Massive Neurilemoma of the Hard Plate in Which Preoperative Diagnosis Was Difficult

Abstract

The patient was an 84-year-old man who was referred to our hospital in mid-December 2012 for a close examination of a mass arising from the left side of the hard palate that was found by a local dentist. The initial examination revealed the presence of a 3.0-cm elastic soft, dome-shaped mass in the left hard palate. CE-CT showed a lesion of size 1.8 × 1.4 cm in the right hard palate, which extended upward and invaded the nasal cavity. The mass was a solid tumor associated with resorption of surrounding bone and expansion of the greater palatine canal. CE-MRI indicated that the mass extended upward and invaded the nasal cavity, and the mass showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and an irregular margin with internal enhancement. Abnormal uptake of FDG on PET-CT (SUVmax = 5.2) was observed in the left hard palate. The biopsy site lesion rapidly increased in size and biopsy was performed again in January 2013 due to suspicion of a malignant tumor. The histopathological diagnosis was a suspected malignant neurogenic tumor. Therefore, the patient underwent partial maxillectomy and a split-thickness skin graft in late February 2013. No recurrence was noted 29 months after the operation.

Palatal Schwannoma: An Analysis of 45 Literature Reports and of an Illustrative Case

“…Clinically, most of the lesions were reported as nontender and/or firm/hard. Tenderness was elicited only twice 21 37 , while soft swelling on palpation was reported in four cases 18 38 43 44 . Jones et al reported a cystic component in the lesion.…”

“…15 16 33 37 38 51 The lesion was seen eroding into the right maxillary sinus through the floor of the sinus in one case; 15 while in another patient, the mass was seen invading the nasal cavity through the palatal bone. 38 Orthopantomogramand maxillary occlusal radiography showed mostly a radiolucent lesion, without any bony alteration or periapical changes. In MRI exams, the mass appeared hypo-to-isointense on T1-weighted images and hyperintense on T2-weighted images, in almost all of the cases.…”

“…From the included articles, clinical, histopathological, radiological, and treatment findings were charted ( Tables 1 and 2 ). 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54…”

“…The mean duration of the lesion from 38 reported cases was of 25.63 months (range: 5days–20 years), while in the remaining 8 cases no information about the duration of the tumor could be retrieved (either the exact numerical duration was not stated, or the lesion was incidentally detected). 10 17 33 38 39 44 46 47 Some articles reported the duration of onset in days, weeks or years. Therefore, the approximate lesional age was converted and charted into months.…”

“…With the exception of two cases, all of the lesions were treated with simple surgical removal, either with enucleation, with wide local excision with a good margin, or with a complete resection without incorporating a wide margin. The remaining two cases were treated by partial maxillectomy, 38 and by en bloc resection. 12 The defect was either closed primarily or was allowed to heal by secondary intention.…”