Submandibular neurilemmoma; a diagnostic dilemma

Abstract

Neurilemmomas are slow growing, benign neoplasms of neural crest Schwann cell origin. They arise from any peripheral, spinal or cranial nerve except the olfactory and optic. Presentation is usually asymptomatic but focal neurological signs and symptoms may be associated with nerve compression. With approximately one third of all documented cases presenting in the head and neck region, we report a case of a submandibular neurilemmoma misdiagnosed pre-operatively. The diagnostic difficulties are discussed and the current literature reviewed. This case highlights the importance of inclusion of nerve sheath tumours in differential diagnoses of soft tissue lesions in the head and neck.

Giant intraosseous schwannoma of scapula: a rare case report and review of the literature

“…Sometimes, the imaging appears features of benign tumor, the histological features also show the morphology of schwannoma, so both the imaging and histology show benign tumor features [12]. However, although with advanced imaging techniques even with fine needle biopsy, sometimes schwannoma still will be misdiagnosed pre-operatively [13]. Because of the rarity of these intraosseous schwannoma, it is important that the diagnosis is made pre-operatively by the pathologist examining the needle biopsies and the radiologist interpreting the scans.…”

Schwannoma causing resorption of zygomatic arch

“…Almeyda et al . [37] reported a case of submandibular schwannoma (3.5 cm × 2 cm × 2 cm) misdiagnosed preoperatively. The differential diagnosis of adenolymphoma (Warthin’s tumor) was based on the clinical examination, ultrasound and two fine needle aspirations.…”

Schwannoma with secondary erosion of mandible: case report with a review of the literature

“…Based on operative findings, the mass was thought to be a tumor derived from the lingual nerve. Almeyda et al 37 reported a case of submandibular schwannoma (3.5 x 2 x 2 cm) misdiagnosed pre-operatively. The differential diagnosis of adenolymphoma (Warthin's tumor) was based on the clinical examination, US and two fine needle aspirations.…”

“…Even with advances in imaging, the diagnostic dilemma remains. 37 MRI has been of greater use, with a distinctive target pattern demonstrated by most, but not all schwannomas. 38 In the case presented by Asaumi et al 39 the US, CT, and MRI appearance of schwannoma of the upper lip (3.8 x 1.8 x 1.4 cm) correlated well with the histologic features.…”

“…The nerve of origin is often not identified at the time of surgical excision, although 8 if presented it is displaced to the side by the expanding tumour. 37 Arda et al 45 presented a schwannoma arising from the parasympathetic fibers of the lingual nerve. They found only a few nerve fibers, which were thought to be the parasympathetic nerve of the sublingual gland, attached to the tumor.…”