Case Reports in Surgery

Case Reports in Surgery / 2020 / Article

Case Report | Open Access

Volume 2020 |Article ID 7942062 | https://doi.org/10.1155/2020/7942062

Mohd. Yusuf Haider, Manjur Rahim, N. M. K. Bashar, Md. Zakir Hossain, Sk Md Jaynul Islam, "Schwannoma of the Base of the Tongue: A Case Report of a Rare Disease and Review of Literatures", Case Reports in Surgery, vol. 2020, Article ID 7942062, 9 pages, 2020. https://doi.org/10.1155/2020/7942062

Schwannoma of the Base of the Tongue: A Case Report of a Rare Disease and Review of Literatures

Academic Editor: Christophoros Foroulis
Received02 Jan 2020
Accepted30 Nov 2020
Published31 Dec 2020

Abstract

Background. Schwannoma is a benign nerve sheath tumor. It was first identified by Virchow in 1908. These tumors can emerge from any nerve covered with a Schwann cell sheath, including the cranial nerves (with the exception of the optic and olfactory nerves), the spinal nerves, and the autonomous nervous system (Harada H, Omura K and Maeda A, 2001). Case Presentation. A 28-year-old male farmer presented with a swelling at the right side of the base of tongue extending into the oral tongue. It was identified incidentally by his newly married wife while he was yawning. It was asymptomatic. The patient had no difficulty in chewing, swallowing, or phonation and also no sensory or taste abnormalities. The tongue movements were normal. Conclusions. Diagnosis of schwannoma should be considered for a smooth, painless, firm swelling in the tongue. A schwannoma of the tongue may grow large enough before producing any symptom. Around 25–40% of schwannoma happen within the head and neck region, and among these, 1-12% occurs in the oral cavity, most regularly the tongue or mouth floor. Schwannoma of the tongue does not show any age or sex predisposition. It usually presents as a painless lump in the tongue, but when it grows larger than 3.0 cm, it may produce dysphagia, pain, or discomfort and change in the quality of voice. Here, we report a case of large () asymptomatic schwannoma of the tongue in a 28-year-old male patient and review the literature available during the last 61 years.

1. Introduction

Schwannoma is a benign nerve sheath tumor. It was first identified by Virchow in 1908. These tumors can emerge from any nerve covered with a Schwann cell sheath, including the cranial nerves (with the exception of the optic and olfactory nerves), the spinal nerves, and the autonomous nervous system [1]. When the nerve of origin is small, it can be difficult to demonstrate its connection with a given tumor. On the other hand, if the site of origin is a larger nerve, it is observed that the nerve fibers are splayed over the outer side of the capsule instead of being absorbed into the tumor mass [2]. About 25–45% of all schwannomas occur in the head and neck [3]. Around 1–12% of these occur intraorally [4, 5] with the tongue being the most common site [5, 6]. Although there are many case reports of tongue schwannomas in the literature, after Hatziotis et al. [6], there has been no comprehensive review of the literature. We present a case of tongue schwannoma and study the literature available from the last 61 years (1959–2019).

2. Materials and Methods

A PubMed search for the terms “tongue schwannoma,” “lingual schwannoma,” “tongue neurilemmoma,” and “lingual neurilemmoma” was conducted with the 1959–2019 date range. The search was restricted to English case reports. Unless the ventral tongue was also involved, mouth floor schwannomas were not included. All the case reports had confirmed the masses’ identity as schwannomas histologically. From the case reports for data analysis, the following elements were extracted: age, gender, location of schwannoma (anterior one-third vs. posterior two-thirds of tongue), symptoms, tumor size, and treatment modality.

3. Case Report

A 28-year-old male farmer presented with a swelling at the right side of the base of tongue extending into the oral tongue. It was identified incidentally by his newly married wife while he was yawning. It was asymptomatic. The patient had no difficulty in chewing, swallowing, or phonation and also no sensory or taste abnormalities. The tongue movements were normal.

