surgery (TORS). A 47-years-old female patient complaining mild dysphagia and snoring, presented a submucosal swelling at the right side of the tongue base. MRI showed a large well-circumscribed solid mass, homogeneously isointense in T1WI and hyperintense on T2WI, with no lymph node metastasis. According to size, location and radiological characteristic of the mass a TORS approach was chosen. An extracapsular dissection was performed, and the lesion was completely removed with no intraoperative complications. The final diagnosis based on histopathological examination and IHC analysis (S-100 positive) was a schwannoma of the tongue base. The post-operative course was uneventful, and no recurrence was observed after 6 months of follow-up. This study demonstrates the feasibility of TORS in the treatment of a tongue base schwannoma. This is a valid alternative to the common transoral approach in order to avoid more invasive external approaches, and further studies are recommended in order to clarify if this approach could be proposed as the first line treatment in selected cases.

Oversized primary intrapulmonary schwannoma: A case report and a review of the literature

BACKGROUND

Schwannomas, also known as neurilemommas, are benign, well-circumscribed encapsulated peripheral nerve sheath tumors with rather indolent evolution. Made up of cells closely related to normal myelinating Schwann cells, these neoplasms may arise from the peripheral nervous system as well as from spinal or cranial nerves. They are mostly found in the base of the skull, neck, chest wall, posterior mediastinum, posterior spinal roots, cerebellopontine angle, retroperitoneum, and flexor surfaces of the extremities. The incidence rate of spinal schwannoma is 0.3-0.5/100,000 cases per year with an average age of 50 at diagnosis. We report a case of intrapulmonary schwannoma, adding a review of the literature.

CASE DESCRIPTION

A 20-year-old female patient with no significant medical history, presented with pleuritic chest pain, shortness of breath, right upper limb weakness, and numbness. A computed tomography of the chest and magnetic resonance imaging showed a 7.2 × 10.5 × 8.3 cm mass in the posterior segment of the right upper lobe, arising from the right T5-6 neural foramen; a concurrent 16 mm thick right pleural effusion was also noticed yet without evidence of nodular enhancement. The findings suggested the presence of a neurofibroma or a schwannoma. Complete resection of the tumor was achieved through posterolateral thoracotomy; the ensuing histopathological and immunohistochemical examinations confirmed the presence of a schwannoma.

CONCLUSION

We believe this rare case of pulmonary invasive schwannoma illustrates the complex dynamics of this extremely rare entity; in this particular case, complete surgical excision proved to be crucial in terms of subacute management and local tumor control, at least at short and middle term. The patient is currently asymptomatic (6 months postsurgery) and remains on follow-up.

PD-1/PD-L1 negative schwannoma mimicking obstructive bronchial malignancy: A case report

Schwannomas are homogeneous tumors of schwann cells and occur at peripheral and cranial nerves on the upper limbs, the head and neck area. Rarely, a bronchial schwannoma may appear in the lung and be misdiagnosed as lung neoplasms. Here, we report a 56‐year old woman with a 5.8 × 7.0 × 2.8 cm lesion in her right upper lobe bronchus. The lesion had a maximum standardized uptake value (SUV_max) of 8.5 by 18‐fluorodeoxyglucose positron emission tomography (FDG‐PET). Bronchoscopy showed a mass obstructing the bronchus that bled easily. Despite repeated biopsies, a lung malignancy could not be excluded, and surgical resection was subsequently performed. Pathological examination demonstrated a primary bronchial schwannoma that was positive for molecular markers S‐100 and SOX‐10, negative for immune checkpoint marker PD‐1/PD‐L1 but also demonstrated certain uncommon pathological features. This case highlights the heterogeneity of bronchial masses and the diagnostic challenge for differentiating benign and malignant tumors in the thorax.

Key points

Rare bronchial schwannoma mimics lung malignancy and poses a diagnostic challenge.

This case of bronchial schwannoma, unlike peripheral schwannoma, lacks PD‐L1. Pathological features indicate autonomic nerve origin for pulmonary schwannomas.

Lingual schwannoma in an adolescent girl- A diagnostic challenge

Shwannoma, a benign neurogenic neoplasm consisting of schwann cells is a slow growing solitarily found pathology. We present a case of shwannoma in a 14 year old girl and its identifying features which can be a diagnostic challenge owing to its similarity with many lesions. The patient visited our center with a nodular growth on her tongue. Transoral excision was performed and pathologic examination confirmed the diagnosis of schwannoma.

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.

Trans-oral, Carbon Dioxide-Assisted Excision of an Unusual Schwannoma of the Tongue Base: Case Report and Review of the Literature

Introduction  Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO ₂ ) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds.

Objective  We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO ₂ -assisted excision. We also provide a review of the available literature, in English language, on humans.

Data synthesis  The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma . Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases.

Conclusion  We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO ₂ laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.