MyMedR

Fulltext Schwannoma of the common peroneal nerve – a rare incidence

Tan, J.A., Levin, K.B., Rhani, S.A., Hisam, A.

Journal of Surgical Academia, 2017;7(2):24-27.

MyJurnal

Schwannomas are benign tumours arising from neurilemmal cells which forms the myelin sheath of peripheral nerves. It usually occurs in the head, but may be found in the brachial plexus and sciatic nerve. Common peroneal nerve schwannoma are rare. We report a case of a middle age gentleman who presented with pain and swelling over the right popliteal fossa with associated right radicular pain of the anterolateral leg and weakness of ankle dorsiflexion. Examination revealed a 3x2 cm lump behind the posterolateral aspect of the right knee with positiveTinel’s sign upon tapping of the lump, sensory deficit over the anterolateral aspect of the leg and the ankle dorsiflexors had a muscle power of grade 3. Magnetic resonance imaging (MRI) of the right leg revealed a well circumscribed, oval lesion located along the pathway of the common peroneal nerve homogenously hypointense on T1-weighted images and heterogeneously hyperintense on T2 weighted images compared to the muscles. The lesion was not surpressed on fat suppression sequences. Intra-operatively, we noted that the schwannoma was in continuity with the common peroneal nerve. The patient underwent excision of the schwannoma. Post operatively, the pain reduced remarkably but patient suffers from numbness and right foot drop as a complication of the tumour. This case highlights the rarity of common peroneal nerve schwannoma which presents with neuropathic symptoms complicated with right foot drop.

Matched MeSH terms: Neurilemmoma*

Fulltext Metastatic malignant schwannoma of orbit: a case report

Jaais F, Sivanesan S

Med J Malaysia, 1986 Dec;41(4):356-60.

PMID: 3670161

A case of metastatic malignant schwannoma of the right orbit is presented here. Although the patient had disseminated disease, it was the eye problems which were striking and most symptomatic.
The orbital lesion was at first thought to be the primary tumour until a history of an excised right wrist mass was probed into and the histology traced.
This report is written as malignant schwannoma is an uncommon tumour. The difficulty in diagnosing malignant schwannoma is mentioned. The importance of diagnosis of an orbital metastatic lesion is also pointed out as this is often misdiagnosed.

Matched MeSH terms: Neurilemmoma/pathology; Neurilemmoma/secondary*

Neurogenous tumour of the larynx (a case report)

Phang WK, Raman R, Jayalaksmi E

J Laryngol Otol, 1987 Nov;101(11):1209-10.

PMID: 3694036

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/pathology

Plexiform schwannoma of the clitoris in a young girl: a case report

Azurah AG, Grover S, McGregor D

J Reprod Med, 2013 Jul-Aug;58(7-8):365-8.

PMID: 23947092

Schwannoma (neurilemoma) is a benign, slow-growing tumor of the nerve sheath. These tumors are rarely found in the female genitalia and to date only 1 case of clitoral schwannoma has been reported in a young girl. We report here the second case of schwannoma of the clitoris.

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/pathology; Neurilemmoma/surgery

Fulltext Ancient schwannoma of the conus medullaris

Saiful Azli MN, Abd Rahman IG, Md Salzihan MS

Med J Malaysia, 2007 Aug;62(3):256-8.

PMID: 18246922 MyJurnal

Cystic spinal or ancient schwannoma is a rare form of intradural tumour especially in the conus medullaris region. Due to its indolent behavior and benign course, the diagnosis of schwannoma is always a challenge and the imaging findings can be misleading. Our patient presented with chronic mild sciatica pain without any other neurological symptom. MRI of the spine showed intradural tumour located at the conus medullaris region with nerves compression and was reported as ependymoma. L3-L5 laminectomy and total excision of tumour was performed without any neurological complication. We concluded that ancient schwannoma of the conus medullaris is a rare benign tumour that can present with minimal non-specific neurological symptom that lead to misdiagnosis. Radical tumour excision is safe with an excellent outcome.

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/pathology; Neurilemmoma/surgery

Schwannoma of the tongue in a ten-year old child

Husain S, Husain S, Yunus MR, Yunus MR, Ramli R, Ramli R, et al.

J Pak Med Assoc, 2011 May;61(5):500-1.

