Tratamiento multimodal en los schwanomas vestibulares grandes

Introducción: Los schwanomas vestibulares son lesiones clasificadas como grado I por la Organización Mundial de la Salud. Las opciones conductuales incluyen la observación, la radiocirugía o la resección microquirúrgica endoscópica. Objetivo: Describir el rol del tratamiento multimodal en los schwanomas vestibulares. Métodos: Se realizó una búsqueda sistemática de literatura médica para la identificación e inclusión de artículos en las siguientes bases de datos: PubMed/Medline, SciELO y Google Scholar, además de los servidores de preprints BioRvix y MedRvix. Se usaron los siguientes descriptores: vestibular schwanoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Se excluyeron editoriales, cartas al editor, libros, revisiones, metaanálisis y aquellos artículos con método deficiente de más de 20 años de publicación o sin mención al tema de interés. Fueron incluidos 16 artículos. Desarrollo: Los artículos incluyeron un total de 699 pacientes, de los cuales solo 228 (32,6 %) recibieron radioterapia en el período posoperatorio. El período de seguimiento promedió 49,6 meses. La preservación de la función facial se logró en el 88,3 % de los casos y el control tumoral en el 80,7 %. El estado de la preservación auditiva solo fue informado en el 50 % de los estudios. El uso de la radioterapia adyuvante mostró gran variabilidad. Conclusiones: El tratamiento multimodal para los schwanomas vestibulares grandes -compuesto por la resección subtotal, vaciamiento intratumoral, seguido de radiocirugía- se ha convertido en una opción plausible. Se necesita la publicación de mayor cantidad de reportes para ofrecer recomendaciones y estratificar la conducta.

Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection. Objective: To describe the role of multimodal treatment for vestibular schwannomas. Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included. Development: The articles included a total of 699 patients, of which only 228 (32.6 %) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 % of cases; and tumor control, in 80.7 %. Hearing preservation status was reported in only 50 % of the studies. The usage of adjuvant radiotherapy showed great variability. Conclusions: Multimodal treatment for large vestibular schwannomas -composed of subtotal resection and intratumoral draining, followed by radiosurgery- has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior.

Schwanoma palatino en paciente pediátrico de 12 años: una rara presentación clínica

El schwanoma es un tumor neural que se origina en las células de Schwann presentes en la vaina nerviosa cuya localización más frecuente a nivel oral es el dorso de lengua, siendo mucho más frecuente en adultos. En población pediátrica la presentación es muy rara siendo lengua su ubicación más frecuente, mientras que a nivel palatino solo se conocen 11 reportes en menores de 16 años. El objetivo de este reporte es presentar un caso clínico inusual de schwanoma palatino en un niño chileno de 12 años de edad, quien fue derivado con diagnóstico clínico presuntivo de carcinoma mucoepidermoide. El caso se complementó con radiografía panorámica, Conebeam, y luego biopsia incisional. Finalmente, se diagnosticó schwanoma palatino variedad sólida. Es importante considerar al schwanoma como diagnóstico diferencial en casos de tumores palatinos, en especial en casos pediátricos ya que se pueden presentar similares características clínicas a tumores de glándula salival.

The Schwannoma or neurilemmoma tumor originates from Schwann cells present in nerve sheaths. At oral level, its most frequent location is at the back of the tongue, being much more frequent in adults. In the pediatric population, this occurrence is rare and most frequently found in the tongue. At palatal level, only 11 reports are known in children under 16 years of age. The aim of this report is to present an unusual clinical case of palatal schwannoma in a 12-year-old Chilean boy, referred with a clinical diagnosis of mucoepidermoid carcinoma. The case was complemented with panoramic radiography and Cone beam, for its subsequent incisional biopsy. Finally, a solid palatal schwannoma was diagnosed. It is important to consider schwannoma as a differential diagnosis in cases of palatal tumors, especially in pediatric cases, since they can present similar clinical characteristics to salivary gland tumors.

