Rare Case of Nasal Tip Schwannoma - A Case Report.

Schwannoma is a benign neurogenic neoplasm which is arising from schwann cells of peripheral nerve sheath. It can occur in anywhere in the body. Schwannoma of sinonasal tract is extremely rare. Here we report a rare case of schwannoma of nasal tip. A 45 year old male presented with a swelling of tip of the nose, causing cosmetic deformity with no other associated symptoms. Surgical excision of the mass done by using external rhinoplasty approach. Histolopathology report of specimen showed a well circumscribed schwannoma with Antoni A and Antoni B areas.

Schwannoma retroperitoneal primario. Presentación de un caso

Los schwannoma son tumores de tejidos blandos que se originan en las células de Schwann de la vaina nerviosa en los nervios periféricos, craneales o viscerales, en cualquier parte del cuerpo. Se trata de una entidad extremadamente inusual. En el artículo se describe el caso de un paciente de piel negra, 47 años de edad y con antecedentes de salud, quien acudió a consulta de clasificación, refiriendo que desde hacía un mes había comenzado a presentar dificultad para orinar, hasta llegar a la retención aguda de orina. Al examen físico se constató, mediante tacto rectal, esfínter tónico, ampolla rectal vacía, próstata aumentada de tamaño grado IV con consistencia fibromuscular de superficie lisa y móvil; no dolorosa. Tras realizarle estudios imagenológicos y complementarios, recibió tratamiento quirúrgico en el Hospital Provincial Docente Oncológico María Curie, de Camagüey, Cuba. Se le diagnosticó un schwannoma retroperitoneal, confirmado por el informe de Anatomía Patológica. Actualmente la evolución del paciente es favorable, sin tratamiento médico, pero con seguimiento periódico.

Schwannoma are soft tissue tumors that originate in Schwann cells of the nerve sheath in peripheral, cranial or visceral nerves, anywhere in the body. This is an extremely unusual entity. The article describes the case of a 47-years-old black-skinned patient with a history of health who attended a triage consultation, reporting that one month ago he had started having difficulty urinating, leading to acute urinary retention. The physical examination confirmed, through digital rectal examination, a tonic sphincter, an empty rectal ampulla, a grade IV enlarged prostate with a fibromuscular consistency with a smooth and mobile surface; not painful. After carrying out imaging and complementary studies, he received surgical treatment at the María Curie Provincial Oncological Teaching Hospital, in Camagüey, Cuba. He was diagnosed with a retroperitoneal schwannoma, confirmed by the Pathology report. Currently the evolution of the patient is positive, without medical treatment, but with periodic follow-up.

Schwannoma intraóseo en fémur, una presentación inusual. Reporte de caso / Intraosseous Schwannoma in femur, an unusual presentation. Case report

El Schwannoma o Neurilemoma es un tumor benigno de derivación neuroectodérmica que se origina en las células de Schwann, que constituyen la envoltura de los nervios. Es el tumor benigno más común de los nervios periféricos, tiene predisposición a originarse a partir de nervios periféricos sensoriales y puede presentarse como tumores en tejidos blandos. La presentación intraósea del Schwannoma es rara y corresponde al 0,2% de los tumores óseos primarios. Se presenta caso clínico de paciente masculino de 36 años de edad con tumor en cóndilo femoral medial de rodilla derecha de 4 años de evolución, cursando con dolor intermitente moderado a quien se le practicó el protocolo oncológico, imagenológico e histológico, de la Unidad de Oncología Ortopédica del estado Monagas. Se diagnosticó Schwannoma intraóseo, se procedió a realizar resección marginal y reconstrucción con alloinjerto y fijación con placa y tornillos con excelente evolución postoperatoria. El Schwannoma intraóseo es extraordinariamente raro y su ubicación en el fémur lo es aún más. El objetivo del presente trabajo es reportar un caso de Schwannoma Intraóseo, mostrar las estrategias para su diagnóstico y los tratamientos aplicados, así como la revisión de los datos al respecto existentes en la literatura(AU)