PMID: 22204190

The case of a 10-year-old girl is presented who had a slow-growing, painless swelling on the left side of the tongue since six months. This was associated with disturbances in mastication and phonation. Examination revealed a 5 cm x 4 cm. globular smooth, mobile mass on left side of the tongue. There was no neurological deficit and no neck nodes palpable. She underwent excision of the mass under general anaesthesia. Complete enucleation with primary closure was carried out. The patient had an uneventful postoperative recovery and histological evaluation was consistent with schwannoma. The patient was recurrence free after one year.

Matched MeSH terms: Neurilemmoma/pathology; Neurilemmoma/surgery*

Fulltext Three cases of head and neck schwannomas: varied clinical presentation

Philip R, Chong AW, Rosalind S, Gurdeep S, Kalyani S

Med J Malaysia, 2007 Jun;62(2):175-6.

PMID: 18705460 MyJurnal

Schwannomas are benign tumors. A series of three unusual cases involving the head and neck region at the Department of ENT, Hospital Ipoh from July 2004 to June 2005 is presented. The first case was a pedunculated schwannoma of the tongue base. The second was a schwannoma of the cervical sympathetic chain who developed a transient Horner's Syndrome upon fine needle aspiration cytology. The third case was a bilobed cervical vagal schwannoma which developed immediate vocal cord palsy postoperatively which was evident at six months follow-up. All tumors were removed surgically.

Matched MeSH terms: Neurilemmoma/pathology*; Neurilemmoma/surgery

Gastric Schwannoma in an elderly man: A case report

Mohamad MA, Jarmin R, Md Pauzi SH

Malays J Pathol, 2020 Dec;42(3):455-459.

PMID: 33361729

Schwannomas are mesenchymal tumors that are characteristically benign and slow growing, which originate from any nerve with Schwann cell sheath. Gastrointestinal schwannomas are rare with distinct morphologic features as compared to schwannomas of soft tissue or central nervous system. A 77-year-old male patient was diagnosed with gastrointestinal stromal tumor based on radiological findings and clinical impression when he presented with worsening abdominal discomfort and pain. He underwent distal gastrectomy however histopathological examination of the tumour revealed schwannoma. This case report presents a rare case of a symptomatic gastric schwannoma, whose definitive diagnosis was established by histopathological and immunohistochemical findings postoperatively.

Matched MeSH terms: Neurilemmoma/diagnosis; Neurilemmoma/pathology*

Multinodular/plexiform schwannoma of the ulnar nerve

Lim CY, Low TH, Sivanoli R, Teh KK, Thuraisingham R

ANZ J Surg, 2014 Jan-Feb;84(1-2):93-4.

PMID: 24165375 DOI: 10.1111/ans.12231

Matched MeSH terms: Neurilemmoma/diagnosis*

Fulltext Atypical neurilemmomas of the tongue--report of two cases.

Siar CH, Ng KH, Chia TY, Kulkarni MG

Singapore Med J, 1988 Feb;29(1):83-5.

PMID: 3406779

The aetiology, clinical and histological features of neurilemmomas of the oral and paraoral regions are briefly outlined. Two cases of atypical neurilemmomas of the tongue are described with an intent to document the partial encapsulation and multilobular distribution of the neurogenic tissue noted in these two lesions.

Matched MeSH terms: Neurilemmoma/pathology

Nasal vestibule schwannoma: report of a rare case

Fadzilah I, Salina H, Khairuzzana B, Rahmat O, Primuharsa Putra SH

Ear Nose Throat J, 2014 Jun;93(6):E33-5.

PMID: 24932827

Schwannomas of the nasal cavity and paranasal sinuses are quite rare, especially in the nasal vestibule. We report the case of a 61-year-old woman who presented with a 2-month history of progressively worsening right-sided epistaxis and nasal blockage. Rigid nasoendoscopy showed a mobile, smooth, globular mass occupying the right nasal vestibule. The mass arose from the lateral nasal wall and impinged on the anterior part of the middle turbinate posteriorly. Computed tomography of the paranasal sinuses showed a 3.8 × 1.7-cm enhancing mass in the right nostril. The mass obliterated the nasal cavity and caused mild deviation of the septum. The preoperative histopathologic examination showed positivity for vimentin and S-100 protein, suggesting a diagnosis of schwannoma. The patient underwent an intranasal laser-assisted excision biopsy. The histopathologic examination confirmed the diagnosis of schwannoma. Postoperative recovery was uneventful, and no recurrence was seen in the follow-up period.