Schwannoma in the nasal cavity: A benign nerve sheath tumor at an odd location

Schwannomas are neurogenic tumors arising from the Schwann cells present in the neural sheath of the myelinated nerves. These are benign tumors that can arise anywhere in the body. Schwannomas are rarely seen in the nose and paranasal sinuses representing <4% of all head-and-neck schwannomas. Surgical excision is the treatment of choice in these cases. Nasal polyps are common nasal cavity lesions which are usually inflammatory polyps. Schwannoma of the nasal cavity usually presented with headache, unilateral nasal obstruction due to mass obliterating the nasal cavity, and epistaxis. Here, we report the case of a 47-year-old female who presented with a mass in the left nasal cavity causing the nasal blockage.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

One case report of CT and MR features of pancreatic schwannoma / 中华内分泌外科杂志

Pancreatic schwannoma is extremely rare. In this paper, the clinical, pathological and imaging features of a case of pancreatic schwannoma were retrospectively analyzed and the literatures were reviewed to improve the diagnostic ability.

Electroencephalographic microstates in vestibular schwannoma patients with tinnitus / 南方医科大学学报

OBJECTIVE@#To explore the biomarkers of tinnitus in vestibular schwannoma patients using electroencephalographic (EEG) microstate technology.@*METHODS@#The EEG and clinical data of 41 patients with vestibular schwannoma were collected. All the patients were evaluated by SAS, SDS, THI and VAS scales. The EEG acquisition time was 10-15 min, and the EEG data were preprocessed and analyzed using MATLAB and EEGLAB software package.@*RESULTS@#Of the 41 patients with vestibular schwannoma, 29 patients had tinnitus and 12 did not have tinnitus, and their clinical parameters were comparable. The average global explanation variances of the non-tinnitus and tinnitus groups were 78.8% and 80.1%, respectively. The results of EEG microstate analysis showed that compared with those without tinnitus, the patients with tinnitus had an increased frequency (P=0.033) and contribution (P=0.028) of microstate C. Correlation analysis showed that THI scale scores of the patients were negatively correlated with the duration of microstate A (R=-0.435, P=0.018) and positively with the frequencies of microstate B (R=0.456, P=0.013) and microstate C (R=0.412, P=0.026). Syntax analysis showed that the probability of transition from microstate C to microstate B increased significantly in vestibular schwannoma patients with tinnitus (P=0.031).@*CONCLUSION@#EEG microstate features differ significantly between vestibular schwannoma patients with and without tinnitus. This abnormality in patients with tinnitus may reflect the potential abnormality in the allocation of neural resources and the transition of brain functional activity.

Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature

Abstract Introduction: Schwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling. Objective: In this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature. Methods: Patients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done. Results: Twenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root. Conclusion: A long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.

Histopathological Approach To The Diagnosis Of Benign Peripheral Nerve Sheath Tumors At Uncommon Location

PARIPEX - INDIAN JOURNAL F RESEARCH |O December - 202Volume - 11 | Issue - 12 | 2 | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex ABSTRACT Peripheral nerve sheath tumors are relatively common lesions that exhibit a wide morphological and biological spectrum. In the presence of classical morphological and immunohistochemical features, the histological diagnosis is usually straightforward, but they may represent diagnostic challenges. Schwannoma is a slow growing encapsulated tumor of neuroectodermal derivation that originates from the Schwann cells of the neural sheath. Most commonly presents as cerebellopontine angle mass but extracranial sites are known and needs to be considered in the differential diagnosis. Intraparotid and penile schwannomas are extremely rare. Their diagnosis could be missed on cytology due to cystic changes. Isolated plexiform neurofibroma of the tongue is again a rare tumor. Plexiform pattern recognition is important for the pathologist as these varients might show malignant transformation. Overall Fine needle aspiration cytology though inconclusive at times, help a lot initially to delineate between benign Vs malignant lesions. Moreover its minimally invasive so can be performed easily at the uncommon locations. Histopathology remains the gold standard. Clinicopathological and imaging correlation is must for definite diagnosis and treatment.

Maxillary Schwannoma – A Rare Case Report

Background: Schwannoma or neurilemmoma are a type of nerve sheath tumors. Most of the literature, reports of schwan- noma in the head and neck involve tongue. Intraosseous schwannomas account to about less than 1% with affliction to the mandible over maxilla. Very few cases of maxillary schwannomas have been reported till date. Case presentation: We present one such rare case of schwannoma involving the maxilla extending till the nasal cavity in a 35 years old male. Wide excision of the lesion with hemi-maxillectomy of the right side was done using modified Weber–Fergusson approach (Dieffenbach’s extension). The patient’s postoperative recovery was uneventful without recurrence when followed up till 2 years. Conclusion: Though schwannoma of the Head and neck region are rare, they should be considered as a differential diagnosis of unilateral slow growing mass in the head and neck region, particularly in an adult.

