Retrospective Analysis of 20 Patients Affected by Schwannomas in the Upper and Lower Limbs / Análise retrospectiva de 20 pacientes acometidos por schwannoma nos membros superior e inferior

Abstract Objective To analyze the epidemiological profile and evolution of 20 patients diagnosed with upper- and lower-limb schwannomas. Methods A group of patients was defined for a retrospective evaluation comprising the period between February 2002 and June 2018, in which we studied and evaluated 20 medical records of patients undergoing surgery due to schwannoma; the diagnosis was confirmed by an anatomopathological examination. Results Male and female patients were equally affected. The average age was 50.85 years, ranging from 12 to 77 years. There was a predominance of the upper limb and of the flexor face. The most affected nerve was the ulnar nerve. In total, 6 (30%) patients had transient postoperative complications. No cases of tumor recurrence were identified. Conclusion Schwannoma is a rare and difficult-to-diagnose lesion. It should always be considered as a hypothesis when facing a soft-tissue tumor affecting the limbs. The Tinel sign should be regarded, given its higher correlation with complications. The patients should be informed of the possible postoperative complications, which are frequent but usually transient.

Resumo Objetivo Analisar o perfil epidemiológico e a evolução de 20 pacientes diagnosticados com schwannoma nos membros superiores e inferiores. Métodos Definiu-se um grupo de pacientes para avaliação retrospectiva, compreendendo o período entre fevereiro de 2002 e junho de 2018, no qual foram estudados e avaliados 20 prontuários de pacientes submetidos a procedimento cirúrgico devido a schwannoma; a confirmação diagnóstica foi feita pelo exame anatomopatológico. Resultados Tanto os pacientes do sexo masculino quanto do feminino foram igualmente acometidos, e a média de idade foi de 50,85 anos, variando de 12 a 77 anos. Houve predomínio do membro superior e da face flexora. O nervo mais acometido foi o ulnar, e 6 (30%) pacientes apresentaram complicações pós-operatórias transitórias. Não foi identificado nenhum caso de recidiva tumoral. Conclusão O schwannoma é uma lesão rara e de difícil diagnóstico. Deve sempre ser considerada como hipótese quando se estiver diante de um tumor de partes moles acometendo os membros. O sinal de Tinel deve ser levado em consideração por conta de sua maior correlação com as complicações. Os pacientes devem ser informados quanto às possíveis complicações pós-operatórias, que são frequentes, mas, geralmente, transitórias.

Peripheral Nerve Schwannomas: A Literature Review

Introduction Schwannomas are benign tumors originating from the cells, which wrap around axons that are usually encapsulated and solitary. These tumors usually lead to little or no symptomatology. They are usually the most common peripheral nerve tumors in adults, with their highest incidence between the third and fifth decades of life. Objective To perform a review about schwannoma of the peripheral nerves, presenting its definition, epidemiology, diagnosis, symptomatology and treatment. Methodology This is a descriptive work, based on a review of articles available in the PubMed database with the descriptors schwannoma and peripheral nerves. Results and Discussion Only papers published between 1981 and 2019, describing studies in humans, and that were available as full articles were selected. A total of 391 articles were included; after reading the titles, we noted that 67 articles fit the topic of the present study. Among the articles selected for reading, 33 fit the objectives of the present work, and were considered for the writing of the present article. Conclusion Schwannomas are benign myelin sheath tumors that develop with local symptomatology or asymptomatic and present a good surgical prognosis with generally reduced rates of surgical complications.

Palatal Schwannoma: An Analysis of 45 Literature Reports and of an Illustrative Case

Abstract Introduction Schwannomas are benign tumors originating from differentiated Schwann cells. Being the least common intraoral neoplasm of neural origin, it is rarely seen in the palate. The literature lacks an extensive review of intraoral schwannoma confined to the palate. Objective To review previously reported cases of palatal schwannoma along with an illustrative case, and to provide a better insight regarding clinicopathological and radiological features of this neural tumor in a rare intraoral site. Data Synthesis We present a case of palatal schwannoma in a 16-year-old female. An additional 45 cases were identified in 2 medical database searches (PubMed and Google Scholar) published fromthe year 1985 onwards, and from13 countries, in the 5 continents. The ages of the patients ranged from3 to 84 years old. Palatal schwannoma showed a slight predilection to females, with a male/female ratio of ~ 1:1.81. Hard palate involvement is almost twice greater than soft palate involvement. Surgical excision was employed inalmost all of the cases, and recurrence was reported only once. Conclusion Palatal schwannomas, although rare, have been reported both over the hard and the soft palate. They mostly present as a painless, firm, well-encapsulated, slow-growing solitary lesion over the lateral palatal aspect. Imaging can add to suspicion and can delineate a differential diagnosis, but the diagnosis is confirmed by pathological examination. Fine-needle aspiration cytology (FNAC) is almost always inconclusive. Immunohistochemistry can assist in confirming a diagnosis, but is more important to rule out close differentials. Complete surgical excision is the treatment of choice, and recurrence or malignant transformation are extremely rare.

