Endoscopic nasal surgery for pterigopalatine fossa schwannoma

Schwannomas are tumors of nerve sheath origin, the lesion being derived from the Schwann cells surrounding neural tissue in most of the peripheral, cranial and autonomic nerves. Schwannomas occurring in the head and neck represent 25-35% of all reported schwannomas, and most commonly arise from the acoustic or the neumogastric nerves. In the nose and paranasal sinuses these tumors are very uncommon (fewer than 4% of all schwannomas). In the pterygopalatine fossa they are very rare, and arise in this case from the ophthalmic and maxillary branches of the trigeminal nerve. In this exceptional site, the tumor is classically approached through a Caldwell-Luc incision. In this case, we report the removal of a schwannoma of the pterygopalatine fossa by endoscopic sinus surgery.     

Schwannoma of the palatine tonsil

Schwannomas can originate in any peripheral, autonomic, or cranial nerve except the olfactory and optic nerves. Between 25 and 48% of all schwannomas have been reported to arise in the head and neck, with the acoustic nerve being the most common site of origin there. Schwannomas of the palatine tonsil are rare; as far as we know, only 6 such cases have been previously reported in the literature; 5 of these 6 occurred in adults and the other in an adolescent. We report a new case in a 42-year-old woman, which was diagnosed on the basis of histopathology.     

Synchrones Schwannom des N. vagus und des zervikalen sympathischen Grenzstrangs

Schwannomas are rare neural sheath tumors which are generally benign. Up to 45% of all schwannomas originate in the head and neck region. In the parapharyngeal space (PPS) they may arise from any of the lower cranial nerves IX, X, XI and XII or from the cervical sympathetic chain. We report a unique case of a synchronous schwannoma of the vagal nerve and the cervical sympathetic chain in a patient without neurofibromatosis.     

Cervical sympathetic schwannoma with postoperative first bite syndrome

Extracranial schwannomas occurring in the head and neck region may arise from cranial, peripheral or autonomic nerves. Determination of the nerve of origin is not often made until the time of surgery. Schwannomas arising from the cervical sympathetic chain are extremely rare. These interesting tumors along with schwannomas in general and the remaining class of neurogenic tumors are known for their ability to mimic the physical and radiological findings of carotid body tumors. Surgery is the treatment of choice and major complications are infrequent. However, we report a case of cervical sympathetic chain schwannoma with postoperative first bite syndrome.     

Degenerativ verändertes parapharyngeales Schwannom “ancient schwannoma”. Fallbericht und Literaturübersicht

Schwannomas are rare, slow-growing, benign neoplasms derived from the schwann cells of the nerve sheath of peripheral nerves. Extracranial schwannomas are most frequently localized within the extremities or the head and neck region. For example, they are common in the skull base, the carotid sheath, and the parapharyngeal space. Beneath several histological variants, schwannomas showing prominent degenerative changes (so-called,,ancient schwannomas") are exceedingly rare. Histopathological features, such as degenerative changes and nuclear atypias in ancient schwannomas, may be easily confused with malignant mesenchymal neoplasm.We present the case of a 32-year-old female who required surgery for a parapharyngeal neoplasm. Histological examination revealed features of an ancient schwannoma.     

Extracranial Head and Neck Schwannomas: A Review of 8 Years Experience

Schwannomas of the head and neck are uncommon tumors that arise from cranial, peripheral or autonomic nerves. In this study we review a series of 52 cases of schwannoma originating in the head and neck region over an 8-year period. All the tumors were benign, with the exception of one malignant schwannoma. The age range of the patients studied was 13-76 years and there was a predilection for males. Twenty-five schwannomas occurred in the scalp, face and external ear canal, 9 in the oral or nasal cavity and 18 in the neck. Seven cases of neck schwannoma originating from the major nerve system were found in the parapharyngeal space, all of which were located in the post-styloid compartment. Cervical plexus schwannomas originated either in the peripheral nerves or in an unidentified area of the nervous system; seven tumors were found in the posterior triangle of the neck and two in the anterior triangle. Two of the tumors originating in the brachial plexus were located in the posterior neck and one in the anterior neck. Tumors originating in the vagus nerve or sympathetic chain were all located in the anterior triangle of the neck.     

Extracranial head and neck schwannomas: a review of 8 years experience

Schwannomas of the head and neck are uncommon tumors that arise from cranial, peripheral or autonomic nerves. In this study we review a series of 52 cases of schwannoma originating in the head and neck region over an 8-year period. All the tumors were benign, with the exception of one malignant schwannoma. The age range of the patients studied was 13-76 years and there was a predilection for males. Twenty-five schwannomas occurred in the scalp, face and external ear canal, 9 in the oral or nasal cavity and 18 in the neck. Seven cases of neck schwannoma originating from the major nerve system were found in the parapharyngeal space, all of which were located in the post-styloid compartment. Cervical plexus schwannomas originated either in the peripheral nerves or in an unidentified area of the nervous system; seven tumors were found in the posterior triangle of the neck and two in the anterior triangle. Two of the tumors originating in the brachial plexus were located in the posterior neck and one in the anterior neck. Tumors originating in the vagus nerve or sympathetic chain were all located in the anterior triangle of the neck.     