Schwannoma intraóseo mandibular: reporte de un caso clínico / Mandibular intraosseous schwannoma: a clinical case report

Objetivo: El schwannoma es un tumor neuroectodérmi- co benigno de la vaina nerviosa o vaina de mielina formada por células de Schwann. Aproximadamente entre el 25 y el 48% de los casos presentan localización en el territorio cer- vicofacial, especialmente en los tejidos blandos de esta re- gión. Se los puede clasificar como schwannomas periféricos o intraóseos, éstos últimos también denominados centrales. Los schwannomas intraóseos son poco comunes, constituyen menos del 1% de los schwannomas presentes en la región en cuestión y menos del 0,2% de todos los tumores primarios óseos. El presente trabajo tiene como objetivo reportar un caso clínico de un schwannoma intraóseo mandibular, revi- sando aspectos clínicos, radiográficos y anatomopatológicos. El schwannoma intraóseo es una entidad poco común, o al menos se encuentra en una condición de subregistro en Argen- tina, por lo que este caso constituye una rareza. Caso clínico: Se presentó a la consulta una paciente de 30 años de edad, derivada al servicio de Cirugía y Trau- matología Bucomaxilofacial del Hospital "Parmenio Piñero" de la Ciudad Autónoma de Buenos Aires por su odontólogo de cabecera, a raíz de un hallazgo radiográfico durante un control de rutina. Se planificó realizar una biopsia incisio- nal, cuyo resultado anatomopatológico fue compatible con el diagnóstico de schwannoma intraóseo. Se procedió a realizar la enucleación completa. Finalmente, la paciente evolucionó sin complicaciones (AU)

Aim: Schwannoma is a benign neuroectodermal tumor of the nerve sheath or myelin sheath formed by Schwann cells. Approximately between 25 and 48% of the cases are located in the cervicofacial territory, especially in the soft tissues of this region. They can be classified into peripheral and intraosseous schwannomas, the last one can also be reported as central. In- traosseous schwannomas are rare, constituting less than 1% of schwannomas present in the region and less than 0.2% of all primary bone tumors. This publication aims to report a clin- ical case of mandibular intraosseous schwannoma, reviewing clinical, radiographic and anatomopathological aspects. In- traosseous schwannoma is a rare entity, or at least is under a condition of underreport in Argentina, so this case is a rarity. Clinical case: A 30-year-old patient, referred to the Buccomaxillofacial Surgery and Traumatology service of the "Parmenio Piñero" Hospital of Ciudad Autónoma de Bue- nos Aires by her dentist, because of a radiographic finding during a routine check. An incisional biopsy was performed, the anatomopathological result of which was compatible with the diagnosis of intraosseous schwannoma. A complete enu- cleation was performed under local anesthesia. Finally, the patient evolved without complications (AU)

Schwannoma retroperitoneal como diagnóstico diferencial de tumor retrocavo, reporte de un caso

Introducción: Los schwannomas suelen ser tumores benignos con origen en el sistema neural que sostiene la célula de Schwann. La mayoría presentan síntomas abdominales inespecíficos. Dado su escasa frecuencia, 1-5% de todos los tumores retroperitoneales en la población mundial, se presenta el siguiente caso. Pueden tener múltiples localizaciones, como el páncreas, tracto gastrointestinal y espacio retroperitoneal. Son pocos los casos que se han reportado siendo apenas notificados menos de 150 casos a la actualidad. Caso Clínico: Paciente femenina de 33 años con dolor abdominal inespecífico. Niega antecedentes relevantes y no presenta hallazgos positivos al examen físico. Estudios complementarios con tomografía y resonancia magnética nuclear de abdomen contrastados mostraron una masa retroperitoneal quística de 5x4 cm de localización suprarrenal derecha, que desplazaba la cava retrohepatica y que realza con medio contraste intravenoso. Debido a que el dolor era incapacitante se realizó resección quirúrgica. No se consideró biopsia preoperatoria, ante el riesgo de ruptura y diseminación tumoral. Se realizó escisión transperitoneal con resección completa, técnicamente compleja por su localización. El reporte histopato-lógico fue Schwannoma, sin tejido supra-adrenal, sugiriendo lesión yuxta-adrenal.