On examination, there was an oval swelling at the right side of base of the tongue measuring about (Figure 1). The surface was smooth, margin regular, and no discoloration or distortion of tongue epithelium. It was nontender, farm in consistency, and was not fixed with underlying or overlying structures. The remaining oral cavity examination was normal; nasopharyngolaryngoscopy revealed no abnormality in the adjacent areas. There was no cervical lymph node enlargement. Clinically, it appeared like a dermoid cyst or lipoma. MRI of the tongue manifested hyperintense well-circumscribed soft tissue mass in the right half of the base of the tongue on T1/T2-weighted image (Figure 2). It was evaluated with FNAC which revealed benign mesenchymal spindle cell neoplasm, suggestive of nerve sheath tumor with possibility of schwannoma (Figure 3). The patient underwent transoral total excision of the mass under general anesthesia with nasotracheal intubation. For the proper visualization of the base of tongue, frenulum of tongue was incised; tongue was released from floor of mouth and pulled out. An incision was given in right lateral margin over the swelling. After splitting the mucosa, mass is exposed, mobilized by blunt dissection, and excised totally (Figures 46). Haemostasis was ensured, and wound closed in layers. Histopathological report revealed features of schwannoma (Figure 7). For confirmation of the tissue of origin, immunocytochemistry was done and found strongly positive for S100 protein. There was no symptom or sign of recurrence in 12 months postoperative follow-up (Figure 8).

4. Discussion

Though this is not clear of the etiology of the schwannoma, it is known to be derived from nerve sheath Schwann cells, which surround cranial, peripheral, and autonomic nerves [6, 7]. The head and neck are rather common location of this neoplasm. Intraoral schwannoma mainly arise from the ongue, followed by the palate, mouth floor, buccal mucosa, gingiva, lip, and vestibule [8, 9], though the tongue is most commonly involved [10]. The lesion is slow growing, and thus, its onset is usually long before presentation. Lingual schwannoma shows no age or gender predisposition [11]. Usually, it presents as a painless lump in any part of the tongue. The average size at presentation was 2.4 cm. However, when the mass exceeds 3.0 cm, dysphagia, pain (or discomfort), dysphonia, and voice changes are usually present (Table 1).


AuthorYearGenderAgeSize (cm)SitePresentationSurgical approach

Mercantini and Mopper [13]1959M221AnteriorIntermittent painTransoral
Cameron [14]1959M251.5AnteriorLumpTransoral
Chadwick [15]1964F202.2PosteriorLumpTransoral
Craig [16]1964F83PosteriorLumpTransoral
Pantazopoulos [17]1965F454.5PosteriorDysphasia/change in voiceTransoral
Chamber [18]1965M295PosteriorThroat discomfortTransoral
Fifer et al. [19]1966F283AnteriorLumpTransoral
Hatziotis and Aspride [20]1967M25HazelnutPosteriorLumpTransoral
Oles and Werthemier [21]1967M521AnteriorLumpTransoral
Paliwal et al. [22]1967M322.5AnteriorLumpTransoral
Crawford et al. [23]1968M230.5AnteriorLumpTransoral
1968M241AnteriorLumpTransoral
Das Gupta et al. [24]1969F215PosteriorPainTransoral
Bitici [25]1969M402.5AnteriorSlight discomfortTransoral
Sinha and Samuel [26]1971M231.5PosteriorDysphagiaTransoral
Mosadomi [27]1975M193AnteriorPainful massTransoral
Swangsilpa et al. [28]1976M263AnteriorLumpTransoral
Sharan and Akhtar [29]1978F301.5AnteriorChange in voiceTransoral
Akimoto et al. [30]1987M151AnteriorLumpTransoral
Sira et al. [31]1988F183PosteriorLumpTransoral
Flickinger et al. [32]1989F283AnteriorLumpTransoral
Talmi et al. [33]1991F751PosteriorLumpTransoral
Gallesio and Berrone [34]1992F211.9Anterior/baseDysphonia/paresthesia/chewing difficultyTransoral
Lopez and Ballistin [10]1993M240.6AnteriorLumpTransoral
Haring [35]1994F492AnteriorLumpTransoral
Nakayama et al. [36]1996F405.5AnteriorLumpTransoral
Dreher et al. [37]1997F313BaseDysphagiaTransoral
Spandow et al. [38]1999M377.9PosteriorThroat discomfortTransoral
de Bree et al. [2]2000F245Posterolateral/baseLumpSubmandibular
Pfeifle et al. [39]2001F300.3AnteriorLumpTransoral
Cinar et al. [40]2004M71AnteriorLumpTransoral
Bassichis and McMlay [41]2004M92.3Posterior/baseSnoringTransoral
Nakasato et al. [42]2005F92Posterolateral/baseBleeding/ulcerationTransoral
Hwang et al. [43]2005M232.8AnteriorLumpTransoral
Lopez-Jornet and Bermejo-Fenoll [44]2005M390.8Posterolateral/baseLumpTransoral
Vafiadis et al. [45]2005M183.1AnteriorLumpTransoral
Bansal et al. [46]2005M264Posterolateral/ventralParesthesia/dysphoniaTransoral
Hsu et al. [7]2006M205Posterior/baseBleedingTransoral
Ying et al. [47]2006F264Posterior/baseDysphagia/otalgiaTransoral
Enoz et al. [48]2006M72.5Anterior/baseDysphagia/painTransoral
Mehrzad et al. [49]2006M492.2Posterior/ventralPainCO2-transoral
Batra et al. [50]2007M303Posterolateral/baseDysphagia, dyspnea, abscessTransoral
Ballesteros et al. [51]2007F312BasePainCO2-transoral
Sawhney et al. [52]2008F374.6Posterolateral/baseDysphagia/snoringSubmandibular
Sethi et al. [53]2008F281Anterolateral/ventralLumpTransoral
Pereira et al. [54]2008M121.5Posterolateral/ventralLump
Cohen and Wang [55]2009M770.7Posterolateral/ventralLumpTransoral
Gupta et al. [56]2009F181Anterior/ventralLumpTransoral
Mardanpour and Rahbar [57]2009M182PosteriorDysphagia/change of voiceTransoral
Karaca et al. [58]2010F132Posterolateral/ventralDysphagiaTransoral
Cigdem et al. [59]2010M132Anterior/ventralLumpTransoral
Jeffcoat et al. [60]2010M681.5LateralLumpTransoral
Naidu and Sinha [61]2010M122Anterolateral/baseParesthesia/bleeding/ulcerationTransoral
Lukšić et al. [62]2011M101.5Posterolateral/ventralLumpTransoral
Batra et al. [63]2011F384.2Posterior/ventralDysphagia/change of voiceTransoral
Nisa et al. [64]2011F388.5Posterolateral/ventralDysphagia/dysphonia/dyspneaTransoral
Monga et al. [65]2013M202Posterolateral/baseLumpTransoral
Lira et al. [5]2013F262.5Posterior/ventralCervical painTransoral
Erkul et al. [66]2013M213Posterolateral/ventralChewing difficultyTransoral
Jayaraman et al. [67]2013F253AnterolateLumpTransoral
George et al. [4]2014M264Posterolateral/baseDysphagia/dysphoniaTransoral
Bhola et al. [11]2014F141.5Anterolateral/ventralLumpTransoral
Moreno-Garcíaet al. [68]2014F132Anterior/ventralLumpLipsplit/mandibulotomy
Nibhoria et al. [69]2015F181.5Posterolateral/ventralLumpTransoral
Gopalakrishnanetal. [70]2016M323Posterolateral/ventralDysphagiaTransoral
Sharma and Rai [71]2016F204Posterolateral/ventralDysphagia/dysphoniaTransoral
Kavčič and Božič [72]2016F201.3Anterolateral/ventral/tipLumpTransoral
Lee et al. [73]2016M284Posterior/ventralLumpTransoral
Zain et al. [12]2016F24Not clearPosteriorLumpTransoral
Steffi Sharmaetal.2018F204PosteriorLumpTransoral
Current2019M284PosteriorLumpTransoral

