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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 34  |  Issue : 3  |  Page : 372-374

Schwannoma in the Buccal Mucosa-An Unusual Presentation


1 Department of Oral Medicine and Radiology, KVG Dental College and Hospital, Sullia DK, Karnataka, India
2 Department of Oral Medicine and Radiology, Amrita School of Dentistry (Amrita Vishwavidyapeetham), AIMS Health Care Campus, Edappily, Kochi, Kerala, India
3 Department of Oral Medicine and Radiology, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India

Date of Submission03-Jul-2021
Date of Decision20-Jul-2022
Date of Acceptance22-Jul-2022
Date of Web Publication26-Sep-2022

Correspondence Address:
Krishna S Kumar
Department of Oral Medicine and Radiology, Amrita School of Dentistry (Amrita Vishwavidyapeetham), AIMS Health Care Campus, Amrita Nagar, Edappily, Kochi, Kerala - 682 041
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_184_21

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   Abstract 


Intraoral schwannomas are rare benign neural neoplasm that originates from the Schwann cells of the peripheral nerves and present as asymptomatic, solitary, slow-growing, submucosal mass and their occurrence is seen in the second-third decade of life. The most favored intraoral sites are the tongue, palate, buccal mucosa, floor of the mouth, gingiva, and lips. Histopathological examination with immunohistochemistry is the gold standard for the diagnosis. As malignant transformation and recurrence rate is rare, surgical excision is the preferred treatment. This article provides an insight into a rare case of schwannoma of the buccal mucosa with a review of the literature.

Keywords: Buccal mucosa, intraoral, schwannoma


How to cite this article:
Anekar J, Kumar KS, Baipadavu J, Supriya H, John IE. Schwannoma in the Buccal Mucosa-An Unusual Presentation. J Indian Acad Oral Med Radiol 2022;34:372-4

How to cite this URL:
Anekar J, Kumar KS, Baipadavu J, Supriya H, John IE. Schwannoma in the Buccal Mucosa-An Unusual Presentation. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 Dec 1];34:372-4. Available from: http://www.jiaomr.in/text.asp?2022/34/3/372/356954




   Introduction Top


Schwannoma is a rare benign tumor that originates from the Schwann cells of the neural sheath which has a predilection to arise from the sensory nerves and is commonly seen associated with a nerve trunk.[1],[2] The underlying etiology is unknown but trauma and radiation exposure are considered to be etiological factors.[3] They are relatively common in the head and neck area, but rare intraorally.[2] As it is difficult to establish a clinical tentative diagnosis histopathological examination and immunohistochemistry (IHC) are essential for a definitive diagnosis. Surgical excision is the treatment of choice and it has a good prognosis.[4]


   Case Report Top


Clinical description

A 54-year-old female reported to Oral Medicine and Radiology department with the complaint of a swelling in the inner right cheek for six months without any associated symptoms. On the right buccal mucosa, a well-defined swelling of size 1.5 cm diameter was palpable which was roughly oval in shape, firm in consistency, non-tender, non-compressible, non-reducible, and mobile.

Diagnostic assessment

Benign/malignant salivary gland tumor, lipoma, and intraoral haemangioma were considered differential diagnoses. An ultrasound (US) examination revealed a well-defined hypoechoic lesion. Fine needle aspiration cytology (FNAC) suspected a benign cystic lesion.

Therapeutic intervention

An Excisional Biopsy was carried out under local anesthesia [Figure 1]a and [Figure 1]b. Histopathological examination revealed a capsulated lesion consisting of irregularly arranged spindle-shaped cells in the Antoni B pattern and cells with spindle-shaped nuclei arranged in a palisading pattern suggestive of Antoni A areas. Nerve bundle is appreciated in the fibrous capsule. A few areas showed cystic degeneration with hemorrhage. Chronic inflammatory cells were seen [Figure 2]. An IHC examination was carried out which revealed diffuse positivity for S 100 protein [Figure 3]. A final diagnosis of Neurilemmoma of right buccal mucosa was arrived at.
Figure 1: (a) Intra operative view of surgical excision under local anaesthesia. (b) Excised specimen

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Figure 2: Histopathological examination revealing fascicles of cells in palisaded and whorling pattern suggestive of Antoni A cells (white arrow) and eosinophilic areas suggestive of verocay bodies (black arrow)

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Figure 3: Immunohistochemistry examination revealing diffuse positivity to S 100 protein