Introduction: Schwannomas are usually benign tumors originating in the neural system that supports the Schwann cell. Most have nonspecific abdominal symptoms. Given its low frequency, 1-5% of all retroperitoneal tumors in the world population, the following case is presented. They can have multiple locations, such as the pancreas, gastrointestinal tract and retroperitoneal space. Few cases have been reported, with less than 150 cases reported to date. Clinical Case: 33-year-old female patient with nonspecific abdominal pain. She denies relevant history and has no positive findings on physical examination. Complementary studies with contrast-enhanced tomography and magnetic resonance imaging of the abdomen showed a 5x4 cm cystic retroperitoneal mass located in the right suprarenal region, displacing the retrohepatic vena cava and enhancing with intravenous contrast medium. Because the pain was incapacitating, surgical resection was performed. A preoperative biopsy was not considered, given the risk of rupture and tumor dissemination. Transperitoneal excision was performed with complete resection, technically complex due to its location. The histopathological report was Schwannoma, without supra-adrenal tissue, suggesting a juxta-adrenal lesion.

Megastomach caused by a pyloric schwannoma in a young woman

Schwannomas are mesenchymal tumors that are characteristically benign and slow growing, which originate from any nerve with schwann cell sheath. Here, we report the case of a 28-year-old woman patient who was diagnosed with stomach obstructive lesions causing severe gastric dilatation. She underwent distal gastrectomy and the histopathological examination of the tumor revealed one obstructive gastric schwannoma.

STUDY OF CLINICAL PROFILE AND MANAGEMENT OF INTRADURAL EXTRAMEDULLARY SPINAL CORD (IDEM) TUMOURS (CONDUCTED AT A TERTIARY CARE CENTER IN CENTRAL MAHARASHTRA)

Aims and objectives: This study aims to analyse the complete profile of patients diagnosed and treated as IDEM spinal cord tumours. The factors studied include age, sex, clinical presentations, histopathology, surgical outcome and post operative recurrence. It is a single center prospective study conducted over a peri Materials and method: od of 18 months. Patient demographics, severity and duration of symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were collected. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel and Nurick grading. The back pain was assessed with help of the Denis pain scale (DPS). Data collected throughout preoperative and postoperative examination and investigations were analyzed and submitted to statistical procedures. Our study Results and analysis: included30 patients, majority being young adults between 20 to 30 years (46.66%). The male and female ratio in our study was 2:1. Predominant presentation was sensory symptoms like numbness, paraesthesia in extremeties (66.66%), followed by pain in back, limbs (33.33%). The most common location found was dorsal cord (50%) followed by lumbar(36.66%). The histopathological examination showed meningioma to be the most common (56.66%), followed by schwannoma (20%), and neurofibroma (16.66%). Pseudomeningocoele was the only complication encountered. Out of 30 patients we had operated, we could achieve total excision in 27 patients (90%). There was no postoperative worsening of symptoms, and no recurrence. The clinical and pre and postoperative profile suggested Summary and Conclusion: IDEM spinal cord tumours were common in 3rd decade, with male predominance. Commonest location was dorsal area with meningioma being the commonest histopathological finding.

SCHWANNOMA TONGUE: TWO CASE REPORTS

Schwannoma of the tongue is a relatively rare tumor of the head and neck. Intraoral schwannoma accounts for 1% of head and neck region and are commonly seen at the base of tongue. In this article we report two cases of schwannoma in young adult presented with painless swelling of the tongue. Lesion was completely excised via an intraoral approach and confirmed as schwannoma tongue in histopathology.

Schwannoma septal, una causa infrecuente de obstrucción nasal / Septal schwannoma, an uncommon cause of nasal obstruction

Resumen Los schwannomas son neoplasias derivadas de las células de Schwann de la cubierta de los nervios periféricos. Su desarrollo en la región nasosinusal es poco frecuente, especialmente a nivel septal. Su diagnóstico diferencial es variado y debe establecerse con otras causas más habituales de masa nasal unilateral. Su tratamiento es quirúrgico. Describimos el caso de un varón de 47 años con una masa nasal derecha intervenida mediante cirugía endoscópica nasosinusal y con diagnóstico anatomopatológico de schwannoma septal.

Abstract Schwannomas are tumors that proceed from Schwann cells in the cover of peripheral nerves. It is uncommon in the sinonasal area, especially in the nasal septum. The differential diagnosis is extensive and requires contemplating other more frequent causes of unilateral nasal mass. The current treatment of septal schwannoma is surgical. We report a 47-year-old male with a right nasal mass operated by endoscopic sinonasal surgery with an anatomopathological diagnosis of a nasal septal schwannoma.