Schwannoma or Neurilemoma is a benign tumor of neuroectodermal derivation that originates in Schwann cells, which constitute the nerve sheath. It is the most common benign tumor of the peripheral nerves, has a predisposition to originate from peripheral sensory nerves, and can present as soft tissue tumors. The intraosseous presentation of Schwannoma is rare and corresponds to 0,2% of primary bone tumors. A clinical case of a 36-yearold male patient with a tumor in the medial femoral condyle of the right knee of 4 years of evolution is presented, presenting with moderate intermittent pain who underwent the oncological, imaging and histological protocol of the Oncology Unit. Monagas State Orthopedic. Intraosseous Schwannoma was diagnosed, marginal resection and allograft reconstruction and plate and screw fixation were performed with excellent postoperative evolution. Intraosseous Schwannoma is extraordinarily rare and its location in the femur is even more so. The objective of this paper is to report a case of Intraosseous Schwannoma, show the strategies for its diagnosis and the treatments applied, as well as the review of the existing data in the literature(AU)

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 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)

Case Report: Neuroblastoma-Like Schwannoma in a Domestic Short-Haired Cat.

An axillary mass was detected in a 6-year-old, neutered, male, domestic short-haired cat during a wellness exam. Gross examination following surgical removal revealed a discrete, deep subcutaneous, discoid mass that was between 0.5- and 0.7-cm-in-diameter and diffusely firm and white. Histologically, the mass was well-demarcated, partially encapsulated, and expanded the panniculus carnosus. It was composed of tightly packed, giant rosettes of radially arranged fusiform cells stacked in one to 10 layers with peripherally palisading nuclei and with centrally oriented, fibrillary, cytoplasmic processes, and collagenous fibers. Laminin immunoreactivity and ultrastructural examination highlighted a continuous basal lamina outside the plasma membrane of each neoplastic cell. Neoplastic cells were immunoreactive for GFAP, S100, periaxin, and Sox-10 and were immunonegative for synaptophysin, smooth muscle actin, and pancytokeratin. Collective findings were consistent with a diagnosis of neuroblastoma-like schwannoma. This is the first veterinary report of this rare variant of benign schwannoma.

Systematic Review of Intra Parotid Facial Nerve Schwannoma and a Case Report.

To evaluate the clinico-epidemiological aspects, pathological features, diagnostic methods, management protocol and functional outcome of the intra-parotid facial nerve schwannoma (IFNS) and to present a case report on intra parotid facial nerve schwannoma. PubMed, ProQuest, Google scholar, Science direct and Scopus were screened for studies. Article selection and data extraction was done by one investigator and other investigator confirmed its accuracy. After abstract and text screening a total of 69 articles were finally selected for the study with the inclusion and exclusion criteria of the systematic review as per PRISMA guidelines. With addition of one case reported to our department. The mean age of diagnosis was 43 ± 16 years with a slight female predominance. The mean duration of the tumour was 29.5 months and the mean size of the tumour on initial diagnosis was 3.6 ± 1.67 cm. Pleomorphic adenoma was the primary diagnosis in 44 cases. Superficial parotidectomy was done in 64 cases followed by resection in 47 cases. Reconstructive treatment was carried out by an end-to-end anastomosis in 3 patients and by facial-hypoglossal anastomosis in 16 patients, GAN cable grafting in 5 patients, a greater auricular nerve graft was done in18 patients and end-to-side interposed sural nerve graft in 8 patients. The type D tumours are treated by extended resection of the facial nerve, which is difficult to reconstruct and also employs a nerve graft that does not often give acceptable recovery of facial function. Facial nerve schwannomas being a rare entity poses a dilemma in diagnosis and management. Managing the lesions is also difficult as intraoperative adherence to the nerve makes a tumour free margin difficult without sacrificing the nerve. At present there is no consensus regarding the management of various types of intra-parotid facial nerve shwannoma.