In the literature review of 61-year period (from 1959 to 2019), 68 cases schwannoma of the tongue were found, and 54% of them are male, and the rest of them are female. More than half of the cases were posterior tongue schwannomas (56%). According to this review, the patients had feeling of lump cases, respectively.

The mean age at diagnosis was nearly 25 years. Transoral excision was performed in 96% cases. However, for two cases, carbon dioxide laser was used for the tongue-base schwannoma, and in three cases, submandibular approach was used. There was no report of recurrence.

Clinically, the schwannomas may be indistinguishable from other encapsulated benign tumors, because biopsy and histological examination are essential to formulate a correct diagnosis. An excisional biopsy was performed to formulate a correct diagnosis and finally find out that the case was uncomplicated. Imaging has become an integral part of evaluation for tongue base lesions, and thus, a systematic imaging approach should be considered. As demonstrated in Fig. 9, lesions of the tongue can be divided into infectious, neoplastic, and congenital categories. An infectious process, such as an abscess, appears hyperintense on T2WI with a thick rimenhancing margin [12]. The present case was totally asymptomatic before surgery, and there was no major complication of surgery. The option of complete resection was chosen on the basis of the size of the lesion and the age of the patient.

5. Conclusions

Diagnosis of schwannoma should be considered for a smooth, painless, firm swelling in the tongue. A schwannoma of the tongue may grow large enough before producing any symptom. Total excision is the treatment of choice particularly in a young patient as it continues to grow. Most of the cases can be completely excised transorally. Total surgical excision of the lesion does not result in any recurrence.

Conflicts of Interest

The authors declare that there is no conflict of interests regarding the publication of this paper.

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Copyright © 2020 Mohd. Yusuf Haider et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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