Schwannoma and neurofibroma of the neck

Three schwannomas and one neurofibroma of the neck were treated surgically in our department during the last years (1980-1987). These tumors are relatively rare. The different clinical and histopathological criteria of the two tumors are discussed. In spite of these differences, in most cases a correct diagnosis is made only during surgery. Therefore, the possibility of temporary or permanent damage to major nerves is always present and the patient should be informed accordingly.     

Schwannoma of the hard palate

Schwannoma or neurilemmomas are benign, slow-growing, usually solitary, encapsulated tumors. They originate from the schwann cells of the nerve sheath. Approximately 30–40% of head and neck tumors are schwannomas. Intraoral schwannomas constitute a mere 1%. Tongue is the commonest site of schwannomas intraorally. Here we report a rare case of a hard palate swelling which was histopathologically diagnosed as schwannoma. The lesion was completely excised intraorally.     

Neurinoma of the hard palate in an 11-year-old girl. Case report]

BACKGROUND: Neurinomas or schwannomas are benign, encapsulated growing tumors of the Schwann cells of the nerve sheets; 25-45% are located in the head and neck region. They are found rarely in the oral cavity. Most of the intraoral schwannomas are located on the tongue. Other less common locations are the buccal mucosa, palate, floor of the mouth, gingiva and lips. The therapy of choice is complete surgical excision. CASE REPORT: An 11-year-old girl presented with a 3-month history of painless swelling of the hard palate. CT scan showed a right palatinal mass of 2 cm, reaching into the right maxillary sinus. After complete surgical excision the histological findings showed a neurinoma (Antoni type A). During a 2-year follow-up, there were no signs of recurrence. Because of the benign tumor type we considered the young patient to be healed.     

Giant cell tumor of the masticator space: case report and literature review

Giant cell tumors of the head and neck are rare. We describe the case of a 50-year-old man who presented with otalgia and eustachian tube dysfunction. After his symptoms persisted despite aggressive medical management, further investigation revealed the presence of a firmness in his left parotid tail. Computed tomography identified a heterogeneously enhancing mass in the left masticator space. The tumor was removed surgically, and it was diagnosed on histopathology as a giant cell tumor. The patient recovered uneventfully and was closely followed for signs of recurrence. To the best of our knowledge, ours is the first reported case of a giant cell tumor in the masticator space. We review the literature on giant cell tumors of the head and neck, with particular attention given to cases involving the temporomandibular joint.     

Monstr?ses benignes Schwannom der Mandibula

BACKGROUND: Schwannomas are rare benign neurogenic tumors that arise from Schwann cells of the peripheral nervous system. The most frequent localisation is the head and neck area. Extracranial schwannomas are most often located in the deep soft tissues. Intraosseous tumor types are rare; the mandible is the most common site. CASE REPORT: We present the case of a 63-year-old woman with a schwannoma which originated from the mandible nerve and describe the therapy of this neoplasm. A rare malignant transformation cannot be excluded. Therefore, the treatment of choice is radical local resection.     

Parapharyngeal and skull base yolk sac tumor: A case report with lessons in diagnosis and management

Yolk sac tumors are rare in the head and neck. A previously healthy 2-year-old female presented with a large parapharyngeal mass. Pathology was pathognomonic for yolk sac tumor, with glandular differentiation and focal mucin production, which has not been reported in a yolk sac tumor. She was treated aggressively with chemotherapy followed by endoscopic exploration with planned resection, but no viable tumor was encountered. Yolk sac tumors can be difficult to diagnose in the head and neck, but complete clinical response can be achieved. New endoscopic approaches to skull base tumors are applicable to the pediatric population with some technical modifications.     

Schwannoma of the external auditory canal: an exceptional location

Solitary schwannoma is a benign, encapsulated tumour of Schwann cell origin, therefore the olfactory and optic nerves are never affected. About 25%-45% of all schwannomas occur in the head and neck but schwannoma of the external auditory canal is a rare finding, and we have found only 6 previous cases reported in the literature world-wide. Our patient was discovered by chance during a stapedectomy because the tumour was sited in the external auditory canal without distorting it.     

A case of angiofibroma originating from the inferior nasal turbinate

Angiofibromas are nasopharyngeal tumors mostly seen in adolescent males. They account for less than 0.5% of all head and neck neoplasms. Extranasopharyngeal angiofibromas, although rare, have been reported. We report a case of extranasopharyngeal angiofibroma arising from the inferior turbinate of a 62-year-old male. The tumor was excised using the Denker approach. The patient is currently free of relapse 10 months after surgery. Previous extranasopharyngeal angiofibromas research was reviewed.     

