CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2019; 23(03): e360-e370
DOI: 10.1055/s-0039-1692635
Systematic Review
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

1   Department of Ear, Nose, and Throat, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
,
Anagha Rajguru
1   Department of Ear, Nose, and Throat, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
,
Vishwakarma Mayashankar
2   Department of Ear, Nose, and Throat, HBT Medical College and Dr RN Cooper Municipal General Hospital, Juhu, Mumbai, Maharashtra, India
,
Indranil Mukherjee
3   Department of Ear, Nose, and Throat, Gouri Devi Institute of Medical Sciences and Hospital, Rajbandh, Durgapur, West Bengal, India
,
Bhagyashree Jaipuria
4   Department of Ear, Nose, and Throat, Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai, Maharashtra, India
,
Devika Shere
5   Department of Ear, Nose, and Throat, Rajiv Gandhi Medical College, Thane, Maharashtra, India
› Author Affiliations
Further Information

Publication History

22 March 2019

13 April 2019

Publication Date:
26 July 2019 (online)

Abstract

Introduction Schwannomas are benign tumors originating from differentiated Schwann cells. Being the least common intraoral neoplasm of neural origin, it is rarely seen in the palate. The literature lacks an extensive review of intraoral schwannoma confined to the palate.

Objective To review previously reported cases of palatal schwannoma along with an illustrative case, and to provide a better insight regarding clinicopathological and radiological features of this neural tumor in a rare intraoral site.

Data Synthesis We present a case of palatal schwannoma in a 16-year-old female. An additional 45 cases were identified in 2 medical database searches (PubMed and Google Scholar) published from the year 1985 onwards, and from 13 countries, in the 5 continents. The ages of the patients ranged from 3 to 84 years old. Palatal schwannoma showed a slight predilection to females, with a male/female ratio of ∼ 1:1.81. Hard palate involvement is almost twice greater than soft palate involvement. Surgical excision was employed in almost all of the cases, and recurrence was reported only once.

Conclusion Palatal schwannomas, although rare, have been reported both over the hard and the soft palate. They mostly present as a painless, firm, well-encapsulated, slow-growing solitary lesion over the lateral palatal aspect.

Imaging can add to suspicion and can delineate a differential diagnosis, but the diagnosis is confirmed by pathological examination. Fine-needle aspiration cytology (FNAC) is almost always inconclusive. Immunohistochemistry can assist in confirming a diagnosis, but is more important to rule out close differentials. Complete surgical excision is the treatment of choice, and recurrence or malignant transformation are extremely rare.

