|Year : 2017 | Volume
| Issue : 2 | Page : 135-137
Schwannoma of floor of mouth: A case report
Anjum Farooqui1, Yogita Khalekar2, Jamebaseer Farooqui3, Vikrant Kasat4
1 Department of Oral Medicine and Radiology, Rural Medical College, Loni, Maharashtra, India
2 Department of Oral Medicine and Radiology, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra, India
3 Department of Forensic Medicine, Rural Medical College, Loni, Maharashtra, India
4 Department of Oral Medicine and Radiology, Government Dental College, Aurangabad, Maharashtra, India
|Date of Submission||05-Dec-2006|
|Date of Acceptance||17-Oct-2017|
|Date of Web Publication||9-Nov-2017|
Department of Oral Medicine and Radiology, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Schwannoma (neurilemmoma) is a benign nerve sheath tumor that is composed entirely of well-differentiated Schwann cells. It is important to highlight that schwannoma is usually found in the head and neck and rarely in the oral cavity. Schwannoma is a benign tumor that originates from the Schwann cells of the peripheral nerves. They are usually asymptomatic, do not recur, and malignant transformation is rare. Here, we report a case of neurilemmoma that was located at an unusual location, i.e., floor of the mouth.
Keywords: Floor of mouth, neurilemmoma, oral cavity, schwannoma
|How to cite this article:|
Farooqui A, Khalekar Y, Farooqui J, Kasat V. Schwannoma of floor of mouth: A case report. J Indian Acad Oral Med Radiol 2017;29:135-7
|How to cite this URL:|
Farooqui A, Khalekar Y, Farooqui J, Kasat V. Schwannoma of floor of mouth: A case report. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 Nov 24];29:135-7. Available from: https://www.jiaomr.in/text.asp?2017/29/2/135/217910
| Introduction|| |
Neurilemmoma was first described by Verocay in 1910. He called it “Neurinoma.” In 1935, the term “Neurilemmoma” was coined by Stout., Neurilemmomas are benign, encapsulated tumors originating from Schwann cells of the nerve sheath. Intraoral neurilemmomas are rare, and it is difficult for clinicians to distinguish neurilemmomas from other benign or malignant tumors. When neurilemmomas occur in the sublingual area, it is important to rule out sublingual gland tumors. A definitive diagnosis of neurilemmoma can only be made by biopsy. Here, we report the case of a 19-year-old girl presenting with a solitary swelling on the floor of the mouth, which was diagnosed as a neurilemmoma after excisional biopsy.
| Case Report|| |
A 19-year-old female patient reported with a chief complaint of a swelling on the floor of the mouth, which was present for the last 3 months. History revealed that the swelling had gradually increased in size since its onset. The swelling was not associated with pain, discharge, or paresthesia. There was no significant medical history. Clinical examination revealed a roughly oval swelling, measuring 1 × 1 cm, and the surface appeared smooth in anterior part of floor of mouth. The mass was firm and mucosa over the mass was normal without erythematous or ulcerative changes. The mass was slightly movable [Figure 1]. A clinical diagnosis of sublingual salivary gland tumor, not ruling out malignancy, was made. Sialolithiasis, adenoid cystic carcinoma, mucoepidermoid carcinoma, lymphoma, and neurogenic tumor were considered as differential diagnoses. Fine needle aspiration cytology (FNAC) was done to rule out any cystic pathology. There was no aspirate on FNAC. An orthopantomograph (OPG) was taken which did not show any significant findings.
Complete surgical excision was conducted under local anesthesia as the size of the swelling was very small and was not attached to the underlying structures [Figure 2]. The specimen was sent for histopathological examination [Figure 3]. The tissue was then processed, and multiple sections were stained with hematoxylin, eosin, and S-100. Stained sections showed presence of encapsulated lesion composed of bundles of spindle cells arranged in two types of cellular pattern: Antoni type A and type B [Figure 4] and [Figure 5]. From the histopathologic features a confirmed diagnosis of schwannoma was made.
| Discussion|| |
Schwannoma is a rare benign neural tumor, arising from the neural sheath Schwann cells of the peripheral, cranial, or autonomic nerves. They are of two types, i.e., central or peripheral schwannoma, located in bone or in soft tissues, respectively. Between 25% and 45% of all neurilemmomas occur in the head and neck region, and 20% of these lesions occur in the intraoral area. Intraoral neurilemmomas arise mainly from the tongue, followed by the palate, floor of mouth, buccal mucosa, gingiva, lips, and vestibular mucosa. Neurilemmomas usually occur in the second or third decade of life but can occur at any age. There is no definite sex predilection.
The etiology of schwannoma is unknown. It is believed to originate from a proliferation of Schwann cells in the perineurium causing displacement and compression of the adjacent nerve. Schwannomas are usually solitary lesions; however, some are seen as multiple lesions as part of neurofibromatosis type I, which was not evident in our case. To rule out neurofibromatosis, OPG was taken which revealed no abnormality. The solitary neurilemoma is a slow growing, encapsulated tumor that typically arises in association with a nerve trunk. As it grows it pushes the nerve aside. Usually, the mass is asymptomatic, although tenderness or pain may occur in some instances. In the present case, the schwannoma presented as an asymptomatic, enlarging, well-circumscribed mass in the anterior floor of the mouth in a 19-year-old female. Schwannoma occurring on the floor of mouth has an intact overlying epithelium, which resembles other benign swellings known to occur in this region.
Microscopic evaluation of neurilemmoma shows two main patterns. The Antoni A pattern consists of densely-packed spindle cells. These cells are arranged in a typical, palisading figure surrounding acellular, eosinophilic areas known as Verocay bodies. The Antoni B pattern, the loose hypocellular arrangement, lies beside the Antoni A pattern. Positive staining for the neural crest marker, S-100 protein, is an important characteristic for diagnosis. The tumor in our patient showed the characteristics typical of neurilemmoma. Hence, the final diagnosis of schwannoma was made.
The current treatment modality for neurilemmoma is complete surgical excision. The intraoral approach avoids extraoral scarring and is preferred. The lesion normally will not recur. Malignant transformation is extremely rare. Hence, complete surgical excision was done in our case.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Baranovi M, Macan D, Begovi EA, Luksic I, Brajdi D, Manojlovi S, et al
. Schwannoma with secondary erosion of mandible: Case report with review of literature. Dentomaxillofac Radiol 2006;35:456-60.
Chrysomali E, Papanicolaou SI, Dekker NP, Regezi JA. Benign neural tumors of the oral cavity. Oral Surg Oral Med Oral Path Oral Radiol Endod 1997;84:381-90.
Arda HN, Akdogan O, Arda N, Sarikaya Y. An unusual site for an intraoral schwannoma: A case report. Am J Otolaryngol 2003;24:348-50.
Naik SM, Goutham MK, Ravishankara S, Appaji MK. Sublingual Schwannoma: A rare clinical entity reported in a hypothyroid female. Int J Head Neck Surg 2012;3:33-9.
Parikh NR. Intraoral schwannoma (neurilemmoma): An unusual anterior palatal swelling- A case report. J Int Oral Health 2010;2:87-92.
Artzi Z, Taicher S, Nass D. Neurilemmoma of the mental nerve. J Oral Maxillofac Surg 1991;49:196-200.
Seung-Kee Shim, Hoon Myoung. Neurilemmoma in the floor of the mouth: A case report. J Korean Assoc Oral Maxillofac Surg 2016;42:60-4.
Charles NSC, Ramesh V. Schwannoma of floor of the mouth. J Nat Sci Biol Med 2013;4:487-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]