Cutaneous plexiform schwannomas in a patient with neurofibromatosis type 2

Rare Case of a Schwannoma of the Posterior Pharyngeal Wall in a Child

We present a rare case of a schwannoma which is localized on the posterior pharyngeal wall. It caused severe difficulty in swallowing and breathing in a 3-year-old child. Schwannomas of the posterior pharyngeal wall have been rarely reported in children. To our knowledge, only 7 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, but none of them is associated with a child. The tumor was removed with plasma radiofrequency excision via a transoral route. Computed tomography or magnetic resonance imaging examination showed no recurrence of the tumor up to 2 years. To our knowledge, for the first time, a case of posterior pharyngeal wall schwannoma has been reported in a 3-year-old child, and the schwannoma was removed via plasma radiofrequency transoral excision. This case study illustrates that schwannoma may occur in children, and it is safe to treat this disease through plasma radiofrequency transoral excision route.

An Assessment and Management of Plexiform Schwannoma of the Third Webspace in a Female: A Case Report

Schwannoma is a rare benign soft tissue tumor that appears like a neuroma based on its specific location and clinical features. We report a case of a plexiform schwannoma in a middle-aged woman who had a painful bump located in the third webspace on the dorsum of her right foot for the last four years. Initially, the swelling was thought to be Morton's neuroma based on location and clinical feature findings. The mass was resected and was sent for histopathological examination, revealing a plexiform schwannoma, most likely developing from the cutaneous nerves on the dorsum of the foot. She reported improvement in her symptoms after complete and careful excision without any neurological deficit. Investigation of any subcutaneous foot swelling should be coupled with a histopathological examination for comprehensive management.

Skin Lesions in Neurofibromatosis Type 2: Diagnostic and Prognostic Significance of Cutaneous (Plexiform) Schwannomas

Background

Neurofibromatosis type 2 (NF2) is a genetic disease characterized by the appearance of multiple tumours in the nervous system. Cutaneous lesions are common and may provide useful diagnostic and prognostic information, but they have not been widely studied.

Objectives

To characterize cutaneous lesions in a Spanish cohort of patients with NF2 and investigate associations with clinical and genetic severity.

Methods

We studied the clinical and histologic characteristics of cutaneous lesions in 49 patients with NF2 and analysed correlations with phenotype‐ and genotype‐based severity scores. We collected information on the presence/absence of cutaneous lesions, location, age at onset, type of lesion, and histologic features. We also studied level of systemic involvement and genetic mutations involved.

Results

Forty‐nine patients (31 women [63.3%] and 18 men [36.7%]) were analysed, and 33 (67.3%) had cutaneous lesions presumed to be schwannomas. According to their clinical form, they were distributed as follows: 24 patients (48%) had deep tumours, 21 (42%) had plaque‐like lesions, and 3 (6%) had superficial tumours. Histologic examination from 27 lesions analysed out 23 patients showed classic schwannoma or hybrid schwannoma‐neurofibroma features in the 8 deep tumours biopsied and plexiform schwannoma features in the 17 plaque‐like lesions and the 2 superficial tumours analysed. Early onset (first 2 decades of life) was reported by all patients with plaques and superficial tumours. In our cohort, 100% of the patients with plaque‐like lesions and superficial tumours with microscopic features of plexiform schwannoma were in the 2 groups with the most severe clinical phenotypes, and 82.6% of them were in the 3 most severe genotype‐based classes.

Conclusions and Relevance

Cutaneous lesions, specially plexiform schwannomas, are common in NF2, and they usually appear at an early age providing useful diagnostic and prognostic information. These tumours are part of the spectrum of cutaneous manifestations in this disease. Although its diagnostic and prognostic value has been pointed out, there are few studies focussed on their analysis.

A rare case of plexiform schwannoma on the foot

Plexiform schwannoma is an uncommon soft tissue tumor that could even rarely presented on the foot and toes.