Tumor retrorrectal: Reporte de un caso de Schwannoma / Retrorectal tumor: A case report of Schwannoma

Introducción. En el espacio retrorrectal o presacro pueden desarrollarse lesiones tumorales, tanto benignas como malignas. La mayoría de los pacientes son asintomáticos y, cuando presentan síntomas, éstos son inespecíficos. Entre los tumores retrorrectales se destaca el grupo de origen neurogénico, donde el Schwannoma es el más frecuente.Caso clínico. Mujer de 32 años, con tumor retrorrectal, que producía una sintomatología escasa e imprecisa, diagnosticado durante una intervención quirúrgica por mioma uterino, que finalmenteresultó ser un Schawnnoma. Conclusión. La tomografía computarizada y la resonancia magnética son importantes para el diagnóstico y para establecer el nivel de la lesión en relación con el sacro. La piedra angular del tratamiento es la resección quirúrgica. El abordaje puede ser anterior (abdominal), posterior (perineal, transsacro o parasacrococígeo) o combinado, de acuerdo con su localización al nivel S4

Introduction. Both benign and malignant tumors can develop in the retrorectal or presacral space. Most patients are asymptomatic and, when they do present symptoms, they are nonspecific. Among retrorectal tumors, the group of neurogenic origin stand out, where Schwannoma is the most frequent one. Clinical case. A 32-year-old woman with a retrorectal tumor, which present with imprecise symptoms, diagnosed during a surgical procedure due to a uterine myoma, which finally turned out to be a Schawnnoma. Conclusion. Computed tomography and magnetic resonance imaging are important for diagnosis and for establishing the level of the lesion in relation to the sacrum. The cornerstone of treatment is surgical resection. The approach can be anterior (abdominal), posterior (perineal, transsacral or parasacrococcygeal), or combined, according to its location at the S4 level.

Multiple neuroendocrine neoplasia in a patient with type i neurofibromatosis (nf1): report of a new mutation (nf1, exons 2-30 deletion) and literature review / Neoplasia neuroendócrina múltipla em doente com neurofibromatose tipo 1 (nf1). descrição de uma nova mutação e revisão da literatura

ABSTRACT BACKGROUND: Plexiform neurofibromas represent a common neoplasia of type 1 neurofibromatosis in which neurofibromas arise from multiple nerves involving connective tissue and skin and rarely affect the colon and rectum. Co-occurrence of plexiform neurofibromas, neuroendocrine tumors with primary involvement of the rectum, and medullary thyroid carcinoma in patients with neurofibromatosis type 1 is a previously undescribed condition. The aim of this manuscript was to present a case of primary plexiform neurofibroma and neuroendocrine tumors of the upper rectum in a patient with neurofibromatosis type 1 whose genetic sequencing found a novel mutation in the neurofibromatosis type 1 gene and to review the literature. CASE REPORT: A 49-year-old woman with a familial history of neurofibromatosis type 1 complained of abdominal cramps for 6 months. She had previously been submitted for a total thyroidectomy due to medullary thyroid carcinoma. She was submitted to a colonoscopy, which identified a submucosa lesion located in the upper rectum. The patient was referred for a laparoscopic rectosigmoidectomy, and the histopathological study of the surgical specimen identified two different tumors. An immunohistochemical panel was done for histopathological confirmation of the etiology of both lesions. The results of the panel showed intense immunoexpression of S100 protein in the largest and superficial lesion, as well as positivity for chromogranin and synaptophysin in the minor and deep lesion confirming the diagnosis of rectal plexiform neurofibromas concomitant with neuroendocrine tumors. The proliferative activity rate using Ki-67 antibodies showed that both tumors had a low rate of mitotic activity (<1%). Genetic sequence panel identified an undescribed mutation in the neurofibromatosis type 1 gene (deletion, exons 2-30). The patient's postoperative evolution was uneventful, and she remains well, without recurrence, 3 years after surgery. CONCLUSION: The co-occurrence of medullary thyroid carcinoma, plexiform neurofibromas, and neuroendocrine tumors of the rectum in patients with neurofibromatosis type 1 is an exceptional and undescribed possibility, whose diagnosis can be confirmed by the immunohistochemical staining and genetic panel.

