BACKGROUND Gastrointestinal schwannomas(GIS)are rare neurogenic tumors arising from Schwann cells in the gastrointestinal tract.Studies on GIS are limited to small case reports or focus on specific tumor sites,undersc...BACKGROUND Gastrointestinal schwannomas(GIS)are rare neurogenic tumors arising from Schwann cells in the gastrointestinal tract.Studies on GIS are limited to small case reports or focus on specific tumor sites,underscoring the diagnostic and thera-peutic challenges they pose.AIM To comprehensively examine the clinical features,pathological characteristics,treatment outcomes,associated comorbidities,and prognosis of GIS.METHODS The study population included patients diagnosed with GIS at the First Affiliated Hospital,Zhejiang University School of Medicine,between June 2007 and April 2024.Data were retrospectively collected and analyzed from medical records,including demographic characteristics,endoscopic and imaging findings,treatment modalities,pathological evaluations,and follow-up information.RESULTS In total,229 patients with GIS were included,with a mean age of 56.00 years and a male-to-female ratio of 1:1.83.The mean tumor size was 2.75 cm,and most(76.9%)were located in the stomach.Additionally,6.6%of the patients had other malig-nant tumors.Preoperative imaging and endoscopy frequently misdiagnosed GIS as gastrointestinal stromal tumors.However,accurate preoperative diagnosis was achieved using endoscopic ultrasound-guided fine-needle aspiration combined with immunohistochemical analysis,in which S100 and SOX-10 markers were mostly positive.Smaller tumors were typically managed with endoscopic resection,while larger lesions were treated with surgical resection.Follow-up results showed that most patients experienced favorable outcomes.CONCLUSION Preoperative diagnosis of GIS via clinical characteristics,endoscopy,and imaging examinations remains challenging but crucial.Endoscopic therapy provides a minimally invasive and effective option for patients.展开更多
Background: Neurilemmoma (Schwannomas) are the most common peripheral nerve tumors and usually do not undergo malignant transformation, except in some atypical cases. Additionally, the imaging appearance of schwannoma...Background: Neurilemmoma (Schwannomas) are the most common peripheral nerve tumors and usually do not undergo malignant transformation, except in some atypical cases. Additionally, the imaging appearance of schwannomas resembles that of neurofibromas, making it difficult to distinguish between the two. Therefore, the clinical diagnosis and treatment of schwannomas may face certain challenges. The management and prognosis of neurilemmomas differ from their malignant counterparts, making correct diagnosis important. Objective: This study evaluates the clinical and histopathological characteristics of 45 cases of neurilemmoma. Methods: This retrospective study involves 45 cases diagnosed with cutaneous neurilemmoma at the Seventh Affiliated Hospital of Sun Yat-sen University between April 2020 and September 2024. All cases were retrieved from medical records. Results: The age range of the 45 patients was 23 to 73 years, with a male to female ratio of 1.6:1. Over half the cases occurred in individuals aged 30 to 59, with most lesions found in the extremities, predominantly in the lower limbs. Disease duration varied from 7 days to 20 years. All tumors were solitary, with diameters ranging from 0.8 cm to 8 cm. Most tumors (33/45, 73.33%) were asymptomatic, though some patients experienced symptoms like pain and numbness. Mass was the most common clinical diagnosis (33/45, 73.33%). Five patients had suspected neurilemmomas prior to surgery. Immunohistochemical staining revealed all positive results for S-100 and SOX-10 markers, while EMA staining showed a negative rate of 93.33%. Most Ki-67 values (19/23, 82.6%) were less than or equal to 5%. Conclusion: The diversity of clinical features, pathological manifestations, and immunohistochemical results of schwannoma poses a challenge to accurate diagnosis. A comprehensive understanding of its clinical and pathological characteristics is essential for accurate diagnosis, and when combined with immunohistochemical analysis, it helps avoid misdiagnosis.展开更多
Objective:To analyze the MRI features and rare manifestations of schwannomas of the extremities to improve diagnosis.Methods:Retrospective analysis of 23 cases of schwannomas in the extremities confirmed by surgical p...Objective:To analyze the MRI features and rare manifestations of schwannomas of the extremities to improve diagnosis.Methods:Retrospective analysis of 23 cases of schwannomas in the extremities confirmed by surgical pathology,summarizing its signs,signal characteristics and MRI enhancement.Results:Among the 23 cases,20 were single lesions,and 3 were multiple lesions,resulting in a total of 28 lesions.The distribution of these lesions included 7 in the thigh,9 in the calves,4 in the armpits,3 in the hips,and 4 each in the upper arms and forearms.Additionally,there was one lesion located in the groin.On T1-weighted imaging(T1WI),the lesions showed iso-intensity or hypo-intensity.On T2-weighted imaging(T2WI),they appeared slightly hyperintense or hyper-intense.Some lesions exhibited multiple small vesicle-like higher signals,cystic changes,and fiber spacing on T2WI.Furthermore,one lesion showed a liquid-liquid plane.The“target sign”was observed in 18 lesions(64.3%)and“neuropathic signs”were present in six lesions(21.4%).Finally,it was noted that on MRI enhancement,the lesions demonstrated uniform or uneven enhancement.The lesions were uniformly or unevenly enhanced on MRI enhancement.Conclusions:The MRI findings of schwannoma in the extremities exhibit specific characteristics.The cystic changes on T2WI also display distinct features.Recognition of rare MRI findings,such as cystic changes,liquid-liquid plane and septum,should be emphasized to enhance the accuracy of pre-diagnosing schwannomas.展开更多