Schwannoma de paladar duro: reporte de un caso y revisión bibliográfica / Schwannoma of the hard palate: report of a case and review of the literature

Los neurilemomas o shwannomas son tumores neurogénicos benignos con origen en la vaina neural. Aproximadamente un 25 a 45 por cinto ocurren en cabeza y cuello y sóloun 1 por ciento tiene origen intraoral, siendo frecuentes en la superficie dorsal de la lengua y en menor grado en paladar, piso de boca, encías, labios y mandíbulas. Suele presentarse entre la tercera y cuarta década de vida, con igual frecuencia entre hombres y mujeres. Es un tumor claramente circunscripto, de tamaño pequeño, de crecimiento lento y gradual. El examen microscópico es necesario para el diagnóstico. El tratamiento de elección es la eliminación quirúrgica completa y después de ésta es rara su recurrencia. Se presenta un caso de schwannoma de rara localización, además de abordar las posibilidades diagnósticas y de tratamiento.

A clinical review of large cerebello pontile angle tumors.

The study was designed as retro-prospective and the study period was 3.5 years. A total of 66 (42 prospective and 24 retrospective) consecutive patients were included in the study. The commonest tumor in CPA is the Schwannoma (76%) followed by Meningioma (13.3%) and Epidermoid (4.44%). Unusual forms are Ependymoma and Hemangiopericytoma. Amongst the troublesome clinical features headache, hearing loss, vertigo and imbalance, vomiting and tinnitus were more important besides visual failure and features of lower cranial nerve involvement. The objective of the study is to "Review the Large Cerebello Pontile Angle tumors clinically". In this study 66 large CPA tumors were included and analyzed. Analysis of variance (ANOVA) was implied for the test of significance. On the whole, n=66 Schwannoma represents 76.70% and Meningioma 15.38%. Of these there are 45 cases with histological verification. The most common presenting (average duration is 1.3 years) symptoms were Headache (94.54%) and Hearing loss of varying grade (85.45%). Vertigo or imbalance was present in 67.27% cases. Vomiting was found in 54.54% of the times and difficulties in deglutition or voice change were complained of in 29.09% cases. Tinnitus was found only in 27.27% cases and it was the complaint mostly in lower diameter tumors. By maximum diameter, there were 24 cases measuring 3-4 cm, 15 more than 4 cm and only one case <3 cm sized tumors. Volume-wise tumors with volume <10 cc were 5 cases, 10-20 cc were 10, 20-30 cc were 13, 30-40 cc were 6 and >40 cc were 6. Similarly tumor volume and posterior fossa volume ratio was as follows: <10% were 6 cases, 10-20% were 15 cases, 20-30% were 7 cases and >30% were 6 cases. Amongst the schwannomas, the consistency of the tumor has been shown to be important factor for LCN involvement. The softer variety involved LCN more often than the harder (p<0.05). The involvement of the different groups of lower cranial nerve ranged from 7% to 92%.

Tumores intracraneales en el Hospital Nacional del sur IPSS / Intracraneal tumors in the Hospital Nacional del Sur-IPSS

En el presente trabajo se investigó la incidencia como manejo y evolución de pacientes con tumor intracraneal. El diagnóstico se confirmó con estudio histopatológico y los resultados obtenidos se evaluaron con el Rating de Karnofsky. De 1556 pacientes operados se encontró 54 casos (3.47 por ciento) de tumores intracraneales de los que 33.34 por ciento correspondian a gliomas, 31.48 por ciento a adenomas, 24.08 por ciento a meningiomas, papilomas de plexos coroideos y craneofaringiomas con 3.70 por ciento cada uno, finalmente el neurinoma del acústico y carcinoma de plexos coroideos con 1.85 por ciento. El sexo más afectado fue el masculino 74.07 por ciento y la edad más comprometida fue la quinta década de la vida (20.37 por ciento). Todos los pacientes recibieron tratamiento quirúrgico; 45 con cirugía total, 7 con parcial, 1 con descomprensiva y 1 con cirugía derivativa. En el post operatorio inmediato 50.02 por ciento tuvieron 80 a 90 en el Rating de Karnofsky y 18.50 por ciento estuvieron por debajo de 70. El resultado final arrojó 42.59 por ciento de pacientes aliviados, 38.86 por ciento de sanos y una mortalidad de 18.52 por ciento. Los resultados de este trabajo fueron comparados con otras casuísticas nacionales y extranjeras.

Neurinomas e meningeomas intrarraquidianos: estudo comparativo de 23 casos / Intraspinal neurinomas and meningiomas: comparative study of 23 cases

Os autores apresentam estudo comparativo entre neurinomas e meningiomas intrarraquídeos. Analisam a incidência de acordo com a idade, sexo, localizaçäo, duraçäo dos sintomas e resultados