Solitary fibrous tumor of the submandibular gland

Solitary fibrous tumors (SFT) are generally benign, well-circumscribed soft-tissue tumors of mesenchymal origin. CD34 antigen expression is characteristic for this tumor. A rare subgroup shows malignant histological patterns with aggressive behavior. The common site of occurrence is the pleura, but various other sites, including the head and neck, have been described. We present a 56-year-old, white, female patient with a solitary fibrous tumor developing in the right submandibular salivary gland. The tumor was surgically removed, and no recurrence or metastases have occurred during the 43 months of follow-up. All solitary fibrous tumors reported in the salivary glands were benign. However, new cases should be presented and followed up carefully to monitor their biological behavior.     

Soft-tissue sarcomas of the head and neck: a retrospective analysis of the Alberta experience 1974 to 1999

BACKGROUND: Soft-tissue sarcomas (STS) of the head and neck constitute a heterogeneous group of rare malignant tumors occurring in an uncommon site. The most common subtypes of STS in the head and neck are malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, and fibrosarcoma. Evidence based subtype-specific treatment decisions are often not possible. METHODS: The medical records of 110 patients diagnosed with head and neck sarcomas were reviewed. All were treated at one of the two major Cancer Centers in Alberta, Canada, between 1974 and 1999. Potential prognostic factors including age, sex, tumor size, histology, grade, tumor location (superficial or deep), and use of adjuvant treatment were evaluated. Cox proportional hazards models were developed to study the impact of these covariates on survival. RESULTS: The median duration of follow-up was 61.5 months. Five year overall, disease specific, and relapse free survival were 65.8%, 83.4%, and 74.2%, respectively. With use of a Cox proportional-hazards model, tumor stage and grade were important prognostic factors affecting survival. CONCLUSIONS: Tumor size and grade were important prognostic factors affecting survival. Tumor location in relation to the superficial fascia (depth) was the best predictor of outcome. The overall and disease-free survival in this patient group was excellent. However, this likely caused by the high proportion of patients with low-grade tumors in our study.     

Multiple paragangliomas of the head and neck

Multiple paragangliomas of the head and neck are rare conditions. The incidence of multiple paragangliomas is reported to the approximately 10% of the total patients, but in familial cases it increases up to 35-50%. In the head and neck region, the most common association is represented by bilateral carotid body tumors or by carotid body tumor associated with tympanic-jugular glomus. The presence of three synchronous glomus tumors is really rare, as well as association with vagal glomus and carotid body. In this paper the authors present a patient affected ipsilaterally by a carotid body tumor and vagal paraganglioma, focusing on the diagnostic options offered by imaging techniques (CT and MRI).     

Experience of head and neck extracranial schwannomas in a whole population-based single-center patient series

Due to their rarity most of the literature concerning head and neck extracranial schwannomas consists of case reports and small patient series. The aim of the study was to describe population-based incidence, presenting signs and symptoms, management and outcome of head and neck extracranial schwannomas in a larger patient group. All the head and neck extracranial schwannoma patients managed during 1987–2008 at the Helsinki University Central Hospital with a referral area of 1.5 million inhabitants were searched. Altogether 47 patients were identified and subjected to retrospective chart review. Population-based incidence of head and neck extracranial schwannomas was 0.14/100,000/year. Eighty-eight percent of the patients had symptoms, which had lasted on average for 11.5 months prior to diagnosis. Presenting signs and symptoms were diverse depending on the affected nerve. Ninety-four percent of the patients were treated surgically. Sixty-four percent of the operations were macroscopically radical. The tumor capsule was intentionally left in place in 9 %. Surgery-related complications were detected in only 7 % of the patients, but 1 month postoperatively 52 % of them had symptoms, majority relating to different nerve deficits. Treatment of extracranial head and neck schwannomas remains challenging. The tumor is benign, and it grows slowly in a vast majority of cases, but its symptoms are highly variable. Correct timing of surgery is essential, as also patients who are preoperatively asymptomatic may suffer severe postoperative morbidity. Preoperative patient counseling needs to address the risks of neurological sequelae.     

Malignant fibrous histiocytoma of the bucca: a case report

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. In the case reported here, the patient was a 61-year-old man who presented with swelling and pain of the left bucca. A CT scan demonstrated a 2.5 cm x 5.0 cm inhomogeneous lesion. In MRI, the tumor displayed an inhomogeneous isointense signal on T1-weighted images and a high-intensity signal on T2-weighted images. Fine-needle aspiration (FNA) was performed twice but we were unable to reach a definitive diagnosis histologically. MFH was subsequently diagnosed by open biopsy, and external radiotherapy with 38 Gy of radiation was performed. However, the tumor enlarged after this therapy, and therefore CyberKnife therapy was performed twice, after which the tumor gradually reduced in size. The patient is alive after a follow-up period of 22 months, and therefore we suggest that CyberKnife treatment may be useful for head and neck MFH.