RESUMO RACIONAL: Os neurofibromas plexiformes representam uma neoplasia frequente na neurofibromatose tipo 1 onde os neurofibromas surgem de múltiplos nervos envolvendo, também, o tecido conjuntivo e a pele raramente acometendo o cólon e o reto. A co-ocorrência de neurofibromas plexiformes, tumores neuroendócrinos, com envolvimento primário do reto, e carcinoma medular de tireoide em pacientes com neurofibromatose tipo 1 é uma condição ainda não descrita. O objetivo deste manuscrito é descrever um caso de neurofibromas plexiformes e tumores neuroendócrinos primários do reto superior, em paciente com neurofibromatose tipo 1, cujo sequenciamento genético identificou uma nova mutação no gene neurofibromatose tipo 1 e revisar a literatura sobre o tema. DESCRIÇÃO DO CASO: Mulher de 49 anos, com história familiar de neurofibromatose tipo 1 queixava-se de cólicas abdominais há seis meses. Tinha sido previamente submetida a tireoidectomia total por carcinoma medular de tireoide. Foi submetida a colonoscopia, que identificou lesão submucosa localizada no reto superior. A doente foi encaminhada para retossigmoidectomia laparoscópica, cujo estudo histopatológico do espécime cirúrgico identificou dois tumores distintos. Realizou-se painel imuno-histoquímico para confirmação histopatológica da etiologia de ambas as lesões. O resultado do painel mostrou intensa imunoexpressão da proteína S-100 da lesão superficial e de maior tamanho,e positividade para cromogranina e somatofisina da lesão mais profunda e de menores dimensões confirmando o diagnóstico de neurofibromas plexiformes retal e tumores neuroendócrinos. O índice de atividade proliferativa utilizando o anticorpo ant-Ki-67 mostrou que ambos os tumores apresentavam baixa índice mitótico (<1%). O painel genético identificou mutação no gene neurofibromatose tipo 1 (deleção, exons 2-30) ainda não descrita. A doente apresentou evolução pós-operatória sem intercorrências, permanecendo bem, sem recorrência, três anos após a cirurgia. CONCLUSÕES: A co-ocorrência de carcinoma medular de tireoide, neurofibromas plexiformes e tumores neuroendócrinos do reto em pacientes com neurofibromatose tipo 1 é uma possibilidade excepcional e ainda não descrita, cujo diagnóstico pode ser confirmado pela coloração imuno-histoquímica e painel genético.

Schwannoma lingual: presentación de un caso y breve revisión de la literatura / Lingual schwannoma: case report and brief review of the literature

Objetivo: Reportar un caso de schwannoma lingual, así como revisar las características diagnósticas (clínicas, por imágenes e histopatológicas) y terapéuticas de esta patología mediante las publicaciones disponibles. Caso clínico: Se presenta un caso de schwannoma in- traoral en un hombre de 26 años de edad con un tumor ubica- do en el tercio anterior de la lengua. Se resolvió mediante un único procedimiento quirúrgico bajo anestesia local sin obser- varse recidivas ni secuelas al menos a 12 meses de seguimien- to a distancia. El schwannoma de la lengua es poco frecuente pero sus características clínico-imagenológicas presentan ras- gos benignos que favorecen la resolución mediante una única biopsia quirúrgica total cuando el tamaño y la ubicación sean propicios para ello (AU)

To describe a case of lingual schwannoma, and through a literature review, to provide data on clinical, imaging and pathological features, as well as treatment methods. Clinical case: A 26-year-old male patient with a swelling in the tip of the tongue was diagnosed as having oral schwannoma. A single surgery was performed, without recurrence or postoperative complications at least during a 12-month follow-up. Lingual schwannoma is a rare entity with benign clinical and imaging characteristics that ena- ble surgical removal without prior biopsy when size and oral location are favorable (AU))

A fast-growing schwannoma of the tongue in a 15-year-old Iranian male: Review of literature and case report.

