Cervical sympathetic schwannoma: case report

OBJECTIVE AND IMPORTANCE: Approximately 20 to 27% of neck masses in the parapharyngeal space may be benign nerve sheath tumors. Cervical sympathetic chain schwannomas or vagal nerve schwannomas are most common. We report a patient with a cervical sympathetic chain schwannoma. CLINICAL PRESENTATION: The patient was a 47-year-old Caucasian man with a 7-month history of a painless, enlarging right neck mass. No hoarseness or Horner's syndrome was found preoperatively. Formal head and neck examination in the otolaryngology department revealed no vocal cord dysfunction. INTERVENTION: By use of a standard right carotid incision, a tumor was identified growing from the cervical sympathetic chain posterior to the carotid bifurcation. A gross total resection was performed and a section of the cervical sympathetic chain was sacrificed. CONCLUSION: Cervical sympathetic chain schwannomas are unusual tumors that require microneurosurgical resection for cure. We discuss the differential diagnosis, evaluation, surgical management, and pathological characteristics of such tumors and review the literature.     

Abducens nerve schwannoma: case report and review of the literature

Schwannomas of the abducens nerve are extremely rare. The authors report a case with this tumor and discuss its clinical and radiographic characteristics. A 36-year-old man presented with 6-month history of diplopia. Right abducens nerve paresis was noted on neurologic examination. Magnetic resonance imaging revealed a 4-cm sized heterogeneously enhancing mass in the right cerebellopontine angle. Although schwannoma was suggested, no direct radiographic evidences regarding its origin were identified. Instead, the facial and vestibulocochlear nerve complex was found to be displaced posteriorly by the tumor on MR three-dimensional T2-weighted driven equilibrium sequence. Resection of the tumor was carried out via retrosigmoid approach. As the encapsulated partially suckable yellowish tumor was debulked and dissected, the abducens nerve was found to fan along and be attached to the medial surface of the tumor, which was cut at this point. Complete excision of the tumor was accomplished, and reanimation of the nerve was done by end-to-end anastomosis. Histologic feature was typical of schwannoma. Abducens schwannoma, although rare, should be taken into account for differential diagnosis of the cerebellopontine angle tumors. Appreciation of the characteristic clinical and radiographic features may provide an accurate preoperative diagnosis.     

腹膜后神经鞘瘤1例报告并文献复习

目的报告1例腹膜后神经鞘瘤,并复习相关文献,分析其临床诊治现状。方法通过对1例腹膜后神经鞘瘤的诊断、治疗方法及术后病理、随访的回顾,结合国内外有关文献报道,综合分析腹膜后神经鞘瘤的诊断及治疗状况。结果本例行手术治疗,术后病理证实为腹膜后神经鞘瘤,随访半年无复发。结论腹膜后神经鞘瘤诊断困难,影像学检查无特异性,确诊依靠病理检查,理想的治疗方法是通过外科手术完整切除肿瘤,其预后良好,早期复发率低。     

原发性膀胱神经鞘瘤1例报告并文献复习

目的 探讨原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤在组织病理学、临床表现、治疗和预后上的特点,确立两者的鉴别诊断思路.方法 回顾1例原发于膀胱的神经鞘瘤的临床诊疗过程,结合有关膀胱神经鞘瘤及膀胱恶性周围神经鞘瘤的文献资料进行分析.结果 在组织病理和免疫组化方面,原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤有明显差异.结论 原发于膀胱的神经鞘瘤临床极其少见,易与膀胱常见肿瘤混淆,造成误诊,免疫组化为重要的确诊依据.膀胱恶性周围神经鞘瘤应以高度恶性的软组织肉瘤进行处理.临床上应重视两种疾病的鉴别,以正确地指导临床诊疗.     

Retroperitoneal giant schwannoma: a case report and review of the literature

Schwannomas are rare tumours that originate in the neural sheath and account for only a small percentage of all retroperitoneal tumours. They are usually solitary, circumscribed and encapsulated lesions eccentrically located on proximal nerves or spinal nerve roots. Presentation is typically varied and non-specific, ranging from abdominal pain, an abdominal mass or an incidental finding. The preoperative diagnosis is difficult and laboratory tests are usually unremarkable. We report the case of a 66-year-old female presenting with abdominal pain in her left flank and with an ultrasonographic diagnosis of a left kidney mass. She was diagnosed as suffering from a giant retroperitoneal schwannoma after surgical exploration and complete excision. The role of CT scan and CT-guided needle biopsy is emphasised, in that ultrasonography and fine needle aspiration alone do not provide sufficient information regarding aetiology and malignancy. Radical surgical excision is curative but recurrences may occur. Careful follow-up is needed.     

