Computed tomography and pathological findings of five nasal neurilemmomas

Hu, Jing; Bao, Yang‐Yang; Cheng, Ke‐Jia; Zhou, Shui‐Hong; Ruan, Lifang; Zhou, Zheng

doi:10.1186/1758-3284-4-26

Cited by 23 publications

(40 citation statements)

References 20 publications

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“…Schwannomas usually exhibit intense immunostaining for S100 (particularly Antoni A areas), which may help to distinguish neoplasms in the sheaths of peripheral nerves from other tumour types. 27,28 Total citations from the PubMed database (n=241)…”

Section: Microscopicmentioning

confidence: 99%

Diagnosis and Management of Schwannomas Originating from the Cervical Vagus Nerve

Behuria

Rout

Pattanayak

2015

annals

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INTRODUCTION A schwannoma is a benign, slow growing, encapsulated nerve sheath tumour. Presentation of a schwannoma is a diagnostic and management challenge. METHODS Internet searches of PubMed/MEDLINE ® for all articles listing schwannomas of the vagus nerve in the cervical/neck region were undertaken to ascertain diagnostic pitfalls. The references of all articles were cross-checked to include all pertinent contributions. Further articles were traced through reference lists. RESULTS Schwannomas are solitary, well circumscribed and medial to the carotid sheath. Preoperative diagnoses of schwannomas in the lateral part of the neck can cause confusion with its nerve of origin (ie whether it arises from the vagus nerve or a sympathetic chain). Computed tomography and magnetic resonance imaging reveal valuable information regarding the location and origin of the tumour as well as aiding surgical planning. The diagnosis can be confirmed intraoperatively. Postoperative recovery of neurological function is dependent on the type of surgery. Histopathological studies searching for classical features and immunohistochemical staining for S100 also confirm the diagnosis. CONCLUSIONS Schwannomas should be considered in the differential diagnoses of unusual masses in the neck. Preoperative imaging elicits valuable information regarding the location and origin of schwannomas and histopathology confirms the diagnosis.

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Section: Microscopicmentioning

confidence: 99%

Diagnosis and Management of Schwannomas Originating from the Cervical Vagus Nerve

Behuria

Rout

Pattanayak

2015

annals

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“…Sinonasal schwannomas usually present themselves with nasal obstruction, rhinorrhea, epistaxis, hyposmia or anosmia and pain [9]. The poor specificity of these symptoms and slow progression of tumour often delays the correct diagnosis for about months to years, or until neurological symptoms began to occur.…”

Section: Discussionmentioning

confidence: 99%

“…Diplopia secondary to, III, IV or VI cranial nerve palsy is a sign, which can allow us to suspect the diagnosis [1]. Other symptoms like exophthalmos, facial swelling and epiphora are less frequently observed [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…The lesions usually have a mottled central lucency with peripheral intensification on contrast enhanced CT. Heterogenous appearance is related to areas of increased vascularity, cystic or necrotic regions [9]. The isoatenuated compared with that of the brain stem and relatively homogeneous mild (masseter muscle) or marked enhancements on CT [1,4] may provide the differential diagnosis in case of the most common causes namely expansive soft-tissue lesions on paranasal sinuses and mucocele, which will not enhance at all [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Both, the MR imaging and CT scans show an intense heterogeneous contrast enhancement [9,11]. The MRI may be useful in obtaining information about the nature of the lesion and in detecting any skull-base or intracranial issues [10].…”

mentioning

confidence: 99%

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Unusual Association of Sphenoidal Schwannoma with Nasosinusal Polyposis

Álvarez-Montero¹,

Mancheño-Losa²,

Rodríguez-Castejón³

et al. 2017

JOENTR

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Schwannomas or neurilemmomas are tumors of benign nerve sheath, and between 25 and 45% of all arise in the head and neck region. Less than 4 % are found in the sinonasal tract and their diagnosis may have difficulty due to non-specific symptoms and image characteristics. In several cases, complete surgical removal by endoscopic approach is the treatment of choice in these tumors. We report the management of an unusual case of sphenoid sinus schwannoma in a 70-years-old male along with massive bilateral nasal polyposis and severe symptoms. The association with severe sinonasal polyposis has not been previously described.Keywords: Schwannoma; Neurilemmoma; Sinonasal polyposis the III, IV and VI cranial nerves, in the autonomic nervous system, in the carotid plexus or sphenopalatine ganglion [1]. Whether sinonasal schwannomas can be derived from the olfactory nerve components is still a controversial issue [2], but recent studies point more likely to its origin in the meningeal or ethmoidal branches of the trigeminal nerve [3]. The most frequent locations in the sinonasal tract are: the ethmoidal sinus, maxillary sinus, nasal cavity and nasal septum. The sphenoid and frontal sinuses are rarely affected [1].The non-specific signs and symptoms of sinonasal schwannomas are the same of those of any mass of the anterior or posterior nasal tract [1], and their imaging findings are rather unspecific [4,5]. Differential diagnosis should be made with other more common skull base tumours or space-occupying mass lesions such as sphenoid mucocele, angiofibroma, inverted papilloma, clival chordoma, chondrosarcoma, meningioma, pituitary adenomas, craniopharyngiomas and plasmacytoma [4,5].Complete surgical excision is considered the preferred treatment and most lesions may be removed by standard endoscopic techniques [1,6,7], although different approaches must be done if intracranial extension is present [1,7].Here in we report an unusual case of sphenoidal schwannoma coupled with sinonasal massive polyposis, and we focus the role of computed tomography (CT) and magnetic resonance image (MRI) on the differential diagnosis and the surgical endoscopic approach. Case ReportA 70-year-old male was attended at the Emergency Department of our hospital, with nasal obstruction, hyposmia, severe headache, ocular pain and diplopia. He had medical history of arterial hypertension, deep venous thrombosis and nasal polyposis in treatment with hydrochlorothizide, acenocumarol and topical intranasal corticosteroids. There was no personal or family history of neurofibromatosis disease. The physical examination showed a VI left cranial nerve palsy. Noncontrast emergency CT revealed a complete sinonasal polyposis opacification with a 5 x 3.5 cm sphenoid sinus expansive lesion. There was no calcification or bone destruction (Figure 1).The initial suspicion was sphenoidal mucocele, and MRI was performed. The MRI showed an expansive mass of the 4.1 x 4.4 x 4.2 cm sphenoid sinus expansive mass, heterogeneous on T2 weighted images and isointense...

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