Intraosseous ancient Schwannoma: A rare case in the mandible and a literature review

Intraosseous schwannoma of the mandible: new case series, literature update, and proposal of a classification

Intraosseous schwannoma of the mandible is rare, with diagnostic and therapeutic challenges. The aims of this study were to report new cases of intraosseous schwannoma of the mandible and to propose a clinical classification, providing suggestions for treatment methods. The cases of 13 patients treated at the authors' hospital and 86 cases reported previously in the literature were reviewed. The most common clinical feature was facial swelling (60/93). The rate of cortical thinning or expansion was 44.8% (43/96); widening of the inferior alveolar nerve canal on radiographs was observed in 15 patients.

Ancient schwannoma of the thoracic spine treated with vertebroplasty: A case report

INTRODUCTION

Intraosseous schwannomas or neurilemomas are rare benign neoplasms. Total resection of the intraosseous schwannoma is considered risky in immunocompromised patients, thus minimally invasive vertebroplasty was conducted in this study.

CASE REPORT

In this case, we presented A 40-year-old male presented with intermittent back pain for the last two years. Imaging and histopathological examination conclude the diagnosis of intraosseous schwannoma. Vertebroplasty was conducted without the resection of the tumor. Excellent pain improvement and functional outcome were reported on one-year follow-up.

CLINICAL DISCUSSION

Minimally invasive surgery could decrease post-operative pain and morbidity such as atelectasis and venous thrombosis, earlier hospital discharge, and improved cosmetics. We considered the use of minimally invasive vertebroplasty due to HIV infection comorbidities in the subject. Extensive tumor resection in this population could increase the risks of infection significantly thus affecting the outcome of the surgery. The aim of percutaneous vertebroplasty is to increase the stability of the collapsed vertebra and improve the symptoms, especially with severe back pain.

CONCLUSION

Intraosseous schwannoma of the vertebrae could be treated effectively with vertebroplasty with excellent pain improvement and functional outcome.

Gnathic Schwannomas: A Report of Two Cases and Systematic Review of the Literature

BACKGROUND

The intraosseous schwannoma (IS) is a benign peripheral nerve sheath tumor postulated to arise de novo or from nerve fibers in preexisting nutrient canals. ISs are uncommon and comprise less than 1% of neoplasms originating in bone. We herein present two cases of mandibular schwannomas-the first case was a 66-year-old female with a four-month history of pain and pressure associated with an anterior mandibular radiolucency, and the second case was an asymptomatic 12-year-old female with separate radiolucencies of her mandibular symphysis and right posterior mandible. Incisional biopsies of all three lesions showed a benign spindle cell neoplasm with histologic features of a schwannoma; the tumor cells were strongly reactive for S-100. The patients underwent complete enucleation of their lesions and are without evidence of disease at ten months and five years, respectively.

METHODS

A systematic review was undertaken to evaluate the diagnostic features, treatment, and patient outcomes of gnathic schwannomas.

RESULTS

A total of 93 cases were identified with the following demographic findings: predominance in females (57%); average age of occurrence of 37.3 years (8 to 77 years); mean size of 3.6 cm; and involvement of the mandibular body (37.6%), mandibular body and ramus (18.3%), and anterior mandible (18.3%). The predominant clinical sign was swelling (69.9%), and the most common radiographic presentation was a radiolucency (94.6%) with well-defined borders (72%).

CONCLUSION

All cases were treated surgically, with an average follow-up interval of 22.9 months and a recurrence rate of 5.4.