Purpose: To report two quite rare cases of giant schwannomas of the cervical and thoracic spine. Surgical resection is usually the treatment of choice for these neoplasms. Methods: The first patient is a 48-year-old m...Purpose: To report two quite rare cases of giant schwannomas of the cervical and thoracic spine. Surgical resection is usually the treatment of choice for these neoplasms. Methods: The first patient is a 48-year-old male that came to our department, complaining about weakness and paresthesia of both lower extremities and upper left extremity, and a considerably big dorsal palpable lump. MRI and CT scan were used to diagnose giant cervical schwannoma. Because of the intensity of symptoms, he was subjected to surgery. Multidisciplinary resection involving neurosurgical and oncosurgicalteamn was performed for intravertebral and extravertebral approaches. The second patient is a 55-year-old female that came to the hospital complaining about incapacitating pain and dysesthesia involving T6, T7, and T8 dermatomes, with no other deficits. MRI and CT scan were used to diagnose giant thoracic schwannoma. Because of the intensity of the pain, surgery was decided as the treatment of choice. Video assisted thoracoscopic surgery was performed and total resection was achieved, with improvement of the symptoms. Results: Both patients showed complete remission of the symptoms, with no major deficits after surgery. Conclusion: Although infrequent, giant spinal schwannomas may be the cause of visible lumps in the back with radicular symptoms. When asymptomatic, conservative treatment could be viable, but when they present symptoms, surgery offers good results.展开更多
Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the micro- surgical treatment of spinal schwannomas. Methods A total of 22 patients underwent hemi-semi laminectomy for the micros...Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the micro- surgical treatment of spinal schwannomas. Methods A total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We ret- rospectively analyzed the clinical outcomes of these patients. Results Of them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwarmomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symp- toms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred. Conclusion Hemi-semi laminectomy is a safe and effective method for resection of spinal schwan- nomas展开更多
Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract.They are usually misdiagnosed as other submucosal tumors preoperatively.Experience of the imaging features of gastric schwannomas is extrem...Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract.They are usually misdiagnosed as other submucosal tumors preoperatively.Experience of the imaging features of gastric schwannomas is extremely limited.In this report,we summarize the features of a series of endoscopic ultrasound(EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate.We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results.Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity,and a well-demarcated margin.The tumors originated from the fourth layer.Cystic changes and calcification were uncommon.Marginal hypoechoic haloes were observed in two patients.The results described here were different from those of previous studies.In the EUS evaluation,the internal echogenicity of gastric schwannomas was heterogeneous and low,but slightly higher than that of muscularis pro-pria.These features might help us differentiate gastric schwannomas from other submucosal tumors.Further investigation is needed to differentiate these mesenchymal tumors.展开更多
BACKGROUND Schwannoma is a rare benign,encapsulated tumor of the nerve sheath under the tongue,mostly occurring as solitary tumors with classical histological pattern and several common morphological variants.To our k...BACKGROUND Schwannoma is a rare benign,encapsulated tumor of the nerve sheath under the tongue,mostly occurring as solitary tumors with classical histological pattern and several common morphological variants.To our knowledge,multiple schwannomas with pseudoglandular element synchronously occurring under the tongue are rare;we report herein the first such case.CASE SUMMARY A 53-year-old man had first noticed an isolated asymptomatic mass under the tongue,and as the mass grew,the tongue was elevated.Physical examination showed multiple oval neoplasms,and the overlying mucosa was normal.Computed tomography showed three low-density oval neoplasms under the tongue,which were cystic-solid with unclear boundary.The patient has no cutaneous tumors,VIII nerve tumors,or lens opacities and no history of neurofibromatosis 2 or confirmed schwannomatosis in any first-degree relative.Magnetic resonance imaging showed no evidence of vestibular schwannoma.The preoperative diagnosis was mucoepidermoid carcinoma.During hospitalization,all neoplasms were completely excised by surgeons through an intraoral approach under general anesthesia.The diagnosis of the multiple schwannomas with pseudoglandular element was made by histopathology after surgery.At the 15-mo follow-up visit,the patient had no sign of recurrence or development of other peripheral nerve tumors.CONCLUSION Although rare,multiple schwannomas with pseudoglandular element do exist in patients presenting with masses under the tongue.Oral surgeons should be aware of the existence of multiple schwannomas with pseudoglandular element when considering masses under the tongue due to the different prognosis between multiple schwannomas with pseudoglandular element and mucoepidermoid carcinoma.展开更多
Objective To analyze the mutation of NF2 gene (exon 2,4,6 and 13) in schwannomas. Methods The NF2 gene mutation in 36 schwannomas were observed by PCR-SSCP and DNA sequence. The proliferative index of schwannoma was d...Objective To analyze the mutation of NF2 gene (exon 2,4,6 and 13) in schwannomas. Methods The NF2 gene mutation in 36 schwannomas were observed by PCR-SSCP and DNA sequence. The proliferative index of schwannoma was detected by immunohistochemistry. Results We found 13 mutations in 36 schwannomas, including 6 deletion or insertion resulting in a frameshift, 2 nonsense mutations, 2 missense mutations, and 3 alterations affecting acceptor or donor of splicing sites in E4,E6,E13. The proliferative index of schwannomas with mutation were significantly higher than those without mutation(P<0.05). Conclusion NF2 gene mutation is the frequent event in the tumorigenesis of schwannomas, and there is some correlation between the mutation and clinical behavior(tumor proliferation).展开更多
Vestibular schwannomas(VS)are benign tumors of the vestibular nerve.The common first symptoms are hearing loss and tinnitus,followed by imbalance,vertigo,and facial nerve involvement.The subjective symptoms of VS pati...Vestibular schwannomas(VS)are benign tumors of the vestibular nerve.The common first symptoms are hearing loss and tinnitus,followed by imbalance,vertigo,and facial nerve involvement.The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests,which often interfere with clinicians’diagnoses.Thus,the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging(MRI),ignoring the evaluation of vestibular function at the source of pathological lesions.With the development and improvement of vestibular evaluation technology and its wide application in the clinic,modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives,providing an objective basis for the diagnosis and treatment of vestibular diseases.In this report,we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.展开更多
BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach′s plexus or less frequently from Meissner′s plexus.The main dif...BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach′s plexus or less frequently from Meissner′s plexus.The main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors(GISTs),which are classified by their immunohistochemistry.The treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important role.Wedge resection,subtotal or total gastrectomy can be done.In its counterpart,esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2%of all esophageal tumors.The main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor,followed by GIST.The treatment consists on tumoral enucleation or esophagectomy.AIM To review the available literature about gastrointestinal schwannomas;especially lesions from de stomach and esophagus,including diagnosis,treatment,and follow up,as well as,reporting our institutional experience.METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines.The following databases were used for reviewing process:Pub Med,Ovid,MEDLINE,and Scopus.Only English language manuscripts were included.All gastrointestinal schwannomas specifically located in the esophagus and stomach were included.Cases that did not report long-term follow-up were excluded.RESULTS Gastric localization showed a higher prevalence in both,the literature review and our institution:94.95%(n=317)and 83%(n=5)respectively.With a follow-up with disease-free survival greater than 36 mo in most cases:62.01%(n=80)vs66.66%(n=4).In both groups,the median size was>4.1 cm.Surgical treatment is curative in most cases CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal tumors.It has a good prognosis,and most are benign.A disease-free survival of more than 36 mo can be achieved by surgery.展开更多
AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs,...AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs, 15 leiomyomas and 6 schwannomas were examined by immunohistochemistry in this study. RESULTS： VEGF protein was expressed in the cytoplasm of tumor cells, and VEGFRol and 2 were expressed both in the cytoplasm and on the membrane of all tumors. Irnrnunohistochernical staining revealed that 26 GISTs （78.8%）, 9 leiornyornas （60.0%） and 3 schwannornas （50.0%/were positive for VEGF; 24 GISTs （72.7%/, 12 leiornyornas （80.0%） and 4 schwannornas （66.7%） were positive for VEGFR-1; 30 GISTs （90.9%/, 5 leiornyornas （33.3%/and 4 schwannornas （66.7%） were positive for VEGFR-2. VEGFR-2 expression was statistically different between GISTs and leiomyomas （P 〈 0.0001）. However, there was no correlation between the expression of VEGF pathway componenets and the clinical risk categories. CONCLUSION： Our results suggest that the VEGF pathway may play an important role in the differentiation of GISTs, leiomyomas and schwannomas.展开更多
AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the...AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the role of Ets-1 in the growth and differentiation of GISTs. METHODS： Twenty-eight GISTs, nine leiomyomas and six schwannomas were examined by immunohistochemical staining method for Ets-1 in this study. Specimens were selected from surgical pathology archival tissues at Nagasaki University Hospital. RESULTS： Ets-1 protein was expressed in the cytoplasm of cells in all of these tumors. Immunohistochemical staining revealed that 27 GISTs （96.4%）, six leiomyomas （66.7%）, and five schwannomas （83.3%） were positive for Ets-1. Ets-1 expression was statistically different between GISTs and leiomyomas （P〈0.005）. However, there was no correlation between Ets-1 expression and clinical risk categories. CONCLUSION： Ets-1 plays an important role in the growth and differentiation of GISTs, leiomyomas and schwannomas.展开更多
BACKGROUND Schwannoma is a benign,encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system.Typical symptoms are soreness,radiating pain and sensory loss co...BACKGROUND Schwannoma is a benign,encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system.Typical symptoms are soreness,radiating pain and sensory loss combined with a soft tissue mass.AIM To evaluate pre-and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation.METHODS In this single center retrospective study design,all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included.The location of the tumor in the extremities was divided into five groups;forearm,arm,shoulder,thigh and leg including foot.The locations of the tumor in the nerves were also categorized as either;proximal,distal,minor or major nerve.During the pre-and postoperative clinical evaluation,symptoms were classified as paresthesia,local pain,radiating pain,swelling,impairment of mobility/strength and asymptomatic tumors that were found incidentally(with magnetic resonance imaging).The patients were evaluated after surgery using the following categories:Asymptomatic or symptomatic patients(radiating and/or local pain)and those with complications.The follow up period was from the time of surgery until last examination of the particular physician.Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up.RESULTS We identified 858 cases from the institutional pathology register.We excluded cases with duplicate diagnoses(n=407),pathology not including schwannomas(n=157),lesions involving the torso,spine and neck(n=150)leaving 144 patients for further analysis.In this group 99 patients underwent surgery and there were five complications recorded:2 infections(treated with antibiotics)and 3 nerve palsies(2 involving the radial nerve and one involving the median nerve)that recovered spontaneously.At the end of follow-up,1.4 mo(range 0.5-76)postoperatively,we recorded a post-operative decrease in clinical symptoms:Local pain 76%(6/25),radiating pain 97%(2/45),swelling 20%(8/10).Symptoms of paresthesia increased by 2.8%(37/36)and there was no change in motor weakness before and after surgery 1%(1/1).Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves(odds ratio:2.63;confidence intervals:1.22-6.42,P=0.029).One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor.No local recurrences were reported.CONCLUSION Surgery of schwannomas can be conducted with low risk of postoperative complications,acceptable decrease in clinical symptoms and risk of malignant transformation is low.展开更多
Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical...Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Touré Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23 - 62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resec-tion was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all cases. Postoperative complications developed in two patients, including one with cerebrospinal fluid leakage and other one with wound infection. In the short-term follow-up period, most of the patients (90.9%) appeared to be improved in comparison with their preoperative neurological status. There was no operative mortality. Conclusion: In this study, the clinical manifestations and surgical results of 11 cases of spinal schwannoma have been reviewed. Early diagnosis and appropriate treatment are essential for good outcome.展开更多
Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several...Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several signs and symptoms which can suggest the facial nerve as the origin of the tumor. Intratemporal FNS can be multiple, like "beads on a string", or solitary lesions of the internal auditory canal. This variable tumormorphology necessitates multiple treatment options to allow patients the best chance of preservation of facial nerve function. Historically FNS were managed with resection of the nerve with cable grafting. However this leaves the patient with permanent facial weakness and asymmetry. Currently most patients find this outcome unacceptable, especially when they present with good to normal facial nerve function. Facial paralysis has a significantly negative impact on quality life, so treatment regimens that spare facial nerve function have been used in patients who present with moderate to good facial nerve function. Nerve sparing options include tumor debulking, decompression of the bony facial canal, radiosurgery, and observation. The choice of management depends on the degree of facial nerve dysfunction at presentation, hearing status in the affected ear, medical comorbidities and patient preference. Each treatment option will be discussed in detail and suggestions for patient management will be presented.展开更多
Background: Vestibular schwannomas exerting brainstem compression with or without hydrocephalus are challenging for neurosurgeons regarding the plan of surgery, operative risk and postoperative sequale. Purpose: To re...Background: Vestibular schwannomas exerting brainstem compression with or without hydrocephalus are challenging for neurosurgeons regarding the plan of surgery, operative risk and postoperative sequale. Purpose: To report our experience with the surgical challenges and outcomes for Hannover type T4a & T4b vestibular schwannomas. Methods: Retrospective case study conducted at neurosurgery department, Mansoura University between October 2016 and May 2019 of 16 patients with vestibular schwannoma compressing the brainstem. We reviewed their clinical, radiological, surgical data, incidence of complications and outcome. Results: We had 16 patients: 10 of Hanover grade T4b and 6 of grade T4a. Gross total resection was achieved in 2 cases while subtotal resection was achieved in 5 cases and in the remaining 9 cases;only partial resection was feasible. We had 4 cases of mortality. Among new onset morbidity after surgery, 3 cases had post-operative bulbar manifestation and 4 cases had brainstem dysfunction. Conclusion: Vestibular schwannomas compressing the brain stem are challenging in their clinical presentation, surgery and post-operative outcome. The outcome of patients treated with hydrocephalus prior to vestibular schwannoma surgery is better than those who did initial VS surgery. Patients presented with significant brainstem, bulbar manifestation had worse outcome and needed longer ICU stay and longer time for recovery.展开更多
We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid tr...We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.展开更多
Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Sc...Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Schwannomas are uncommon within the upper extremity, and they are exceedingly rare within the hand and wrist [1]. We describe a case of an 80-year-old female presented with a soft tissue mass within her right thumb. She underwent excisional biopsy of the mass, and pathology showed features consistent with schwannoma. She had resolution of her symptoms thereafter. We discuss the differential diagnosis for soft-tissue tumors in this location. When assessing patients with soft tissue tumors of the hand and wrist, it is important for the treating provider to maintain a broad differential diagnosis in order to facilitate appropriate management of these lesions.展开更多
BACKGROUND Rectal schwannoma(RS)is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity.The absence of typical symptoms,specific signs,and distinctive radiographic findings oft...BACKGROUND Rectal schwannoma(RS)is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity.The absence of typical symptoms,specific signs,and distinctive radiographic findings often hinders clinicians from reaching a definitive diagnosis before surgical intervention.Herein,we report a case of RS who underwent complete resection through endoscopic full-thickness resection(EFTR)and discuss the clinical,imaging,and pathological features for differential diagnosis.CASE SUMMARY A 71-year-old Chinese woman presented to our outpatient clinic with a 4-year history of a rectal mucosal mass for a follow-up surveillance colonoscopy.A neurogenic tumor with extraluminal growth was considered based on the imaging findings.Resection was required,and an EFTR was performed.On endoscopic exploration,a smooth surface extruding mass was identified at the rectum.The patient was discharged 48 hours after the operation without infection or bleeding.Based on the pathological and immunohistochemical findings of the resected mass,a rectal benign schwannoma was diagnosed.The patient did not undergo any adjuvant therapy.Nearly one year later,a follow-up surveillance colonoscopy and an abdominal and pelvic plain plus enhancement scan were performed,and no tumor recurrence or metastasis was noted.CONCLUSION EFTR is safe and effective for resecting gastrointestinal stromal tumors,especially those with extraluminal growth and no lymph node involvement.展开更多
