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Bakir M, Enabi J, Almeshal H. Unusual Lower Lip Swelling: A Rare Case of Lip Schwannoma. Cureus 2021; 13:e19242. [PMID: 34900449 PMCID: PMC8647776 DOI: 10.7759/cureus.19242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/08/2022] Open
Abstract
Schwannoma (neurilemmoma) is a benign neoplasm that arises from the nerve sheath's Schwann cells. Between 25% and 40% of all schwannomas are discovered in the soft tissues of the head and neck area, but they are infrequently detected in the oral cavity, with the lips being the most unusual site of involvement. Peripheral nerves in the intraoral cavity originate only 1% of schwannomas despite the fact that lips and oral cavity are heavily innervated anatomical areas. Schwannomas are more common in people between the third and fifth decades of life, and there is no predilection based on gender or race. Here, we report a case of lip schwannomas in a 22-year-old female. The lesion was affecting her lower lip and growing steadily for the past two years. The mass measured 1.5 x 1 cm, involving the lower lip with surface telangiectasia. The patient underwent surgical removal of the lower lip mass, and the mass was sent for histopathological correlation that showed completely excised encapsulated schwannoma with free margins. The patient did not have any postoperative complications and was discharged home on the same day. The patient was followed up in the outpatient clinics, and she made full recovery and was pleased with the outcome.
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Affiliation(s)
- Mohamad Bakir
- Medicine and Surgery, College of Medicine, Alfaisal University, Riyadh, SAU
| | - Joud Enabi
- Medicine and Surgery, College of Medicine, Alfaisal University, Riyadh, SAU
| | - Hanan Almeshal
- Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, SAU
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Elsayed N, Shimo T, Harada F, Hiraki D, Tashiro M, Nakayama E, Abiko Y, Nagayasu H. A challenging diagnosis of a mucocele in the maxillary gingiva: Case report and literature review. Int J Surg Case Rep 2021; 84:106030. [PMID: 34167072 PMCID: PMC8239459 DOI: 10.1016/j.ijscr.2021.106030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mucoceles are mucous extravasation phenomena resulting from spontaneous ductal rupture or, less commonly, a traumatic cutting of a salivary excretory duct. Occasionally, the appearance of a mucocele closely resembles a neoplastic lesion, and it can be difficult to diagnose. PRESENTATION OF CASE A 74-year-old Japanese male patient was referred to our clinic with painless swelling related to the upper right canine-premolar area. Preoperative imaging of the lesion revealed that it was fluid-filled and the histopathological biopsy suggested a myxoid tumor. We excised the lesion with the patient under general anesthesia, using safety margins based on the histology of the biopsy specimen to reach the definitive diagnosis and treatment. The final pathological diagnosis was a mucocele in the vicinity with an aberrant small salivary gland. Follow-up visits showed complete healing of the epithelium, and no recurrence has been observed during the subsequent 30 months. DISCUSSION In cases with a difficult definitive diagnosis based on medical history, diagnostic imaging and pathological examination, it is important to proceed carefully with the possibility of a tumor in mind. CONCLUSION This case emphasizes that some mucous cysts are challenging for clinicians in terms of diagnosis and treatment due to an uncommon presentation.
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Affiliation(s)
- Nagwan Elsayed
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Tsuyoshi Shimo
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
| | - Fumiya Harada
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Daichi Hiraki
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Masayasu Tashiro
- Division of Oral and Maxillofacial Radiology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Eiji Nakayama
- Division of Oral and Maxillofacial Radiology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Yoshihiro Abiko
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Hiroki Nagayasu
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
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Abstract
Pleomorphic adenoma constitutes 50% of salivary gland tumors affecting mostly the parotid gland extraorally, and the palate intraorally. While the upper lip is a common site, it is unusual to encounter this tumor in the lower lip. A 26-year-old man complained of a persistent lump affecting the lower lip. The lesion was excised and was shown on histopathological examination to be a pleomorphic adenoma with squamous metaplasia. At the 18-month review appointment, there was complete healing and no recurrence. Pleomorphic adenoma in the lower lip should be considered among the differential diagnosis of lower labial swellings, especially in young patients. There needs to be reconsideration of the epidemiological and histological characteristics.
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Affiliation(s)
- Ibrahim Nourwali
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | - Najla Dar-Odeh
- Department of Oral Basic and Clinical Sciences, College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
- Department of Oral Surgery, Oral Medicine and Periodontics, School of Dentistry, University of Jordan, Amman, Jordan
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Upadhyay S, Bhavthankar J, Mandale M, Humbe J. A diagnosis of an unusual lower lip swelling: Schwannoma. Niger Postgrad Med J 2019; 24:191-193. [PMID: 29082911 DOI: 10.4103/npmj.npmj_121_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Schwannoma is a benign tumour of Schwann cell origin. Although it commonly occurs in the head and neck region, its intraoral presentation is rare. Establishing a clinical diagnosis of schwannoma is often difficult due to its non-specific clinical features. Hence, histopathological telltale features of Antoni A and Antoni B areas are unexpected in most cases. Reported here is a case of intraoral schwannoma affecting a 17-year-old male who presented with a slow growing mass in the lower lip.