Matched MeSH terms: Neurilemmoma/complications; Neurilemmoma/diagnosis*; Neurilemmoma/surgery

Fulltext Thumb Schwannoma : A Frequent Misdiagnosis

Mooi SS, Ahmad TS

Malays Orthop J, 2016 Mar;10(1):53-54.

PMID: 28435548 MyJurnal DOI: 10.5704/MOJ.1603.010

A 32 year-old Malay lady presented with a swelling over the dorsal surface of her right thumb for 6 months. The swelling was non-tender, smooth surfaced, mobile and nonfluctuating with no bony involvement. The provisional diagnosis was ganglion cyst. Excisional biopsy did not show features of ganglion cyst as it appeared to be wellencapsulated, multi-lobulated and yellowish in colour. Histopathological examination showed that it was a schwannoma. Schwannomas are relatively rare benign tumours which are frequently misdiagnosed. In this case, it was misdiagnosed both as a ganglion and a lipoma.

Matched MeSH terms: Neurilemmoma

Fulltext Cervical schwannoma: report of four cases

Rohaizam J, Tang IP, Jong DE, Tan TY, Narihan MZ

Med J Malaysia, 2012 Jun;67(3):345-8.

PMID: 23082435 MyJurnal

Extracranial schwannomas in the head and neck region are rare neoplasms. The tumours often present as asymptomatic, slowly enlarging lateral neck masses and determination of the nerve origin is not often made until the time of surgery. Preoperative diagnosis maybe aided by imaging studies such as magnetic resonance imaging or computed tomography, while open biopsy is no longer recommended. The accepted treatment for these tumors is surgical resection with preservation of the neural pathway. We report four cases of cervical schwannomas that we encountered at our center during four years of period. The clinical features, diagnosis and origin, management and pathological findings of these benign tumors are discussed.

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/surgery

Fulltext An extensive cervical vagal nerve schwannoma: a case report

Chiun KC, Tang IP, Prepageran N, Jayalakshmi P

Med J Malaysia, 2012 Jun;67(3):342-4.

PMID: 23082434 MyJurnal

Vagal nerve schwannoma is extremely rare. The majority of cases present with a slow growing neck swelling without neurological deficit. Magnetic resonance imaging is the gold standard investigation to establish a pre-operative diagnosis. We report a case of a 32-year-old man with an extensive right vagal nerve schwannoma involving the right jugular foramen and parapharyngeal space. The tumour was resected via a transcervical approach. Complete excision of the tumour is the key to prevent recurrence.

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/surgery

Fulltext Intraparotid facial nerve schwannoma: a case report

Irfan M, Shahid H, Yusri MM, Venkatesh RN

Med J Malaysia, 2011 Jun;66(2):150-1.

PMID: 22106700 MyJurnal

Schwannoma in the head and neck region is very rare. The tumour occurring in the intraparotid facial nerve is even rarer. A patient presenting with a parotid swelling with facial nerve paralysis is not pathognomonic of a facial nerve schwannoma. However it may occur because enlargement of the parotid, by any kind of tumour especially a malignant one can cause facial nerve paralysis. We report a case of an intraparotid facial nerve schwannoma, in a patient who presented with parotid enlargement and facial nerve paralysis.

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/surgery

Benign orbital apex tumors treated with multisession gamma knife radiosurgery

Goh ASC, Kim YD, Woo KI, Lee JI

Ophthalmology, 2013 Mar;120(3):635-641.

PMID: 23149128 DOI: 10.1016/j.ophtha.2012.08.015

OBJECTIVE: The orbital apex is an important anatomic landmark that hosts numerous critical neurovascular structures. Tumor resection performed at this complex region poses a therapeutic challenge to orbital surgeons and often is associated with significant visual morbidity. This article reports the efficacy and safety of multisession gamma knife radiosurgery (GKRS) in benign, well-circumscribed tumors located at the orbital apex.

DESIGN: Retrospective interventional case series.

