Extratemporal intraparotid facial nerve schwannoma

Chowdhary, Stuti; Thangavel, Saranya; Ganesan, Sivaraman; Alexander, Arun

doi:10.1136/bcr-2020-239407

Cited by 3 publications

(1 citation statement)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is possible that in certain selected cases where the imaging arguments are strong in favor of the diagnosis of schwannoma and there is no clinical peripheral facial palsy, the conservative attitude of imaging monitoring of the tumor for a short time may be considered. But, considering that the diagnosis of certainty cannot be formulated by histological examination, and the increase in the size of the tumor also increases the surgical risks, the wisest attitude seems to be informed consent of the patient regarding the operative risks, with the presentation of the possibility of intraoperative reconstruction of a damaged facial nerve [ 31 ]. As a consequence, choosing surgery depends on the location and extension of the tumor, the preoperative function of the facial nerve, the experience of the surgeon, and the results obtained previously regarding the reconstruction of the nerve, but also on the patient’s preferences.…”

Section: Therapeutic Strategies In the Management Of Fns Extracranial...mentioning

confidence: 99%

Extracranial Facial Nerve Schwannoma—Histological Surprise or Therapeutic Planning?

et al. 2023

View full text Add to dashboard Cite

Schwannomas (neurilemomas) are benign, slow-growing, encapsulated, white, yellow, or pink tumors originating in Schwann cells in the sheaths of cranial nerves or myelinated peripheral nerves. Facial nerve schwannomas (FNS) can form anywhere along the course of the nerve, from the pontocerebellar angle to the terminal branches of the facial nerve. In this article, we propose a review of the specialized literature regarding the diagnostic and therapeutic management of schwannomas of the extracranial segment of the facial nerve, also presenting our experience in this type of rare neurogenic tumor. The clinical exam reveals pretragial swelling or retromandibular swelling, the extrinsic compression of the lateral oropharyngeal wall like a parapharyngeal tumor. The function of the facial nerve is generally preserved due to the eccentric growth of the tumor pushing on the nerve fibers, and the incidence of peripheral facial paralysis in FNSs is described in 20–27% of cases. Magnetic Resonance Imaging (MRI) examination is the gold standard and describes a mass with iso signal to muscle on T1 and hyper signal to muscle on T2 and a characteristic “darts sign.” The most practical differential diagnoses are pleomorphic adenoma of the parotid gland and glossopharyngeal schwannoma. The surgical approach to FNSs requires an experienced surgeon, and radical ablation by extracapsular dissection with preservation of the facial nerve is the gold standard for the cure. The patient’s informed consent is important regarding the diagnosis of schwannoma and the possibility of facial nerve resection with reconstruction. Frozen section intraoperative examination is necessary to rule out malignancy or when sectioning of the facial nerve fibers is necessary. Alternative therapeutic strategies are imaging monitoring or stereotactic radiosurgery. The main factors which are considered during the management are the extension of the tumor, the presence or not of facial palsy, the experience of the surgeon, and the patient’s options.

show abstract

Section: Therapeutic Strategies In the Management Of Fns Extracranial...mentioning

confidence: 99%

Extracranial Facial Nerve Schwannoma—Histological Surprise or Therapeutic Planning?

et al. 2023

View full text Add to dashboard Cite

show abstract

Challenges in the Cytodiagnosis of Intraparotid Schwannoma

Sinehaa,

Jain,

Sood

et al. 2024

Diagnostic Cytopathology

View full text Add to dashboard Cite

Clear cell tumors of parotid gland encompass a wide spectrum of neoplasms, including benign and malignant epithelial neoplasms. Additionally, tumors from adjacent structures such as paraganglioma, and metastatic neoplasms may also show clear cells. Overlapping cytological features may cause difficulty in diagnosis. This 50‐year‐old female presented with inability to close the right eye for 4 years, and with an infra‐auricular swelling. Fine‐needle aspiration cytology (FNAC) done outside was submitted for review with a diagnosis of neuroendocrine tumor. Smears showed clusters of tumor cells with abundant vacuolated cytoplasm and uniform round to ovoid nuclei. Features were those of salivary gland neoplasm of uncertain malignant potential, that is Milan category IVB: cellular neoplasm with clear cell features, with differential diagnoses of myoepithelial cell neoplasms, acinic cell carcinoma and paraganglioma. FNAC repeated for better characterization showed similar polygonal cells, accompanied by few spindle‐shaped cells with ovoid nuclei, suggestive of paraganglioma. However, DOTANOC uptake was absent. Patient underwent radical parotidectomy; intraoperative frozen section showed a spindle cell tumor. Final histopathology revealed an intraparotid facial nerve schwannoma. The tumor was multi‐nodular, with some nodules being composed almost entirely of polygonal cells with clear cytoplasm, that is, Antoni B areas, and others showing typical Antoni A areas admixed with Antoni B areas. Parotid FNAC has high accuracy for diagnosis of epithelial lesions; however, mesenchymal tumors often pose a diagnostic difficulty. Intraparotid schwannoma is not uncommon and may be diagnosed easily on FNAC when morphology is classical. However, intra‐tumoral heterogeneity and less common histological subtypes may present a pitfall in cytodiagnosis.

show abstract