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Affiliation(s)
- Sneha Upadhyay
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Jyoti Bhavthankar
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Mandakini Mandale
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Jayanti Humbe
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
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Comprehensive Analyses of Intraoral Benign and Malignant Nerve Sheath Tumors: The Rare Disease Entities Revisited. J Craniofac Surg 2019; 30:e317-e327. [PMID: 30845091 DOI: 10.1097/scs.0000000000005231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Intraoral benign and malignant nerve sheath tumors (BNST and MNST) are rare tumors with non-specific clinical presentations and represent diagnostic and therapeutic challenges. Current knowledge regarding their demographic, clinicopathological features and treatments remains fragmented. MATERIALS AND METHODS The original data about patients diagnosed as intraoral BNST and MNST were retrieved from our disease registry (2005-2017). Comprehensive reviews of English and Chinese literature were performed to collect and analyze the epidemiological, clinicopathological data and treatment outcomes about those published cases. RESULTS Thirty-four intraoral BNSTs were found at our institution in the past 13 years. Literature reviews identified 354 intraoral BNSTs in 223 articles and 60 intraoral MNSTs in 50 articles. Most intraoral BNSTs and MNSTs were presented in the second to fifth decade of life. Males outnumbered females in MNSTs, while BNSTs displayed a slight female preponderance. The common sites for intraoral BNSTs were parapharyngeal space followed by tongue, whereas mandible was the most common site for MNSTs. Most intraoral BNSTs were presented as slow-growing, painless mass or swelling, while MNSTs usually appeared as painful and invasive mass with discomfort. Surgical excision was preferred for intraoral BNSTs with excellent prognosis. Complete resection was indicated for intraoral MNST with dismal prognosis as evidenced by much recurrence, metastasis, and death. CONCLUSION Intraoral BNST and MNST are rare diseases which should not be ignored when intraoral painless or painful mass/swelling is found. Surgical excision is indicated for intraoral BNST with favorable outcomes. However, further investigations are warranted to optimize the treatment for intraoral MNST to improve its prognosis.
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Sitenga J, Aird G, Vaudreuil A, Huerter CJ. Clinical features and management of schwannoma affecting the upper and lower lips. Int J Dermatol 2018; 57:1047-1052. [PMID: 29377087 DOI: 10.1111/ijd.13920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/21/2017] [Accepted: 01/01/2018] [Indexed: 11/30/2022]
Abstract
Head and neck schwannomas comprise 25-40% of all schwannomas, with presentation on the lips as the rarest and most surgically complicated site for perioral tumors. A systematic literature review was conducted to include 21 cases of patients with schwannoma of the upper or lower lips. The majority of patients presented with a single, painless, well-encapsulated nodule on the upper or lower lips. The nodules were consistently slow-growing, with an average 29.3 months from symptom onset to clinical presentation. Most cases were complicated by profound cosmetic disfigurement as well as dysphagia, dysarthria, snoring, and/or sleep apnea. Overall, histological analysis was consistent with classic schwannoma, and all cases were treated via complete surgical excision, and for malignant tumors, additional therapy was utilized. All but four cases achieved full remission by final follow-up. Recurrence rate for benign lip schwannomas was 5.3%, which is remarkably different from the standard recurrence rate of 8-24% for benign peripheral schwannomas. Additionally, the proportion of malignant tumors was greater for lip schwannomas than other schwannomas. Lip schwannomas demonstrate different characteristics than schwannomas from other locations on the body, and these remarkable differences highlight significant implications for clinical practice. Complete excision is the primary mode of treatment with overall excellent postoperative prognosis and rare instances of recurrence. Given the rarity of this tumor, this review of available cases serves to comprehensively describe clinical presentation and surgical treatment approaches to upper and lower lip schwannomas.
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Affiliation(s)
- Jenna Sitenga
- Creighton University School of Medicine, Omaha, NE, USA
| | - Gregory Aird
- Creighton University School of Medicine, Omaha, NE, USA
| | - Adam Vaudreuil
- Division of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
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Mohamad I, Muhamed NA, Abdul Hamid SS. Swelling on the inner aspect of the lower lip. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2014; 9:64. [PMID: 25893070 PMCID: PMC4399407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- I Mohamad
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus
| | - NA Muhamed
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus
| | - SS Abdul Hamid
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia Health Campus
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