Schwannoma en el puerperio / Schwannoma in the puerperium

Resumen: Se presenta el caso de una paciente de 48 años, previamente sana, sometida a cesárea bajo bloqueo epidural que presenta datos de compresión medular en el puerperio inmediato. El diagnóstico inicial fue una complicación por anestesia neuroaxial, después de la resonancia magnética se reporta tumor intrarraquídeo a nivel de T9-T10 que fue extirpado con diagnóstico histológico de schwannoma. La evolución postquirúrgica de la paciente fue favorable sin secuelas neurológicas. Los schwannomas son tumores benignos cuya principal manifestación son síntomas de compresión medular.

Abstract: It is presented a case of a 48-year-old patient, previously healthy, who underwent cesarean section under epidural block and presented data of spinal cord compression in the immediate puerperium. The initial diagnosis was a complication due to the neuraxial anesthesia. Afterwards, the MRI reported an intraspinal tumor at the T9-T10 level, which was removed with a histological diagnosis of schwannoma. The patient´s postoperative evolution was favorable, with no neurological sequelae. Schwannomas are benign tumors, whose main manifestation is symptoms of spinal cord compression.

Tumor de nervio periférico: una localización poco habitual / Peripheral nerve tumor: an unusual location

Benign tumors of peripheral nerves called Schwannomas or neurilemomas, correspond to a rare pathology, represent 5% of all tumors of the upper extremity, and affects, mainly, the ulnar nerve. The incidence of Schwannoma in the literature for the radial nerve is not clearly established given the infrequency of its presentation, there are only reports of isolated cases The following publication presents the case of a male patient with a radial nerve schwannoma. Clinically, presents increased painful volume on palpation, well delimited, of soft consistency in the distal third of the right arm of 3 years of evolution, without history of previous trauma, without irradiation, or paresthesia, with preservation of motor and sensory function of radial, median and ulnar nerve. Considering that the involvement of the radial nerve is very low frequency, a review is carried out in PubMed, in the last 10 years, there are only 9 studies, grouped in case reports and imaging studies for diagnosis.

Schwannoma pancreático como tumor sincrónico. Reporte de caso / Pancreatic schwannoma as a synchronous tumor. Case report

Los Schwannomas son tumores derivados de las células de Schwann de las vainas de los nervios periféricos. Se pueden localizar en cualquier región anatómica que contenga tejido nervioso periférico, siendo más frecuentes en la región craneofacial y las extremidades. Los Schwannomas pancreáticos son entidades sumamente infrecuentes de las cuales solo se han descrito 68 casos a nivel mundial. En el presente trabajo se presenta el caso de un paciente con hallazgo incidental de tres tumores sincrónicos dentro de los cuales se encuentra un Schwannoma pancreático.Caso clínico : Paciente femenino de 66 años de edad con antecedente de diabetes mellitus tipo 1 y enfermedad diverticular pancolónica quien acude presentando cuadro clínico compatible con absceso lumbar izquierdo. Se realiza TC de abdomen y pelvis con doble contraste que evidencia extensa área de colección heterogénea en región retroperitoneal que diseca hacia región lumbar y glútea izquierda, además de la presencia de tumor hipodenso de bordes lobulados en mesogastrio. Se realiza colonoscopia que reporta lesión exofítica ulcerada en unión rectosigmoidea. El resto de paraclínicos y estudios de extensión se encontraban dentro de límites normales. Se decide resolución quirúrgica mediante drenaje percutáneo de absceso y laparotomía exploradora. Informe histopatológico: cistoadenoma seroso microquístico de cuerpo de páncreas, Schwannoma de cola de páncreas y adenocarcinoma moderadamente diferenciado de colon sigmoides.Conclusión : Los Schwannomas pancreáticos son entidades sumamente infrecuentes que pueden presentarse con una amplia variedad de manifestaciones clínicas, sin embargo, deben tenerse en cuenta como posible diagnóstico diferencial ante el hallazgo de un tumor pancreático(AU)