Schwannoma can be included in the list of differential diagnoses of tongue masses but seems to be a rare finding in the Iranian population. The current case was presented as an exophytic nodular sessile mass which was growing fast.

Schwannoma de nervio vago cervical / Schwannoma of the cervical vagus nerve

RESUMEN Los schwannomas del espacio parafaríngeo son tumores benignos de la vaina de los nervios pe riféricos y corresponden al 0,09% de todos los tumores de cabeza y cuello; es aún más inusual su localización en el nervio vago. El diagnóstico suele ser desafiante debido a las diversas patologías ubicadas en la región lateral del cuello. Habitualmente se presentan como masas cervicales laterales asintomáticas. Presentamos el caso de un paciente de 42 años que consulta asintomático. Se le realizó tomografía computarizada y angiografía de vasos del cuello. Se procedió a su resección completa, ob jetivándose parálisis de cuerda vocal derecha en el posoperatorio. La disfonía causada por la parálisis de cuerda vocal es una complicación frecuente; si se presenta, debe comenzarse con rehabilitación fonatoria temprana.

ABSTRACT Schwannomas of the parapharyngeal space are benign tumors that arise from the peripheral nerve sheaths and represent 0.09% of all head and neck tumors. Those originating from the vagus nerve are rarer. The diagnosis represents a challenge due to the different conditions encountered in the lateral neck. They usually present as asymptomatic lateral neck masses. An asymptomatic 42-year-old male patient sought medical advice. He underwent computed tomography scan and carotid angiography. The patient underwent complete resection and developed postoperative vocal cord paralysis. Dysphonia due to vocal cord paralysis is a common complication requiring immediate vocal cord rehabilitation.

Schwannoma esofágico gigante, un diagnóstico de exclusión: reporte de caso / Giant esophageal schwannoma, a diagnosis by exclusion: Case report

Resumen Introducción: Los schwannomas esofágicos son tumores de elementos perineurales de la vaina nerviosa de la célula de Schwann en los nervios periféricos y representan el 2 % de los tumores primarios de esófago. Su difícil diagnóstico está dado por la baja incidencia que este presenta; sin embargo, es una etiología que debe considerarse debido a que su comportamiento clínico e imagenológico es rápidamente progresivo e inusual, comparado con otros tumores benignos de esófago. Caso clínico: Paciente femenina de 38 años con cuadro clínico de disfagia de 1 año de evolución, con endoscopia de vías digestivas altas y tomografía axial computarizada (TAC) de tórax contrastada que evidencian una masa a nivel del esófago cervical y torácico transmural, que obstruye la luz y ejerce el efecto de masa sobre la tráquea. Se realizó una biopsia que reportó un tumor fusocelular con inmunohistoquímica positiva para el marcador S100, por lo que se diagnosticó un schwannoma esofágico. En la actualidad, la paciente se encuentra en controles periódicos y en espera del concepto por oncología clínica para proponer tratamiento no quirúrgico dado el compromiso adyacente. Conclusión: Ante la sospecha de tumor primario de esófago, la primera impresión diagnóstica según la incidencia será un leiomioma, pero con nuestro reporte de caso de schwannoma esofágico, se resalta que, en un cuadro clínico no usual, este es un diagnóstico diferencial que requiere atención precoz para evitar complicaciones y secuelas en los pacientes.

Abstract Introduction: Esophageal schwannomas are tumors of the perineural components of the Schwann cell nerve sheath in peripheral nerves and account for 2% of primary esophageal tumors. Its low incidence makes diagnosis challenging; however, this etiology should be considered because its clinical and imaging behavior is rapidly progressive and unusual compared to other benign esophageal tumors. Case study: A 38-year-old female patient with a 1-year history of dysphagia underwent upper digestive tract endoscopy and contrast chest CT showing a mass at the cervical and transmural thoracic esophagus level, obstructing the lumen and exerting a mass effect on the trachea. A biopsy revealed a spindle cell tumor with positive immunohistochemistry for the S100 marker, leading to the diagnosis of esophageal Schwannoma. The patient is currently undergoing regular check-ups and is awaiting the advice of a clinical oncologist to recommend non-surgical treatment options due to the involvement of adjacent structures. Conclusion: The first diagnostic impression in the case of a suspected primary esophageal tumor would be a leiomyoma based on its incidence. The present case report of an esophageal schwannoma emphasizes that this is a differential diagnosis that requires timely treatment to avoid complications and sequelae in patients.

