Abstract
Schwannomas are rare, benign neoplasms that can arise from any cranial, peripheral, or autonomic nerve that contains Schwann cells. Approximately 25% to 45% of all schwannomas occur in the head and neck. They occur most commonly in the eighth cranial nerve, but it has been reported that 20% to 58% arise in the oral cavity, with approximately 10% of these located on the hard palate. We report a case of schwannoma of the hard palate, present important pathologic considerations for diagnosis, and provide a review of the literature regarding extracranial schwannomas.
1
Introduction
Schwannomas are infrequent, benign neoplasms that can arise from any cranial, peripheral, or autonomic nerve that contains Schwann cells. Most head and neck schwannomas present as a solitary, slowly enlarging, nontender, encapsulated mass. Approximately 25% to 45% of schwannomas occur in the head and neck . It has been reported that between 20% and 58% arise in the oral cavity, with approximately 10% of these located on the hard palate . Most present in the second and third decades of life . The most common intraoral sites are the tongue, followed by the palate, the floor of the mouth, the buccal mucosa, the gingiva, the lips, and the vestibular mucosa . We report a case of schwannoma of the hard palate, present important pathologic considerations for diagnosis, and provide a review of the literature regarding extracranial schwannomas.
2
Case report
A 33-year-old otherwise healthy white male presented with a 3-month history of a progressively enlarging broad-based mass located in the midline of his hard palate. There was no history of trauma, bleeding, or discomfort from the lesion. He denied odynophagia, dysphagia, and dyspnea. Family history and review of systems were noncontributory.
Physical examination revealed a 2 × 2-cm pedunculated, nontender, nonfriable firm palatal mass ( Fig. 1 ). The remainder of the physical examination was unremarkable. A contrasted computed tomography of the head and neck demonstrated a 2.5-cm soft tissue density centered to the left of midline and posterior to the junction of the hard and soft palate. A shave biopsy revealed a variably cellular proliferation of spindled cells with foci of nuclear palisading. Immunohistochemical staining was positive for S-100 protein and vimentin.
A wide local excision of the mass was performed, and free margins were obtained. On gross examination, the resected tumor consisted of a well-circumscribed 2.0 × 1.0 × 2.0-cm yellow and tan soft tissue mass. The cut surface showed tan, and nodular tissue with no necrosis. On microscopic examination, low-power magnification showed an encapsulated tumor composed of alternating hypercellular and hypocellular elements. Higher magnification demonstrated hypocellular areas adjacent to hypercellular compact rows of spindled cells with well-aligned nuclei arranged in palisading whorls surrounded by eosinophilic cytoplasm ( Fig. 2 ).
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