Schwannomas, also called Neurilemmomas or Neurinomas, are tumors derived from Schwann cells of the peripheral nerve sheaths. They can be located in any anatomical region that contains peripheral nervous tissue, being more frequent in the craniofacial region and the extremities. Pancreatic Schwannomas are extremely rare entities of which only 68 cases have been described worldwide. In the present study we present the case of a patient with an incidental finding of three synchronous tumors, including a pancreatic Schwannoma.Clinical case : A 66-year-old female patient with a history of type 1 diabetes mellitus and pancolonic diverticular disease who presented with symptoms compatible with left lumbar abscess. A double-contrast CT of the abdomen and pelvis was performed, which revealed a large area of heterogeneous collection in the retroperitoneal region that dissected towards the left lumbar and gluteal region, in addition to the presence of a hypodense tumor with lobulated borders in the mesogastrium. A colonoscopy was performed, which reported an ulcerated exophytic lesion at the rectosigmoid junction. The rest of the paraclinical and extension studies were within normal limits. Surgical resolution is decided by percutaneous abscess drainage and exploratory laparotomy. Histopathological report: microcystic serous cystadenoma of the body of the pancreas, Schwannoma of the pancreas tail, and moderately differentiated adenocarcinoma of the sigmoid colon.Conclusion : Pancreatic Schwannomas are extremely rare entities that can present with a wide variety of clinical manifestations, however, they should be taken into account as a possible differential diagnosis when a pancreatic tumor is found(AU)

Hipoacusia sensorineural asimétrica en el diagnóstico de schwannoma vestibular / Asymmetric sensorineural hearing loss in the diagnosis of vestibular schwannoma

Introducción: se ha descrito que los pacientes con hipoacusia asimétrica cursan en un 2% con lesiones retrococleares. La conducta de escrutinio se ha basado en la audiometría. Existen varias definiciones de asimetría audiométrica descritas en la literatura, pero sin llegar a un consenso. Aunque la prueba de oro para el diagnóstico de schwannoma vestibular es la resonancia magnética con gadolíneo, la sospecha clínica se hace en base a la asimetría audiométrica. Objetivo: hacemos una revisión de los trabajos publicados al respecto en la literatu-ra y comentamos nuestra experiencia. Reflexión: queremos enfatizar en la importancia de estudiar a los pacientes con hipoacusia asimétrica con el fin de descartar patología retrococlear. Conclusión: a pesar de que no existe un consenso claro en la definición de hi-poacusia asimétrica, la sospecha clínica de un schwannoma vestibular se basa en la audiometría

Background: It is described that 2% of patients with asymmetric hearing loss have retrocochlear lesions. The scrutiny behavior has been based on audiometry. There are several definitions of audiometric asymmetry described in the literature, but without reaching a consensus. Although the gold standard for the diagnosis of vestibular schwannoma is gadolinium magnetic resonance imaging, the clinical sus-picion is based on audiometric asymmetry. Objective: we review the results published in this regard in the literature and com-ment on our own experience. Reflection: we want to emphasize the importance of studying asymmetric hearing loss patients in order to rule out retrocochlear etiology. Conclusions: although there is no clear consensus on the definition of asym-metric hearing loss, the clinical suspicion of a vestibular schwannoma is based on the audiometry.

Rehabilitation nursing of hoarseness and dysphagia after resection of schwannoma in jugular foramen: a case report / 中国实用护理杂志

Objective:To summarize the combined rehabilitation nursing process of a case of voice and deglutition disorders following surgical removal of intra-and extracranial schwannoma in the jugular foramen area.Methods:A case of hoarseness and dysphagia after surgery for intracranial and extracranial schwannomas in the left jugular foramen region in Xuanwu Hospital, Capital Medical University in October 2020 was collected. Early step-wise voice training assisted by respiratory muscles and tongue muscle exercises was carried out, electronic laryngoscope-based breathing and swallowing methods, assessment of food and bite-size, maintenance of food consistency with the assistance of chewing times, and swallowing and ingestion guidance for the update of dietary methods were performed. The continuous rehabilitation training was provided throughout the process.Results:The grade of GRBAS scale decreased from G3 to G2 after training from home for 3 months following discharge; the voice handicap index of Chinese version reduced from 75 points to 52 points, and the average pronunciation time extended from 2.45 s to 5.32 s. The frequency of choking with food optimized from 0.4 to 0.5 times/min to no choking.Conclusions:Early rehabilitation training of voice and, swallowing and ingestion is a boon for the recovery of hoarseness and dysphagia after resection of schwannomas in the jugular foramen region.