BACKGROUND Gastric schwannoma(GS)is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter.However,these two types differ significantly in pathology and biological behavior.AIM T...BACKGROUND Gastric schwannoma(GS)is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter.However,these two types differ significantly in pathology and biological behavior.AIM To evaluate the computed tomography characteristics of GS and provide insights into its accurate diagnosis.METHODS Twenty-three cases of GS confirmed between January 2011 and December 2023 were assessed clinically and radiologically.Imaging characteristics,including tumor location,size,contour,ulceration,growth pattern,enhancement degree and pattern,cystic change,calcification,and perigastric lymph nodes(PLNs),were reviewed by two experienced radiologists.RESULTS Our sample included 18 females and 5 males,with a median age of 54.7 years.A total of 39.1%of cases were asymptomatic.GSs appeared as oval and well-defined submucosal tumors,with exophytic(43.5%)or mixed(endoluminal+exophytic;43.5%)growth patterns.The tumors were primarily located in the gastric body(78.3%).Ulcerations were observed in 8 cases(34.5%),and PLNs were observed in 15 cases(65%).The average degree of enhancement was 48.3 Hounsfield units.Twenty cases(87%)showed peak enhancement in the delayed phase.Most GSs were homogeneous,while cystic change(13.0%)and calcification(17.4%)were rare.CONCLUSION GS predominantly showed gradual homogenous enhancement with peak enhancement in the delayed phase.PLNs around GS are helpful in differentiating GS from other gastric submucosal tumors.展开更多
文摘BACKGROUND Gastrointestinal schwannomas(GIS)are rare neurogenic tumors arising from Schwann cells in the gastrointestinal tract.Studies on GIS are limited to small case reports or focus on specific tumor sites,underscoring the diagnostic and thera-peutic challenges they pose.AIM To comprehensively examine the clinical features,pathological characteristics,treatment outcomes,associated comorbidities,and prognosis of GIS.METHODS The study population included patients diagnosed with GIS at the First Affiliated Hospital,Zhejiang University School of Medicine,between June 2007 and April 2024.Data were retrospectively collected and analyzed from medical records,including demographic characteristics,endoscopic and imaging findings,treatment modalities,pathological evaluations,and follow-up information.RESULTS In total,229 patients with GIS were included,with a mean age of 56.00 years and a male-to-female ratio of 1:1.83.The mean tumor size was 2.75 cm,and most(76.9%)were located in the stomach.Additionally,6.6%of the patients had other malig-nant tumors.Preoperative imaging and endoscopy frequently misdiagnosed GIS as gastrointestinal stromal tumors.However,accurate preoperative diagnosis was achieved using endoscopic ultrasound-guided fine-needle aspiration combined with immunohistochemical analysis,in which S100 and SOX-10 markers were mostly positive.Smaller tumors were typically managed with endoscopic resection,while larger lesions were treated with surgical resection.Follow-up results showed that most patients experienced favorable outcomes.CONCLUSION Preoperative diagnosis of GIS via clinical characteristics,endoscopy,and imaging examinations remains challenging but crucial.Endoscopic therapy provides a minimally invasive and effective option for patients.
文摘Background: Neurilemmoma (Schwannomas) are the most common peripheral nerve tumors and usually do not undergo malignant transformation, except in some atypical cases. Additionally, the imaging appearance of schwannomas resembles that of neurofibromas, making it difficult to distinguish between the two. Therefore, the clinical diagnosis and treatment of schwannomas may face certain challenges. The management and prognosis of neurilemmomas differ from their malignant counterparts, making correct diagnosis important. Objective: This study evaluates the clinical and histopathological characteristics of 45 cases of neurilemmoma. Methods: This retrospective study involves 45 cases diagnosed with cutaneous neurilemmoma at the Seventh Affiliated Hospital of Sun Yat-sen University between April 2020 and September 2024. All cases were retrieved from medical records. Results: The age range of the 45 patients was 23 to 73 years, with a male to female ratio of 1.6:1. Over half the cases occurred in individuals aged 30 to 59, with most lesions found in the extremities, predominantly in the lower limbs. Disease duration varied from 7 days to 20 years. All tumors were solitary, with diameters ranging from 0.8 cm to 8 cm. Most tumors (33/45, 73.33%) were asymptomatic, though some patients experienced symptoms like pain and numbness. Mass was the most common clinical diagnosis (33/45, 73.33%). Five patients had suspected neurilemmomas prior to surgery. Immunohistochemical staining revealed all positive results for S-100 and SOX-10 markers, while EMA staining showed a negative rate of 93.33%. Most Ki-67 values (19/23, 82.6%) were less than or equal to 5%. Conclusion: The diversity of clinical features, pathological manifestations, and immunohistochemical results of schwannoma poses a challenge to accurate diagnosis. A comprehensive understanding of its clinical and pathological characteristics is essential for accurate diagnosis, and when combined with immunohistochemical analysis, it helps avoid misdiagnosis.
文摘Objective:To analyze the MRI features and rare manifestations of schwannomas of the extremities to improve diagnosis.Methods:Retrospective analysis of 23 cases of schwannomas in the extremities confirmed by surgical pathology,summarizing its signs,signal characteristics and MRI enhancement.Results:Among the 23 cases,20 were single lesions,and 3 were multiple lesions,resulting in a total of 28 lesions.The distribution of these lesions included 7 in the thigh,9 in the calves,4 in the armpits,3 in the hips,and 4 each in the upper arms and forearms.Additionally,there was one lesion located in the groin.On T1-weighted imaging(T1WI),the lesions showed iso-intensity or hypo-intensity.On T2-weighted imaging(T2WI),they appeared slightly hyperintense or hyper-intense.Some lesions exhibited multiple small vesicle-like higher signals,cystic changes,and fiber spacing on T2WI.Furthermore,one lesion showed a liquid-liquid plane.The“target sign”was observed in 18 lesions(64.3%)and“neuropathic signs”were present in six lesions(21.4%).Finally,it was noted that on MRI enhancement,the lesions demonstrated uniform or uneven enhancement.The lesions were uniformly or unevenly enhanced on MRI enhancement.Conclusions:The MRI findings of schwannoma in the extremities exhibit specific characteristics.The cystic changes on T2WI also display distinct features.Recognition of rare MRI findings,such as cystic changes,liquid-liquid plane and septum,should be emphasized to enhance the accuracy of pre-diagnosing schwannomas.