Giant plexiform schwannoma in the plantar aspect of the foot: a case report

Plexiform schwannoma is a rare Schwann cell tumor that usually occurs in the head and neck. Here, we report a giant plexiform schwannoma (5.5 × 4.0 cm) in the right plantar aspect of the foot. This tumor presented from the dermis to the subcutaneous fat in the plantar aspect, forming a multiocular shape.

Plexiform Schwannoma of the Tongue in a Pediatric Patient with Neurofibromatosis Type 2: A Case Report and Review of Literature

Introduction

Plexiform schwannoma is a rare variant of schwannoma that accounts for only 5% of all schwannomas. Herein, we present a rare case of plexiform schwannoma of the tongue in a pediatric patient with neurofibromatosis type 2 (NF2).

Case Presentation

A 13-year-old female presented with a growing left-sided tongue mass. The patient has a past medical history of NF2. The tongue mass was excised and histopathological examination revealed a spindle cell tumor with multinodular growth pattern, with Verocay bodies' formation. Tumor cells were strongly positive for S-100 protein and negative for smooth muscle actin (SMA), and EMA highlighted perineural fibroblasts surrounding tumor nodules. These findings were diagnostic of plexiform schwannoma.

Conclusion

Plexiform schwannoma of the tongue is an extremely rare tumor seen in patients with NF2. Clinical examination and histopathological evaluation are important for diagnosis of plexiform schwannoma.

The concept of type 2 segmental mosaicism, expanding from dermatology to general medicine

In autosomal dominant skin disorders, the well-known type 1 segmental mosaicism reflects heterozygosity for a postzygotic new mutation. By contrast, type 2 segmental mosaicism originates in a heterozygous embryo from an early postzygotic mutational event giving rise to loss of the corresponding wild-type allele, which results in a pronounced segmental involvement being superimposed on the ordinary, non-segmental phenotype. Today, this concept has been proven by molecular analysis in many cutaneous traits. The purpose of this review was to seek publications of cases suggesting an extracutaneous manifestation of type 2 segmental mosaicism. Case reports documenting a pronounced extracutaneous segmental involvement were collected from the literature available in PubMed and from personal communications to the author. Pertinent cases are compared to the description of cutaneous segmental mosaicism of type 1 or type 2 as reported in a given trait. In total, reports suggesting extracutaneous type 2 segmental mosaicism were found in 14 different autosomal dominant skin disorders. In this way, clinical evidence is accumulated that extracutaneous type 2 segmental mosaicism does likewise occur in many autosomal dominant skin disorders. So far, however, molecular proof of this particular form of mosaicism is lacking. The present review may stimulate readers to inform colleagues of other specialties on this new concept, in order to initiate further research in this particular field of knowledge that has important implications for diagnosis, treatment and genetic counselling.

Septic arthritis: a unique complication of nasal septal abscess

Nasal septal abscesses (NSAs) occur between the mucoperichondrium and the nasal septum. They most often arise when an untreated septal hematoma becomes infected. The most commonly reported sequela is a loss of septal cartilage support, which can result in a nasal deformity. Other sequelae include potentially life-threatening conditions such as meningitis, cavernous sinus thrombosis, brain abscess, and subarachnoid empyema. We report the case of a 17-year-old boy who developed an NSA after he had been struck in the face with a basketball. He presented to his primary care physician 5 days after the injury and again the next day, but his condition was not correctly diagnosed. Finally, 7 days after his injury, he presented to an emergency department with more serious symptoms, and he was correctly diagnosed with NSA. He was admitted to the intensive care unit, and he remained hospitalized for 6 days. Among the abscess sequelae he experienced was septic arthritis, which has heretofore not been reported as a complication of NSA. He responded well to appropriate treatment, although he lost a considerable amount of septal cartilage. He was discharged home on intravenous antibiotic therapy, and his condition improved. Reconstruction of the nasal septum will likely need to be pursued in the future.

