Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 352

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
SHORT COMMUNICATION Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 457-459
Schwannoma of the tongue: An unusual presentation in a child


1 Department of Oral Medicine & Radiology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
2 Department of Pedodontics & Preventive Dentistry, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Click here for correspondence address and email

Date of Submission16-Nov-2009
Date of Decision14-Jan-2010
Date of Acceptance21-May-2010
Date of Web Publication29-Sep-2010
 

   Abstract 

Schwannomas are benign tumors of nerve sheath and quite uncommon in the oral cavity. In contrast to the earlier reports in the literature, a confounding case of a lingual schwannoma presenting as a symptomatic and exophytic growth on the ventral surface of the tongue in a 12-year-old boy is discussed here.

Keywords: Child, neurilemmoma, neurinoma, schwannoma, ulceration

How to cite this article:
Naidu GS, Sinha SM. Schwannoma of the tongue: An unusual presentation in a child. Indian J Dent Res 2010;21:457-9

How to cite this URL:
Naidu GS, Sinha SM. Schwannoma of the tongue: An unusual presentation in a child. Indian J Dent Res [serial online] 2010 [cited 2019 Apr 26];21:457-9. Available from: http://www.ijdr.in/text.asp?2010/21/3/457/70790
Schwannomas (neurilemmomas or neurinomas) are benign encapsulated nerve sheath neoplasms composed of Schwann cells first described by Verocay in 1908. [1] Schwannomas in the head and neck regions constitute 25% of all extracranial schwannomas, but only 1% show intraoral origin. [1],[2] Of these, one such case of a lingual schwannoma confounded us due to its unusual presentation as a symptomatic and exophytic growth on the ventral surface of the tongue in a 12-year-old boy in contrast to the earlier reports in the literature.


   Case Report Top


A 12-year-old Nepalese boy, reported to our clinic with a growth in the ventral aspect of the tongue purportedly of 15 days duration. The growth was asymptomatic at first and nonprogressive but ulcerated after few days and began to bleed readily. Paresthesia and dysgeusia to sour and sweet foods was reported in the right half of the tongue. No history of trauma was elicited nor any systemic or local infections. The medical and family histories were unremarkable. A physical examination revealed a moderately built and nourished male with no known systemic disorders. Intraoral examination showed an exophytic growth in the ventral surface of the right half of the tongue measuring 20×10 mm in size [Figure 1]. The base of the growth was an area of ulceration, which had firm, well-defined borders that were non-tender on palpation. The growth itself appeared necrotic and covered by slough. It was soft, friable, and non-tender on palpation and bled readily on manipulation. The dentition and the adjacent oral mucosa revealed no abnormalities. Tongue movements were unrestricted and simple gustatory testing to sweet, sour, and salt yielded normal results.
Figure 1: Intraoral photograph showing an exophytic growth on the ventral surface of the tongue

Click here to view


A provisional diagnosis of a pyogenic granuloma was made and inflammatory fibrous hyperplasia, fibroepithelial polyp, granulomatous ulcer, schwannoma, neurofibroma, and granular cell tumor were considered as an alternative diagnoses. After obtaining a complete blood profile, which was within normal limits, incisional biopsy was planned under local anesthesia. On attempting to obtain the specimen the soft and friable nature of the growth prompted an excision of the entire lesion along with the ulcerated base. Because encapsulation was not evident, blunt dissection was carried out till the muscle plane to free the tongue of any lesional tissue [Figure 2]. Direct invasion into the adjacent muscle or nerve fibers was not evident nor was any significant bleeding encountered.
Figure 2: Postoperative intraoral photograph showing biopsy site of the lesion

Click here to view


The histopathology with routine hematoxylin and eosin-stained sections revealed predominantly spindle-like cells with abundant fibrillar cytoplasm along with a mixed inflammatory cell infiltrate. Areas of palisading arrangement of nuclei suggestive of Verocay bodies were noted [Figure 3]. Necrotic material with bacterial colonies was also noted. However, the bacterial and fungal cultures failed to show any pathogens. Immunohistochemistry with S-100 neural marker showed strong reactivity [Figure 4], but remained negative to muscle marker actin. A conclusive diagnosis of schwannoma was made based on the above findings. The patient was reviewed after a week and adequate healing was appreciated. A 3-month follow-up [Figure 5] showed no signs of recurrence and the patient remained asymptomatic.
Figure 3: Schwannoma of tongue showing spindle cells arranged in palisading pattern forming verocay bodies (Antoni A area) (H and E stain, ×100)

Click here to view
Figure 4: Schwannoma showing strong S-100 reactivity (200×)

Click here to view
Figure 5: Postoperative intraoral photograph (after 3 months) showing complete resolution of the lesion

Click here to view



   Discussion Top


Peripheral nerve tumors of the oral cavity include schwanomma, neurofibroma, traumatic neuroma, and 2 very rare entities, the palisaded encapsulated neuroma and neurothekeoma. Embryologically, Schwann cells arise during the fourth week of development from ectomesenchymal cells of the neural crest. They enhance nerve conductance by either forming a thin barrier around peripheral nerve fibers or a thick myelin sheath. [1],[2]