文摘Purpose: To report two quite rare cases of giant schwannomas of the cervical and thoracic spine. Surgical resection is usually the treatment of choice for these neoplasms. Methods: The first patient is a 48-year-old male that came to our department, complaining about weakness and paresthesia of both lower extremities and upper left extremity, and a considerably big dorsal palpable lump. MRI and CT scan were used to diagnose giant cervical schwannoma. Because of the intensity of symptoms, he was subjected to surgery. Multidisciplinary resection involving neurosurgical and oncosurgicalteamn was performed for intravertebral and extravertebral approaches. The second patient is a 55-year-old female that came to the hospital complaining about incapacitating pain and dysesthesia involving T6, T7, and T8 dermatomes, with no other deficits. MRI and CT scan were used to diagnose giant thoracic schwannoma. Because of the intensity of the pain, surgery was decided as the treatment of choice. Video assisted thoracoscopic surgery was performed and total resection was achieved, with improvement of the symptoms. Results: Both patients showed complete remission of the symptoms, with no major deficits after surgery. Conclusion: Although infrequent, giant spinal schwannomas may be the cause of visible lumps in the back with radicular symptoms. When asymptomatic, conservative treatment could be viable, but when they present symptoms, surgery offers good results.
文摘Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the micro- surgical treatment of spinal schwannomas. Methods A total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We ret- rospectively analyzed the clinical outcomes of these patients. Results Of them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwarmomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symp- toms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred. Conclusion Hemi-semi laminectomy is a safe and effective method for resection of spinal schwan- nomas
文摘Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract.They are usually misdiagnosed as other submucosal tumors preoperatively.Experience of the imaging features of gastric schwannomas is extremely limited.In this report,we summarize the features of a series of endoscopic ultrasound(EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate.We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results.Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity,and a well-demarcated margin.The tumors originated from the fourth layer.Cystic changes and calcification were uncommon.Marginal hypoechoic haloes were observed in two patients.The results described here were different from those of previous studies.In the EUS evaluation,the internal echogenicity of gastric schwannomas was heterogeneous and low,but slightly higher than that of muscularis pro-pria.These features might help us differentiate gastric schwannomas from other submucosal tumors.Further investigation is needed to differentiate these mesenchymal tumors.
基金Supported by Basic Clinical Fund Project of The Fist Hospital of Lanzhou University,No.ldyyyn2015-04.
文摘BACKGROUND Schwannoma is a rare benign,encapsulated tumor of the nerve sheath under the tongue,mostly occurring as solitary tumors with classical histological pattern and several common morphological variants.To our knowledge,multiple schwannomas with pseudoglandular element synchronously occurring under the tongue are rare;we report herein the first such case.CASE SUMMARY A 53-year-old man had first noticed an isolated asymptomatic mass under the tongue,and as the mass grew,the tongue was elevated.Physical examination showed multiple oval neoplasms,and the overlying mucosa was normal.Computed tomography showed three low-density oval neoplasms under the tongue,which were cystic-solid with unclear boundary.The patient has no cutaneous tumors,VIII nerve tumors,or lens opacities and no history of neurofibromatosis 2 or confirmed schwannomatosis in any first-degree relative.Magnetic resonance imaging showed no evidence of vestibular schwannoma.The preoperative diagnosis was mucoepidermoid carcinoma.During hospitalization,all neoplasms were completely excised by surgeons through an intraoral approach under general anesthesia.The diagnosis of the multiple schwannomas with pseudoglandular element was made by histopathology after surgery.At the 15-mo follow-up visit,the patient had no sign of recurrence or development of other peripheral nerve tumors.CONCLUSION Although rare,multiple schwannomas with pseudoglandular element do exist in patients presenting with masses under the tongue.Oral surgeons should be aware of the existence of multiple schwannomas with pseudoglandular element when considering masses under the tongue due to the different prognosis between multiple schwannomas with pseudoglandular element and mucoepidermoid carcinoma.
文摘Objective To analyze the mutation of NF2 gene (exon 2,4,6 and 13) in schwannomas. Methods The NF2 gene mutation in 36 schwannomas were observed by PCR-SSCP and DNA sequence. The proliferative index of schwannoma was detected by immunohistochemistry. Results We found 13 mutations in 36 schwannomas, including 6 deletion or insertion resulting in a frameshift, 2 nonsense mutations, 2 missense mutations, and 3 alterations affecting acceptor or donor of splicing sites in E4,E6,E13. The proliferative index of schwannomas with mutation were significantly higher than those without mutation(P<0.05). Conclusion NF2 gene mutation is the frequent event in the tumorigenesis of schwannomas, and there is some correlation between the mutation and clinical behavior(tumor proliferation).
文摘Vestibular schwannomas(VS)are benign tumors of the vestibular nerve.The common first symptoms are hearing loss and tinnitus,followed by imbalance,vertigo,and facial nerve involvement.The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests,which often interfere with clinicians’diagnoses.Thus,the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging(MRI),ignoring the evaluation of vestibular function at the source of pathological lesions.With the development and improvement of vestibular evaluation technology and its wide application in the clinic,modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives,providing an objective basis for the diagnosis and treatment of vestibular diseases.In this report,we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.