Abducens nerve schwannoma: a case report and review of the literature

BACKGROUND: Schwannomas of the abducens nerve are extremely rare tumors; only 10 cases have been reported so far. The tumor may be located within the cavernous sinus (CS) or more commonly at the prepontine region. Patients usually present with VIth cranial nerve paresis. CASE DESCRIPTION: We report a case of a 42-year-old male patient who presented with headache, vertigo, and hearing deficit, but no symptoms or signs related to a VIth cranial nerve impairment. Computed tomography and magnetic resonance imaging showed a large mass with a ring-like contrast enhancement in the prepontine area. Surgical treatment, via a simple retrosigmoid suboccipital approach, revealed a schwannoma originating from the VIth cranial nerve at its prepontine portion. Postoperative histological examination confirmed the diagnosis of schwannoma, and the patient had only a VIth cranial nerve palsy, which resolved during long-term follow-up. CONCLUSIONS: Abducens schwannomas are rare tumors, representing less than 1% of all intracranial schwannomas in our clinic and about 13% of oculomotor nerve schwannomas reported in the literature. These lesions can be mainly divided into tumors originating from the intracavernous portion of the VIth cranial nerve or more commonly from the cisternal part of the nerve, leading to a lesion in the prepontine region. In such cases, with no invasion of the cavernous sinus, radical tumor resection with preservation of the abducens nerve can be performed via a simple suboccipital retrosigmoid approach.     

Cervical extradural meningioma: case report and literature review

BACKGROUND: Extradural lesions are most commonly metastatic neoplasms. Extradural meningioma accounts for 2.7 to 10% of spinal neoplasms and most commonly is found in the thoracic spine. DESIGN: Case report. FINDINGS: A 45-year-old woman presented with posterior cervicothoracic pain for 8 months following a motor vehicle crash. Magnetic resonance imaging of the cervical spine revealed an enhancing epidural mass. Computerized tomography of the chest, abdomen, and pelvis revealed no systemic disease. Due to the lesion's unusual signal characteristics and location, an open surgical biopsy was completed, which revealed a psammomatous meningioma. Surgical decompression of the spinal cord and nerve roots was then performed. The resection was subtotal due to the extension of the tumor around the vertebral artery. CONCLUSION: Meningiomas should be considered in the differential diagnosis of contrast-enhancing lesions in the cervical spine.     

Spinal schwannoma causes acute subarachnoid haemorrhage: A case report and literature review

BackgroundSpinal schwannomas that arise from spinal nerve root sheaths are the most common intradural extramedullary spinal tumours and are often accompanied by nerve roots or spinal cord irritation symptoms. The phenomenon of spinal schwannoma causing subarachnoid haemorrhage (SAH) is rare, with ependymoma of the conus medullaris accounting for most cases.Case reportA 45-year-old man was admitted to our hospital due to progressive lower limb weakness and sudden back pain after hard physical work. The patient had not been able to walk for 2 hours upon admission. An emergency magnetic resonance imaging (MRI) scan showed that the spinal cord at the C6-T4 level was severely compressed by a subdural mass. During the emergency operation, exploration of the dura and arachnoid mater revealed a fresh blood clot covering a tumour located on the ventral side of the spinal cord. The size of the tumour was approximately 3 × 2 × 1 cm without adhesion to the surrounding tissue, but the drainage vein was ruptured. Postoperative pathology showed that the tumour was a schwannoma with areas of fresh haemorrhage and focal necrosis.ConclusionsSpinal schwannomas presenting with SAH are rare events. In our opinion, spinal pathology with rapid progression of neurological symptoms requires early diagnosis and emergency management. Complete excision of haemorrhagic tumours is the goal of treatment to prevent recurrence, which can effectively avoid irreversible damage to the spinal cord resulting from spinal cord compression.     

Cervical synovial cysts: case report and review of the literature

The authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient’s symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1- and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary. Received: 12 January 1998 Revised: 17 September 1998 Accepted: 19 October 1998     

Pathological laughter in trigeminal schwannoma: case report and review of the literature

Pathological laughter is an uncommon manifestation of neurosurgical diseases. Very few cases of trigeminal schwannoma have been reported in the literature presenting with pathological laughter as a predominant symptom. We are reporting on a case of multi-compartmental trigeminal schwannoma presenting as pathological laughter and discuss a review of the literature. A 23-year-old lady presented with pathological laughter, along with symptoms pertaining to other cranial nerves and cerebellar dysfunction. Magnetic resonance imaging (MRI) of the brain was suggestive of a dumbbell-shaped mass in the middle and posterior cranial fossa on the left side, causing significant compression of the pons. She was investigated and operated for multi-compartmental trigeminal schwannoma. Following surgery, abnormal laughter disappeared immediately and no recurrence of symptoms was -present for a follow-up of 16 months. This case supports the role of the brainstem, especially the pons, in the control of laughter and, perhaps, of the medial temporal lobe too.     