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Outcome and follow up

The patient review was done after a week of surgery, wound healing was satisfactory. Further follow-up was done at 1st and 3 months. No recurrence was observed [[Table 1]-Timeline of the case].
Table 1: Timeline of events in this case

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   Discussion Top


Schwannoma was first described by Verocay in 1910. Masson introduced the term schwannoma in 1932. Stout in 1935 used the term Neurilemmoma and explained its histopathological features.[1],[2] Generally, it is asymptomatic but may cause pain and paraesthesia due to nerve involvement.[5] Clinical appearance in the present case was similar to the reported literature as a solitary slow-growing submucosal nodular lesion.[6] In this case, a clinical tentative diagnosis of schwannoma was difficult to establish as the patient did not present with a medical or family history of neural lesions.[3] Oral mucosal lesions appearing as smooth submucosal swelling were considered as differential diagnosis. As schwannoma is indistinguishable from these lesions clinically, histopathological examination was essential.

FNAC is usually inconclusive in similar cases.[2] Imaging for schwannomas includes US, magnetic resonance imaging, and computed tomography.[7] In US examination, it presents as a lesion with well-defined border and homogenous echotexture similar to the present case.[8] The tumor is usually encapsulated and two types of cell arrangements are seen, Antoni type A and B. Antoni type A is made of closely packed Schwann cells arranged in bundles or rows with elongated palisaded nuclei. They are arranged around a central eosinophilic area known as verocay bodies. Antoni type B consists of a smaller number of irregularly arranged cells.[1],[2] Degenerative changes may be seen in chronic cases which include cystic changes, nuclear atypia, fibrosis, and hemorrhagic phenomenon.[2],[6]

Other similar lesions are ruled out by IHC. Schwannoma demonstrates an immensely positive reaction to S 100 protein demonstrating its affinity for Schwann cells. Excision with preservation of nerve of origin, if possible is the treatment of choice.[9] Recurrence and malignant transformation are rare.[2]


   Conclusion Top


Schwannoma even though a rare tumor in the oral cavity, should be included in the differential diagnosis of swellings of oral mucosa. Surgical excision is the treatment of choice and recurrence is rare.

Declaration of patient consent

Patient consent was obtained to use the relevant clinical details and images for the scientific publication purpose without revealing the identity

Key messages

Schwannomas of the oral cavity are extremely rare as they comprise only 1% of tumors of the head and neck region. Along with clinical and histopathological examination, immunohistochemistry is very essential to arrive at a conclusive diagnosis and for effective management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lambade PN, Palve D, Lambade D. Schwannoma of the cheek: Clinical case and literature review. J Maxillofac Oral Surg 2015;14:327-31.  Back to cited text no. 1
    
2.
Dokania V, Rajguru A, Mayashankar V, Mukherjee I, Jaipuria B, Shere D. Palatal schwannoma: An analysis of 45 literature reports and of an illustrative case. Int Arch Otorhinolaryngol 2019;23:e360-70.  Back to cited text no. 2
    
3.
Hwang K, Kim SG, Ahn SI, Lee SI. Neurilemmoma of the tongue. J Craniofac Surg 2005;16:859-61.  Back to cited text no. 3
    
4.
Sanchis JM, Navarro CM, Bagán JV, Onofre MA, Murillo J, De-Andrade CR, et al. Intraoral schwannomas: Presentation of a series of 12 cases. J Clin Exp Dent 2013;5:e192-6.  Back to cited text no. 4
    
5.
Martins MD, Anunciato de Jesus L, Fernandes KPS, Bussadori SK, Taghloubi SA, Martins MAT. Intra-oral schwannoma: Case report and literature review. Indian J Dent Res 2009;20:121-5.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Cohen M, Wang MB. Schwannoma of the tongue: Two case reports and review of the literature. Eur Arch Otorhinolaryngol 2009;266:1823-9.  Back to cited text no. 6
    
7.
Rathore AS, Srivastava D, Narwal N, Shetty DC. Neurilemmoma of retromolar region in the oral cavity. Case Rep Dent 2015;2015:320830.  Back to cited text no. 7
    
8.
Sugawara C, Takahashi A, Kawano F, Kudo Y, Ishimaru N, Miyamoto Y. Intraoral ultrasonography of tongue mass lesions. Dentomaxillofac Radiol 2016;45:20150362.  Back to cited text no. 8
    
9.
Aswath N, Manigandan T, Sankari SL, Yogesh L. A rare case of palatal schwannoma with literature review. J Oral Maxillofac Pathol 2019;23(Suppl 1):36-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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