文摘BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach′s plexus or less frequently from Meissner′s plexus.The main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors(GISTs),which are classified by their immunohistochemistry.The treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important role.Wedge resection,subtotal or total gastrectomy can be done.In its counterpart,esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2%of all esophageal tumors.The main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor,followed by GIST.The treatment consists on tumoral enucleation or esophagectomy.AIM To review the available literature about gastrointestinal schwannomas;especially lesions from de stomach and esophagus,including diagnosis,treatment,and follow up,as well as,reporting our institutional experience.METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines.The following databases were used for reviewing process:Pub Med,Ovid,MEDLINE,and Scopus.Only English language manuscripts were included.All gastrointestinal schwannomas specifically located in the esophagus and stomach were included.Cases that did not report long-term follow-up were excluded.RESULTS Gastric localization showed a higher prevalence in both,the literature review and our institution:94.95%(n=317)and 83%(n=5)respectively.With a follow-up with disease-free survival greater than 36 mo in most cases:62.01%(n=80)vs66.66%(n=4).In both groups,the median size was>4.1 cm.Surgical treatment is curative in most cases CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal tumors.It has a good prognosis,and most are benign.A disease-free survival of more than 36 mo can be achieved by surgery.
文摘AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs, 15 leiomyomas and 6 schwannomas were examined by immunohistochemistry in this study. RESULTS： VEGF protein was expressed in the cytoplasm of tumor cells, and VEGFRol and 2 were expressed both in the cytoplasm and on the membrane of all tumors. Irnrnunohistochernical staining revealed that 26 GISTs （78.8%）, 9 leiornyornas （60.0%） and 3 schwannornas （50.0%/were positive for VEGF; 24 GISTs （72.7%/, 12 leiornyornas （80.0%） and 4 schwannornas （66.7%） were positive for VEGFR-1; 30 GISTs （90.9%/, 5 leiornyornas （33.3%/and 4 schwannornas （66.7%） were positive for VEGFR-2. VEGFR-2 expression was statistically different between GISTs and leiomyomas （P 〈 0.0001）. However, there was no correlation between the expression of VEGF pathway componenets and the clinical risk categories. CONCLUSION： Our results suggest that the VEGF pathway may play an important role in the differentiation of GISTs, leiomyomas and schwannomas.
文摘AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the role of Ets-1 in the growth and differentiation of GISTs. METHODS： Twenty-eight GISTs, nine leiomyomas and six schwannomas were examined by immunohistochemical staining method for Ets-1 in this study. Specimens were selected from surgical pathology archival tissues at Nagasaki University Hospital. RESULTS： Ets-1 protein was expressed in the cytoplasm of cells in all of these tumors. Immunohistochemical staining revealed that 27 GISTs （96.4%）, six leiomyomas （66.7%）, and five schwannomas （83.3%） were positive for Ets-1. Ets-1 expression was statistically different between GISTs and leiomyomas （P〈0.005）. However, there was no correlation between Ets-1 expression and clinical risk categories. CONCLUSION： Ets-1 plays an important role in the growth and differentiation of GISTs, leiomyomas and schwannomas.
文摘BACKGROUND Schwannoma is a benign,encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system.Typical symptoms are soreness,radiating pain and sensory loss combined with a soft tissue mass.AIM To evaluate pre-and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation.METHODS In this single center retrospective study design,all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included.The location of the tumor in the extremities was divided into five groups;forearm,arm,shoulder,thigh and leg including foot.The locations of the tumor in the nerves were also categorized as either;proximal,distal,minor or major nerve.During the pre-and postoperative clinical evaluation,symptoms were classified as paresthesia,local pain,radiating pain,swelling,impairment of mobility/strength and asymptomatic tumors that were found incidentally(with magnetic resonance imaging).The patients were evaluated after surgery using the following categories:Asymptomatic or symptomatic patients(radiating and/or local pain)and those with complications.The follow up period was from the time of surgery until last examination of the particular physician.Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up.RESULTS We identified 858 cases from the institutional pathology register.We excluded cases with duplicate diagnoses(n=407),pathology not including schwannomas(n=157),lesions involving the torso,spine and neck(n=150)leaving 144 patients for further analysis.In this group 99 patients underwent surgery and there were five complications recorded:2 infections(treated with antibiotics)and 3 nerve palsies(2 involving the radial nerve and one involving the median nerve)that recovered spontaneously.At the end of follow-up,1.4 mo(range 0.5-76)postoperatively,we recorded a post-operative decrease in clinical symptoms:Local pain 76%(6/25),radiating pain 97%(2/45),swelling 20%(8/10).Symptoms of paresthesia increased by 2.8%(37/36)and there was no change in motor weakness before and after surgery 1%(1/1).Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves(odds ratio:2.63;confidence intervals:1.22-6.42,P=0.029).One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor.No local recurrences were reported.CONCLUSION Surgery of schwannomas can be conducted with low risk of postoperative complications,acceptable decrease in clinical symptoms and risk of malignant transformation is low.
文摘Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Touré Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23 - 62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resec-tion was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all cases. Postoperative complications developed in two patients, including one with cerebrospinal fluid leakage and other one with wound infection. In the short-term follow-up period, most of the patients (90.9%) appeared to be improved in comparison with their preoperative neurological status. There was no operative mortality. Conclusion: In this study, the clinical manifestations and surgical results of 11 cases of spinal schwannoma have been reviewed. Early diagnosis and appropriate treatment are essential for good outcome.