PARTICIPANTS: Five patients with visual disturbances resulting from a benign, well-circumscribed orbital apex tumor (3 cases of cavernous hemangioma and 2 cases of schwannoma).

METHODS: Each patient treated with GKRS with a total radiation dose of 20 Gy in 4 sessions (5 Gy in each session with an isodose line of 50%) delivered to the tumor margin.

MAIN OUTCOME MEASURES: Best-corrected visual acuity, visual field changes, orbital imaging, tumor growth control, and side effects of radiation.

RESULTS: All patients demonstrated improvement in visual acuity, pupillary responses, color vision, and visual field. Tumor shrinkage was observed in all patients and remained stable until the last follow-up. No adverse events were noted during or after the radiosurgery. None of the patients experienced any radiation-related ocular morbidity.

CONCLUSIONS: From this experience, multisession GKRS seems to be an effective management strategy to treat solitary, benign, well-circumscribed orbital apex tumors.

Matched MeSH terms: Neurilemmoma/pathology; Neurilemmoma/surgery*

Giant nerve sheath tumour: report of six cases

Ghani AR, Ariff AR, Romzi AR, Sayuthi S, Hasnan J, Kaur G, et al.

Clin Neurol Neurosurg, 2005 Jun;107(4):318-24.

PMID: 15885392

Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma. The current views are that schwannomas arise from the progenitor of the schwann cell. Whereas the neurofibroma series probably arise from a mesenchymal origin closer to a fibroblast. We report on six cases of nerve sheath tumour that occur in the spinal and paraspinal region that presented to us over a 5 year period.

Matched MeSH terms: Neurilemmoma/pathology*; Neurilemmoma/surgery

Fulltext The different faces of facial nerve schwannomas

Abdullah A, Mahmud MR, Sabir HA, Saim L

Med J Malaysia, 2003 Aug;58(3):450-3.

PMID: 14750390

Facial nerve schwannomas are rare benign tumors. The tumor can arise anywhere along the course of the facial nerve. The most common presentation for this tumor is a slowly progressive facial nerve paralysis. Sensorineural hearing loss (SNHL) and tinnitus are later symptoms. The symptoms and signs depend on the site of tumor along the nerve. We report three cases of facial nerve schwannomas with different clinical presentations. Appropriate management of a facial nerve schwannoma should be based on the site and extent of the tumor and status of the nerve function.

Matched MeSH terms: Neurilemmoma/complications; Neurilemmoma/diagnosis*

Diagnostic conundrum of a perineal tumour: a rectal gastrointestinal stromal tumour mimic

Shi R, Chew MH, Leow WQ

Malays J Pathol, 2017 Dec;39(3):293-296.

PMID: 29279593

Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall. One, GISTs are relatively more common than schwannomas in the rectum. Two, schwannomas usually have very little mitoses. Three, rectal GISTs commonly exhibit nuclear palisades. We also discuss the diagnostic, prognostic and therapeutic functions of immunohistochemical and molecular investigations. As the surgical intent for rectal GISTs is for en-bloc excision with wide margins, we surmise that the intraoperative consult should include GIST as a possible differential diagnosis for rectal mesenchymal tumours. In view of the potential for neoadjuvant treatment with imatinib before surgical excision to preserve sphincter function, a multidisciplinary approach is recommended for establishing most effective treatment strategy in these rare complex cases.

Matched MeSH terms: Neurilemmoma/diagnosis*; Neurilemmoma/pathology

Fulltext Surgical access to parapharyngeal space tumours--the Manipal experience

Hazarika P, Dipak RN, Parul P, Kailesh P

Med J Malaysia, 2004 Aug;59(3):323-9.

PMID: 15727377

A few series of parapharyngeal space tumours have been reported earlier but recently not many series have been published in English literature. It is rare for any medical center, let alone an individual surgeon, to develop sufficient experience in evaluating these tumours. We present our experience in the treatment of 41 cases of parapharyngeal tumours from January 1992 to December 2001. FNAC, ultrasound and CT scan of the presenting mass was done in most of the patients as the main pre-operative work-up. The strategic location and extension of the tumour may occasionally alter the surgical approach for tumour excision.

Matched MeSH terms: Neurilemmoma/complications; Neurilemmoma/diagnosis; Neurilemmoma/pathology; Neurilemmoma/surgery

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