Gastric plexiform schwannoma in association with neurofibromatosis type 2

Plexiform schwannoma (PS) is an uncommon variant of schwannoma characterized by a multinodular (plexiform) growth pattern. It comprises up to 5 % of all schwannomas. The association between PS and neurofibromatosis type 1 or type 2 (NF1/NF2) is only rarely reported. Most cases of PS occur in the skin and subcutaneous soft tissue, with only a few reports of digestive tract involvement. We describe an 18-year-old male with NF2 who had bilateral vestibular schwannomas and multiple cutaneous PSs, and a 3-year history of abdominal pain. The patient ultimately underwent a distal gastrectomy for a partially obstructing submucosal antral mass, associated with an overlying ulcer. Histopathologic examination showed the mass to be a PS. The patient is alive and well, without symptoms, 12 months postoperatively. A review of the English language medical literature yielded only ten examples of PS arising in the digestive tract. Our patient is the first to be reported to have a gastric PS, and only the second patient to be reported with a digestive tract PS to have NF2, and the only patient reported to have both digestive tract and cutaneous PSs. Despite its rare occurrence with NF2, the finding of PS at any site should stimulate an examination for other manifestations of this disorder.

CLINICAL TRIAL REGISTRATION

None.

Dermal and Subcutaneous Plexiform Soft Tissue Neoplasms

This article presents an overview of soft tissue tumors that have a plexiform histomorphology. The more commonly encountered entities, including plexiform fibrohistiocytic tumor, cellular neurothekeoma, dermal nerve sheath myxoma, plexiform schwannoma, and plexiform neurofibroma, are discussed in detail, and other tumors are noted. Information on clinical features, microscopic findings, ancillary studies, differential diagnosis, and prognosis is provided for each entity.

Plexiform Schwannoma of Lumbar Region

Plexiform schwannoma is an unusual peripheral nerve sheath tumor. It can mimic plexiform neurofibroma. A five-year-old girl presented with painful swelling in left lumbar region. Radiologic investigations showed a multinodular tumor in the subcutaneous plane of lumbosacral region. A complete excision and histopathologic examination revealed a plexiform tumor composed of hypocellular and hypercellular areas with verocay bodies. The tumor cells showed strong positivity for S-100 protein, rendering a final diagnosis of plexiform schwannoma. The child has been free of recurrence in 12-month follow-up.

Multiple faces of children and juvenile meningiomas: a report of single-center experience and review of literature

OBJECTIVE

Pediatric meningiomas are extremely rare tumors often associated with various medical conditions. This report is an attempt to analyze the clinical behavior, pathological presentation and recommended management of both isolated and neurofibromatosis type 2 (NF2) related pediatric meningiomas in comparison to their adult counterparts.

METHODS

The investigated group consisted of three male and six female patients suffering from meningiomas of the central nervous system, who were hospitalized at our department in years 2001-2012.

RESULTS

In our group three children were diagnosed with NF2. Two were released with a suspicion of that disease. Three patients had multiple meningiomas at the first presentation. The most common manifestation were focal neurological deficits (47%). Meningiomas were mostly located at the brain convexity (29%). Histological examination revealed the domination of fibrous type in our group (29%). Apart from surgical management a preoperative embolization of the tumors' vessels was implemented in two children. Another three children underwent postoperative radiotherapy (RTh), one received a chemotherapy (ChTh).

CONCLUSION

Meningiomas in children differ from their counterparts in adults. Due to common coexistence of pediatric meningiomas and neurofibromatosis type 2, this group of patients should be taken under strict control, because of high risk of tumor recurrence.

Multiple cutaneous plexiform schwannomas as initial presentation of neurofibromatosis 2 in a 9-year-old

Neurofibromatosis 2 (NF2) is an autosomal-dominant disease caused by genetic mutations of the NF2 gene on chromosome 22. Patients are often diagnosed according to the presence of bilateral vestibular schwannomas and other tumors in the brain and spinal cord. In children, NF2 can present early with ocular findings and cutaneous tumors. We report here a 9-year-old girl who presented with multiple pigmented, slightly tender plaques on her scalp, face, and back that were revealed by histopathology to be plexiform schwannomas. We suspected NF2 and sent the patient's blood for genetic testing, which confirmed our diagnosis.