Schwannomas in the head and neck regions constitute 25% of all extracranial schwannomas, but only 1% show intraoral origin. [1,2] Of these, 50% tumors have been shown to have a direct relation with a nerve. [2] Within the tongue, schwannomas may rise from the hypoglossal nerve, glossopharyngeal nerve, [3] or the lingual nerve. Although they may arise at any age, the peak incidence varies between the third and the sixth decades with only 4 cases of lingual schwannoma reported in children. [4] Clinically, schwannomas are solitary, slow growing, smooth surfaced, and usually asymptomatic. Ulceration of the overlying mucosa is uncommon and generally the result of trauma. [2] Lesions of the tongue that are exophytic or fungating are extremely rare, with only 2 such reports till date; one in an adult and the other in a 9-year-old child. [5] Interestingly, our patient hailed from the remote hilly regions of Nepal and may have reported to our clinic only when the growth was sufficiently symptomatic after bleeding and paresthesia were encountered. Hence, the short duration of clinical presentation as revealed by the patient would seem improbable. However, the unusual and misleading presentation of a symptomatic, exophytic, and poorly encapsulated schwannoma was unique to this case.

Diagnostic investigations include ultrasound scanning, computed tomography, magnetic resonance imaging (MRI), and fine-needle aspiration cytology. However, MRI is the best choice in detailing of the extent of the tumors and correlates well with operative findings. [4] The definitive diagnosis is based on histopathology with the presence of alternating patterns of Antoni A and B areas, nuclear palisading, whorling of cells, and Verocay bodies. The absence of large multipolar fibroblasts, reticulin, and a mucoid matrix distinguishes schwannoma from other histologic entities, such as meningioma, leiyomyoma/leiyomyosarcoma, palisaded myofibroblastoma, and pleomorphic hyalinizing angiectatic tumor of soft tissue, with similar findings. [1],[2] The use of a myriad of immunohistochemistry markers beyond neural-specific S-100 stain for identification is therefore not uncommon in such lesions.

Schwannomas are managed by complete surgical excision, but wide excision is not recommended because schwannomas show few recurrences after surgery. [2] Malignant transformation of schwannoma is an exceptionally rare event and can be safely disregarded. [1] The above case was of peculiar interest due to the symptomatic, poorly encapsulated, and exophytic clinical presentation in a young boy.

 
   References Top

1.Bansal R, Trivedi P, Patel S. Schwannoma of the tongue. Oral Oncol Extra. 2005;41:15-7.  Back to cited text no. 1      
2.Lo΄pez-Jornet P, Bermejo-Fenoll A. Neurilemmoma of the tongue. Oral Oncol Extra 2005;41:154-7.  Back to cited text no. 2      
3.Biswas D, Marnane CN, Mal R, Baldwin D. Extracranial head and neck schwannomas: A 10-year review. Auris Nasus Larynx 2007;34:353-9.  Back to cited text no. 3      
4.Karaca CT, Habesoglu TE, Naiboglu B, Habesoglu M, Oysu C, Egeli E, et al. Schwannoma of the tongue in a child. Am J Otolaryngol 2010;31: 46-8.  Back to cited text no. 4      
5.Bassichis BA, Mcclay JE. Pedunculated neurilemmoma of the tongue base. Otolaryngol Head Neck Surg 2004;130:639-41.  Back to cited text no. 5      

Top
Correspondence Address:
Giridhar S Naidu
Department of Oral Medicine & Radiology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan
Nepal
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.70790

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

This article has been cited by
1 Schwannoma de la lengua
R.A. Feltes-Ochoa,R. Maseda-Pedrero,E. Ruíz-Burguillos
Actas Dermo-Sifiliográficas. 2015;
[Pubmed] | [DOI]
2 Schwannoma of the Tongue in a Paediatric Patient: A Case Report and 20-Year Review
Nitin Bhola,Anendd Jadhav,Rajiv Borle,Gaurav Khemka,Umesh Bhutekar,Sanatan Kumar
Case Reports in Dentistry. 2014; 2014: 1
[Pubmed] | [DOI]
3 intraoral schwannomas: presentation of a series of 12 cases
sanchis, j.-m. and navarro, c.-m. and bagán, j.-v. and onofre, m.-a. and murillo, j. and de-andrade, c.-r. and díaz, j.-m. and pereira-filho, v.-a.
journal of clinical and experimental dentistry. 2013; 5(4): 192-196
[Pubmed]
4 schwannoma of the tongue: a report of two cases and review
erkul, e. and cincik, h. and haholu, a. and çekin, e. and güngör, a.
gulhane medical journal. 2013; 55(2): 135-140
[Pubmed]
5 Soft Palate Schwannoma
Sandhya Venkatachala,R. Krishnakumar,Sheik Afzal Rubby
Indian Journal of Surgery. 2013; 75(S1): 319
[Pubmed] | [DOI]
6 Intraosseous schwannoma; a case report and short review
Sumalatha, M.N. and RaviPrakash, S. and Shankar, V.N.
Oral Surgery. 2012; 5(2): 64-67
[Pubmed]
7 A Schwannoma of the soft palate in a child: Histological and immunohistochemical features and surgical method
Rahpeyma, A. and Jafarian, A.H. and Ahmadi, S.K. and Sarabadani, J.
Iranian Journal of Otorhinolaryngology. 2012; 24(67): 95-99
[Pubmed]
8 Intra osseous schwannoma - A case report
S. Gadiputi,M.N. Sumalatha
Journal of Pierre Faucharad Academy (India Chapter). 2012; 26(1): 22
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed6689    
    Printed100    
    Emailed4    
    PDF Downloaded213    
    Comments [Add]    
    Cited by others 8    

Recommend this journal