Intraosseous neurilemoma of the mandible with unusual multilocular presentation: a case report.

This case report describes an intraosseous neurilemoma, observed radiographically as a multilocular lesion, in a 12-year-old patient. Physical examination revealed facial asymmetry, swelling on the right side of the mandibular body, and bone expansion in the region of the base of the buccal sulcus. Panoramic radiography revealed a multilocular radiolucency on the right side of the mandibular body in the periapical region extending from the distal region of the first premolar root to the second molar and adjacent to the third molar. Evaluation of a radiograph obtained 3 years earlier for an orthodontic assessment revealed that the lesion was present, appearing as a unilocular radiolucency near the root of the mandibular right first molar. An incisional biopsy of the multilocular lesion was performed, and Antoni A and Antoni B histologic patterns were identified by microscopic analysis. Immunohistochemical analysis was conducted, and neoplastic cells stained positive for the S-100 protein. The patient underwent conservative surgical excision of the lesion, and no recurrence was observed during 7 years of clinical follow-up. Based on analysis of the present case and previous cases reported in the literature, intraosseous neurilemoma, especially its multilocular variant, is an uncommon neoplasm. In the present case, evaluation of the lesion when it was first radiographically detectable, prior to orthodontic treatment, would have permitted a more limited surgical approach for the excision of a small intraosseous lesion.

Investigation of Schwannomas in the Forearms, Hands, and Digits: A Retrospective Study.

Background: Previous reports on schwannomas of the upper extremities have mainly focused on proximal involvement. This study aimed to evaluate pre- and peri-operative findings in schwannomas of the distal upper extremities and assess the accuracy of diagnosis and surgical outcome. Methods: We identified 24 patients with isolated tumors. Seven patients had schwannomas located in the forearm, eleven in the hand, and six in the digits. We collected the following data: preoperative clinical and magnetic resonance imaging findings, provisional diagnosis, surgical findings and procedures, tumor volume, and postoperative clinical findings. Data were compared between tumors of different locations. Results: The mean age of our cohort at the time of surgery was 48.0 years and the mean follow-up period was 10.6 months. All patients with forearm schwannomas were diagnosed preoperatively by the presence of the Tinel-like sign and suggestive magnetic resonance imaging findings. In contrast, schwannomas in the hands and digits often lacked these diagnostic features; only five patients with hand schwannomas and one with digit schwannoma were correctly diagnosed. Microsurgical enucleation was the most common treatment. Ten patients reported newly acquired paresthesia after operation, which resolved within the follow-up period in nine patients. Three of the four patients with preoperative paresthesia and one patient who underwent enucleation with surgical loupes still had paresthesia at the final follow-up. Conclusions: In schwannomas of the distal upper extremities, a more distal location is associated with a lower occurrence of the Tinel-like sign and fewer suggestive magnetic resonance imaging findings, resulting in lower diagnostic accuracy. However, intra-operative diagnosis is usually straightforward and microsurgical enucleation does not cause iatrogenic nerve deficit. When treating soft tissue tumors in the hand and digits that present without specific or suggestive findings, the possibility of schwannoma should be considered.

Intraocular schwannoma with extrascleral extension.

