Schwannoma (Neurilemmoma) is a benign, slow-growing tumor that originates from the Schwann’s cells of the peripheral nerves. The tumor is usually asymptomatic, do not recur, and malignant transformation is rare. The Schwannoma is usually found in the head and neck (i.e. acoustic neuromas) or in autosomic dominant disorders with mutation of the NF2 gene on chromosome 22 (22q12). It’s instead rare in the oral cavity. When it does occur in this area, the tongue is the most common site, followed by the palate, floor of mouth, buccal mucosa, lips, and jaws. It can present itself at any age. This lesion is not taken into account during clinical practice and the differential diagnosis includes numerous benign neoformations based on epithelial and connective tissues. In the majority of cases, the diagnosis can only be made during surgery and by histological study, however the preoperative tomography and magnetic resonance imaging are very helpful. The Schwannoma showed two different pattern of growth: Antoni A and Antoni B. The Anti-S-100, NSE protein is the most used antibody to identify the neoplasm. The authors describe a case of slow growing mass, in the oral mouth floor, the surgical choice treatment and the outcome at follow-up. R.A. female 63 y.o., is admitted in Maxillofacial Surgery Department of University of L’Aquila with a 3 month history of swelling of submucosal layer of the right mouth floor, progressive difficulty to speech and deglutition.A 5x3,5 cm fixed rounded mass, with normal surrounding mucosa is observed on the right mouth floor.No smoke and no alcol abuse, not referred recent trauma or pain at palpation. Negative the neck examination.Laboratory, only the flogosis marker is moved (VES 17mm/h and PCR 13mg/dl).CT and MRI revealed a well circumscribed oval mass in the sublingual space, a thickened wall that strongly enhanced after injection of contrast medium. Preserved the muscular layer, glandular and bony structures.For this, the surgical choice is complete transoral excision, saving the lingual vessels and nerve, submandibular gland, Warthon’s duct and hypoglossal nerve.The post-operative course is regular without complications.At one month follow-up the scar is consolidated not referred dysesthesia, paresthesia or deficit of taste, the motility of tongue is saved.After six month and one year of follow-up on observe total healing of mouth floor, no recurrence of disease is noted, they is also confirmed by new control imaging study.The schwannoma is a rare benign neoplasm; in head neck region is relativity common but the oral localization is unusually.Although rare, the oral floor schwannoma may have clinical aspects similar to other benign lesions like mucocele, fibromas, lipomas, hemangiomas, lymphangioma, leyomioma, epidermoid and dermoid cysts and benign salivary gland tumors.The treatment of choice consists of total surgical lesion removal.The presence of schwannoma calls for the careful search for nerve tumors in other parts of the body.In conclusion the schwannoma represents a lesion not often encountered in clinical practice.The submucosal form of this lesion is indistinguishable from other benign neoplasms more frequent observed in the same region.The final diagnosis should be done after histopathological exam and after immunohistochemical analysis (S-100 antibodies, NSE).The therapeutical conduct is the total removal of the lesion.

Giant Schwannoma of the oral floor.

CUTILLI, Tommaso
2010-01-01

Abstract

Schwannoma (Neurilemmoma) is a benign, slow-growing tumor that originates from the Schwann’s cells of the peripheral nerves. The tumor is usually asymptomatic, do not recur, and malignant transformation is rare. The Schwannoma is usually found in the head and neck (i.e. acoustic neuromas) or in autosomic dominant disorders with mutation of the NF2 gene on chromosome 22 (22q12). It’s instead rare in the oral cavity. When it does occur in this area, the tongue is the most common site, followed by the palate, floor of mouth, buccal mucosa, lips, and jaws. It can present itself at any age. This lesion is not taken into account during clinical practice and the differential diagnosis includes numerous benign neoformations based on epithelial and connective tissues. In the majority of cases, the diagnosis can only be made during surgery and by histological study, however the preoperative tomography and magnetic resonance imaging are very helpful. The Schwannoma showed two different pattern of growth: Antoni A and Antoni B. The Anti-S-100, NSE protein is the most used antibody to identify the neoplasm. The authors describe a case of slow growing mass, in the oral mouth floor, the surgical choice treatment and the outcome at follow-up. R.A. female 63 y.o., is admitted in Maxillofacial Surgery Department of University of L’Aquila with a 3 month history of swelling of submucosal layer of the right mouth floor, progressive difficulty to speech and deglutition.A 5x3,5 cm fixed rounded mass, with normal surrounding mucosa is observed on the right mouth floor.No smoke and no alcol abuse, not referred recent trauma or pain at palpation. Negative the neck examination.Laboratory, only the flogosis marker is moved (VES 17mm/h and PCR 13mg/dl).CT and MRI revealed a well circumscribed oval mass in the sublingual space, a thickened wall that strongly enhanced after injection of contrast medium. Preserved the muscular layer, glandular and bony structures.For this, the surgical choice is complete transoral excision, saving the lingual vessels and nerve, submandibular gland, Warthon’s duct and hypoglossal nerve.The post-operative course is regular without complications.At one month follow-up the scar is consolidated not referred dysesthesia, paresthesia or deficit of taste, the motility of tongue is saved.After six month and one year of follow-up on observe total healing of mouth floor, no recurrence of disease is noted, they is also confirmed by new control imaging study.The schwannoma is a rare benign neoplasm; in head neck region is relativity common but the oral localization is unusually.Although rare, the oral floor schwannoma may have clinical aspects similar to other benign lesions like mucocele, fibromas, lipomas, hemangiomas, lymphangioma, leyomioma, epidermoid and dermoid cysts and benign salivary gland tumors.The treatment of choice consists of total surgical lesion removal.The presence of schwannoma calls for the careful search for nerve tumors in other parts of the body.In conclusion the schwannoma represents a lesion not often encountered in clinical practice.The submucosal form of this lesion is indistinguishable from other benign neoplasms more frequent observed in the same region.The final diagnosis should be done after histopathological exam and after immunohistochemical analysis (S-100 antibodies, NSE).The therapeutical conduct is the total removal of the lesion.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11697/43796
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