文摘Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several signs and symptoms which can suggest the facial nerve as the origin of the tumor. Intratemporal FNS can be multiple, like "beads on a string", or solitary lesions of the internal auditory canal. This variable tumormorphology necessitates multiple treatment options to allow patients the best chance of preservation of facial nerve function. Historically FNS were managed with resection of the nerve with cable grafting. However this leaves the patient with permanent facial weakness and asymmetry. Currently most patients find this outcome unacceptable, especially when they present with good to normal facial nerve function. Facial paralysis has a significantly negative impact on quality life, so treatment regimens that spare facial nerve function have been used in patients who present with moderate to good facial nerve function. Nerve sparing options include tumor debulking, decompression of the bony facial canal, radiosurgery, and observation. The choice of management depends on the degree of facial nerve dysfunction at presentation, hearing status in the affected ear, medical comorbidities and patient preference. Each treatment option will be discussed in detail and suggestions for patient management will be presented.
文摘Background: Vestibular schwannomas exerting brainstem compression with or without hydrocephalus are challenging for neurosurgeons regarding the plan of surgery, operative risk and postoperative sequale. Purpose: To report our experience with the surgical challenges and outcomes for Hannover type T4a & T4b vestibular schwannomas. Methods: Retrospective case study conducted at neurosurgery department, Mansoura University between October 2016 and May 2019 of 16 patients with vestibular schwannoma compressing the brainstem. We reviewed their clinical, radiological, surgical data, incidence of complications and outcome. Results: We had 16 patients: 10 of Hanover grade T4b and 6 of grade T4a. Gross total resection was achieved in 2 cases while subtotal resection was achieved in 5 cases and in the remaining 9 cases;only partial resection was feasible. We had 4 cases of mortality. Among new onset morbidity after surgery, 3 cases had post-operative bulbar manifestation and 4 cases had brainstem dysfunction. Conclusion: Vestibular schwannomas compressing the brain stem are challenging in their clinical presentation, surgery and post-operative outcome. The outcome of patients treated with hydrocephalus prior to vestibular schwannoma surgery is better than those who did initial VS surgery. Patients presented with significant brainstem, bulbar manifestation had worse outcome and needed longer ICU stay and longer time for recovery.
文摘We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.
文摘Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Schwannomas are uncommon within the upper extremity, and they are exceedingly rare within the hand and wrist [1]. We describe a case of an 80-year-old female presented with a soft tissue mass within her right thumb. She underwent excisional biopsy of the mass, and pathology showed features consistent with schwannoma. She had resolution of her symptoms thereafter. We discuss the differential diagnosis for soft-tissue tumors in this location. When assessing patients with soft tissue tumors of the hand and wrist, it is important for the treating provider to maintain a broad differential diagnosis in order to facilitate appropriate management of these lesions.
基金Supported by Chengdu Key Technology Innovation R&D Projects(In the Field of Population Health)in the 2023,No.2022-YF05-02120-SN.
文摘BACKGROUND Rectal schwannoma(RS)is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity.The absence of typical symptoms,specific signs,and distinctive radiographic findings often hinders clinicians from reaching a definitive diagnosis before surgical intervention.Herein,we report a case of RS who underwent complete resection through endoscopic full-thickness resection(EFTR)and discuss the clinical,imaging,and pathological features for differential diagnosis.CASE SUMMARY A 71-year-old Chinese woman presented to our outpatient clinic with a 4-year history of a rectal mucosal mass for a follow-up surveillance colonoscopy.A neurogenic tumor with extraluminal growth was considered based on the imaging findings.Resection was required,and an EFTR was performed.On endoscopic exploration,a smooth surface extruding mass was identified at the rectum.The patient was discharged 48 hours after the operation without infection or bleeding.Based on the pathological and immunohistochemical findings of the resected mass,a rectal benign schwannoma was diagnosed.The patient did not undergo any adjuvant therapy.Nearly one year later,a follow-up surveillance colonoscopy and an abdominal and pelvic plain plus enhancement scan were performed,and no tumor recurrence or metastasis was noted.CONCLUSION EFTR is safe and effective for resecting gastrointestinal stromal tumors,especially those with extraluminal growth and no lymph node involvement.
基金Supported by the National Natural Science Foundation of China,No.82101985.
文摘BACKGROUND Gastric schwannoma(GS)is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter.However,these two types differ significantly in pathology and biological behavior.AIM To evaluate the computed tomography characteristics of GS and provide insights into its accurate diagnosis.METHODS Twenty-three cases of GS confirmed between January 2011 and December 2023 were assessed clinically and radiologically.Imaging characteristics,including tumor location,size,contour,ulceration,growth pattern,enhancement degree and pattern,cystic change,calcification,and perigastric lymph nodes(PLNs),were reviewed by two experienced radiologists.RESULTS Our sample included 18 females and 5 males,with a median age of 54.7 years.A total of 39.1%of cases were asymptomatic.GSs appeared as oval and well-defined submucosal tumors,with exophytic(43.5%)or mixed(endoluminal+exophytic;43.5%)growth patterns.The tumors were primarily located in the gastric body(78.3%).Ulcerations were observed in 8 cases(34.5%),and PLNs were observed in 15 cases(65%).The average degree of enhancement was 48.3 Hounsfield units.Twenty cases(87%)showed peak enhancement in the delayed phase.Most GSs were homogeneous,while cystic change(13.0%)and calcification(17.4%)were rare.CONCLUSION GS predominantly showed gradual homogenous enhancement with peak enhancement in the delayed phase.PLNs around GS are helpful in differentiating GS from other gastric submucosal tumors.