Thoracic splenosis mimicking thoracic schwannoma: case report and review of the literature

BACKGROUND: Thoracic splenosis is a rare entity. It occurs sometime after splenic and diaphragmatic injury, and it is rarely symptomatic. CASE DESCRIPTION: We report a case of left upper thoracic paraspinal splenosis 25 years after a thoracoabdominal penetrating trauma that required a splenectomy. The pathology was suspected on a routine chest x-ray and it mimicked a schwannoma on magnetic resonance imaging. Less than 40 cases of thoracic splenosis were described in the literature, but few were misinterpreted as schwannoma. CONCLUSION: Alertness to the possibility of thoracic splenosis can lead to confirmation of the diagnosis with technetium Tc 99m-tagged red blood cell radionuclide scanning based on a previous history of traumatic splenectomy.     

Cervical juxtafacet cysts: case report and literature review.

BACKGROUND: Juxtafacet cysts of the cervical and thoracic spine are rare and often present with myelopathy. Juxtafacet cysts are well recognized entities found commonly in the lumbar spine but are unusual in the cervical and thoracic spine. We present a case of a patient with gait disturbance and early myelopathy who was found to have a juxtafacet cyst at the cervico-thoracic junction. We further review the literature. PURPOSE: To describe a case of a cervico-thoracic juxtafacet cyst and review the literature. STUDY DESIGN: Case report and subject review. METHODS: One patient presenting with early myelopathy and pain underwent surgery for resection of the lesion. Pathologic analysis revealed a juxtafacet cyst. RESULTS: The patient recovered uneventfully with relief of his pain. Pubmed review revealed less than 30 similar cases in the literature. CONCLUSION: Juxtafacet cysts of the cervical spine are rare entities. These lesions comprise both synovial cysts and ganglion cysts. The benign lesions present with myelopathy and should be considered in patients with cystic lesions in the cervical spinal canal.     

Benign solitary schwannoma of the foot. A case report and review of the literature

Benign solitary schwannomas of the foot are a rare occurrence; only four cases have been previously reported. A schwannoma associated with the medial plantar nerve present for more than 40 years before the onset of symptoms was diagnosed in a 73-year-old man. Excision of the mass, with preservation of the involved nerve, was possible and successfully relieved symptoms.     

Cervical esophageal duplication cyst: case report and review of the literature

Cervical esophageal duplication cysts are rare congenital anomalies that can be successfully managed surgically. These anomalies are rare causes of upper airway obstruction. We present here a case of a cervical esophageal duplication cyst in an infant, along with a review of the literature concerning this anomaly.     

Intramedullary schwannoma of the spinal cord. A case report and review of the literature

A 9-year-old boy presented with the numbness in both arms and hands, and neck stiffness. On examination, he had a slight quadriparesis and restricted neck movements. There were no signs of von Recklinghausen's disease. Magnetic resonance imaging (MRI) scan disclosed a gadolinium enhanced intramedullary tumor located at C6-T1 associated with syringomyelia. C6-T1 laminectomies were performed and the intramedullary tumor was totally removed by a microsurgical technique. Postoperative course was uneventful. The pathological examination revealed an intramedullary schwannoma. The occurrence of intramedullary schwannoma in a patient without signs of von Recklinghausen's disease is extremely rare. We have been able to find 57 cases of intramedullary schwannoma reported in the literature. Intramedullary schwannomas are usually seen in males. The ages of the patients ranged from 9 to 75 years (mean 40.44 years). Only 4 cases in the pediatric age group have been reported. The duration of symptoms ranged from 3 months to 20 years (mean 31.03 months). Symptoms and signs varied with the location of tumor. The vertebral levels of intramedullary schwannomas were usually cervical (61%). MRI has been the choice of diagnostic tool in the cases reported since 1986. The majority of the cases showed either a partial or complete recovery in the postoperative period.     

Intracerebral schwannoma: case report and review

A case of intraparenchymal schwannoma of the brain in a 4-year-old girl is presented. Most of the small number of intracranial schwannomas unassociated with cranial nerves, reported have occurred in children or young adults. There is no male or female predominance. Most of the parenchymatous schwannomas are located supratentorially. The presence of a cyst together with the tumor appears to be characteristic of intraparenchymal schwannoma of the brain.