PURPOSE: To report a rare case of intraocular schwannoma with extrascleral extension in a patient with juvenile idiopathic arthritis and to review the literature for this topic. METHODS: Case report. RESULTS: A 19-year-old male with a history of juvenile idiopathic arthritis was referred for diagnosis and management of an episcleral mass, initially thought to be focal nodular scleritis. The ocular surface of the right eye revealed an elevated amelanotic episcleral nodule inferonasally, with thin strands of overlying sclera, feeding episcleral vessels, and measuring 11 mm × 11 mm in diameter and 5 mm in thickness. Ophthalmoscopic examination revealed a minimally pigmented ciliochoroidal tumor measuring 13 mm in diameter and 11.4 mm in total thickness and without associated subretinal fluid, orange pigment, or drusen. Ultrasound biomicroscopy and anterior-segment optical coherence tomography confirmed a solid mass with scleral disruption and extraocular extension. Shave biopsy revealed palisading spindle cells and interspersed eosinophilic fibrillary cytoplasmic processes, forming Verocay bodies. The specimen stained positive for S-100 and negative for Melan-A, consistent with benign schwannoma. Observation was recommended. CONCLUSION: Intraocular schwannoma is a rare, benign uveal tumor that can demonstrate extrascleral extension, mimicking inflammatory and malignant neoplastic processes. Clinical diagnosis is challenging, and tissue biopsy is required for definite diagnosis.

Abducens nerve schwannoma of the cavernous sinus: A case report and literature review.

BACKGROUND: Schwannomas of the abducens nerve are a rare pathology and are encountered less within the cavernous sinus. We describe a case of sixth cranial nerve schwannoma, in the cavernous sinus. CASE DESCRIPTION: A 50-year-old lady, presented with 2 years history of double vision and left facial numbness that started 6 months before presentation, found to have hyperintense lobulated mass at the left cavernous sinus extending into Meckel's cave with bony remodeling on magnetic resonance imaging. She underwent left frontotemporal craniotomy, combined extra-intradural approach, gross total resection. She had a gradual recovery of the sixth cranial nerve function. CONCLUSION: Abducens nerve schwannoma of the cavernous sinus is a rare and challenging tumor. However amenable to surgical intervention with favorable neurological outcome.

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.

Schwannoma axilar. Reporte de un caso y revisión de la literatura / Axillary Schwannoma. Case report and literature reviewz

Introducción: El schwannoma (neurinoma o neurilemoma) es un tumor benigno originado en la vaina de mielina de los nervios periféricos a partir de la células de Schwann. En su variedad benigna es el tumor más frecuente dependiente de esta estructuras. Se manifiesta entre la tercera y quinta década de vida, sin distinción de género. La localización axilar es extremadamente infrecuente, constituyendo el 5% de todos los casos reportados. Los schwannomas son tumores bien delimitados y de lento crecimiento. La presentación más frecuente es como masa palpable o por la sintomatología clínica correspondiente al territorio de inervación del nervio afectado. Es importante tener en cuenta que estas lesiones puedes formar parte de cuadros clínicos de base genética más complejos como la neurofibromatosis, entre otros. El método diagnóstico de elección es la resonancia magnética nuclear. El tratamiento consiste en la extirpación de la lesión tratando de preservar la función de la estructura nerviosa afectada. Objetivo: El objetivo del presente trabajo es realizar el reporte de un caso de lesión compatible con schwannoma axilar y realizar un revisión de la literatura.

Introduction: Schwannoma (neurinoma or neurilemoma) is a benign tumor originated in myelin sheath of peripheral nerves from schwann cells. In its benign variety, it is the most frequent tumor dependent of these structures. It appears between the third and fifth decade of life without distinction of geder. Axillary location is extremely rare, accounting for 5% of all reported cases. Schwqnnomas are well-defide, slow-growing tumors. The most frequent presentation is as palpabel mass or due to the clinical symptoms corresponding to the innervation territory of the affected nerve. It's important to know that these lesions can be part of more complex genetic-based clinical cases such as neurofibromatosis. The diagnostic method of choice is magnetic resonance imaging. Treatment cosists of excising the lesion, trying to preserve the function of the affected nerve structure. Objetive: The aim of this report is to describe our experience with one case of axillary schwannoma diagnosed in our institution and to perform a review of the literature.