 
  • References

  • 1 Shah AA, Latoo S, Ahmad I, Malik AH, Singh AP, Hassan S. Schwannoma causing resorption of zygomatic arch. J Oral Maxillofac Pathol 2011; 15 (01) 80-84
  • 2 Pfeifle R, Baur DA, Paulino A, Helman J. Schwannoma of the tongue: report of 2 cases. J Oral Maxillofac Surg 2001; 59 (07) 802-804
  • 3 Colreavy MP, Lacy PD, Hughes J. , et al. Head and neck schwannomas--a 10 year review. J Laryngol Otol 2000; 114 (02) 119-124
  • 4 Verocay J. Zur Kenntnis der Neurofibrome. Beitr Pathol Anat 1910; 156: 1-68
  • 5 Masson P. Experimental and Spontaneous Schwannomas (Peripheral Gliomas): I. Experimental Schwannomas. Am J Pathol 1932; 8 (04) 367-388 .1, 1
  • 6 Tarlov IM. Origin of perineural fibroblastoma. Am J Pathol 1940; 16 (01) 33-40 , 7
  • 7 Buric N, Jovanovic G, Pesic Z. , et al. Mandible schwannoma (neurilemmoma) presenting as periapical lesion. Dentomaxillofac Radiol 2009; 38 (03) 178-181
  • 8 Subhashraj K, Balanand S, Pajaniammalle S. Ancient schwannoma arising from mental nerve. A case report and review. Med Oral Patol Oral Cir Bucal 2009; 14 (01) E12-E14
  • 9 Jahanshahi G, Haghighat A, Azmoodeh F. Intraosseous neurilemmoma of the mandible: report of a rare ancient type. Dent Res J (Isfahan) 2011; 8 (03) 150-153
  • 10 Yamashita N, Kameyama T, Takenaka M. , et al. Schwannoma of the soft palate: Report of a case. Jpn J Oral Maxillofac Surg. 1985; 31 (10) 2467-2470
  • 11 Jones JA, McWilliam LJ. Intraoral neurilemmoma (schwannoma): an unusual palatal swelling. Oral Surg Oral Med Oral Pathol 1987; 63 (03) 351-353
  • 12 Hieda T, Okina T, Wakae H. , et al. A case of neurilemoma of the palate. Kurume Med J 1987; 34 (02) 75-81
  • 13 Krolls SO, McGinnis Jr JP, Quon D. Multinodular versus plexiform neurilemoma of the hard palate. Report of a case. Oral Surg Oral Med Oral Pathol 1994; 77 (02) 154-157
  • 14 Amir R, Altman KW, Zaheer S. Neurilemmoma of the hard palate. J Oral Maxillofac Surg 2002; 60 (09) 1069-1071
  • 15 Rabbels J, Scheer M, Heibel H, Wickenhauser C, Kübler AC. [Neurinoma of the hard palate in an 11-year-old girl. Case report]. Mund Kiefer Gesichtschir 2005; 9 (06) 400-403
  • 16 López-Carriches C, Baca-Pérez-Bryan R, Montalvo-Montero S. Schwannoma located in the palate: clinical case and literature review. Med Oral Patol Oral Cir Bucal 2009; 14 (09) e465-e468
  • 17 Baliga M, Uppal N, Ramanathan A. Schwannomas of the head and neck: a case series. J Maxillofac Oral Surg 2009; 8 (03) 283-286
  • 18 Murthy VA, Ramaswamy S, Sunita M. Schwannoma of the hard palate. Indian J Otolaryngol Head Neck Surg 2009; 61 (Suppl. 01) 52-54
  • 19 Lollar KW, Pollak N, Liess BD, Miick R, Zitsch III RP. Schwannoma of the hard palate. Am J Otolaryngol 2010; 31 (02) 139-140
  • 20 Parikh NR, Desai N. Intraoral schwannoma (neurilemmoma): an unusual anterior palatal swelling-A case report. J Int Oral Health 2010; 2 (04) 87-91
  • 21 Isildak H, Yilmaz M, Ibrahimov M, Aslan M, Karaman E, Enver O. Schwannoma of the hard palate. J Craniofac Surg 2010; 21 (01) 276-278
  • 22 Santos PP, Freitas VS, Pinto LP, Freitas RA, de Souza LB. Clinicopathologic analysis of 7 cases of oral schwannoma and review of the literature. Ann Diagn Pathol 2010; 14 (04) 235-239
  • 23 Chawla O, North S, Yates JM. Schwannoma presenting in the soft palate of a nine-year-old boy. Dent Update 2011; 38 (05) 327-328
  • 24 dos Santos JN, Silva Gurgel CA, Gonçalves Ramos EA, Pereira Júnior FB, Crusoé-Rebello IM, Campos Oliveira M. Plexiform schwannoma mimicking a salivary gland tumor: an unusual case report in pediatric patient. Int J Pediatr Otorhi. 2011; 6: 317-321
  • 25 Dhupar A, Yadav S, Dhupar V. . Schwannoma of the hard palate: A Rare Case. The Internet J Head Neck Surg [1937–819X]. 2010 ; 4:[about 4p.]. Available from: http://archive.ispub.com:80/journal/the-internet-journal-of-head-and-neck-surgery/volume-4-number-2/schwannoma-of-the-hard-palate-a-rare-case.html
  • 26 Handschel J, Heikaus S, Depprich R. , et al. Intraoral schwannoma: review of the literature and presentation of a rare case. Cranio 2012; 30 (02) 150-153
  • 27 Shetty SR, Mishra C, Shetty P, Kaur A, Babu S. Palatal schwannoma in an elderly woman. Gerodontology 2012; 29 (02) e1133-e1135
  • 28 Prasanna Kumar D, Meghashri K. Schwannoma of the hard palate: a case report and review of literature. J Adv Oral Research. 2012; 3: 24-29
  • 29 Kapetanakis S, Vasileiadis I, Petousis A, Fiska A, Stavrianaki A. Plexiform (multinodular) schwannoma of soft palate. Report of a case. Folia Med (Plovdiv) 2012; 54 (03) 62-64
  • 30 Rahpeyma A, Jafarian AH, Khajeh Ahmadi S, Sarabadani J. A schwannoma of the soft palate in a child: histological and immunohistochemical features and surgical method. Iran J Otorhinolaryngol 2012; 24 (67) 95-99
  • 31 Venkatachala S, Krishnakumar R, Rubby SA. Soft palate schwannoma. Indian J Surg 2013; 75 (Suppl. 01) 319-321
  • 32 Gainza-Cirauqui ML, Eguía-Del Valle A, Martínez-Conde R, Coca-Meneses JC, Aguirre-Urizar JM. Ancient Schwannoma of the hard palate. An uncommon case report and review. J Clin Exp Dent 2013; 5 (01) e62-e65
  • 33 Chikhale NP, Mishra A, Patel RD, Chaturvedi UP, Jayalakshmi V, Cherian S. Neurilemmoma of the hard palate: report of a case and review of literature. Int J Head Neck Surg 2013; 4: 123-125
  • 34 Moradzadeh Khiavi M, Taghavi Zenouz A, Mesgarzadeh AH, Sabetmehr O, Mahmoudi SM, Kouhsoltani M. Schwannoma in the midline of hard palate: a case report and review of literature. J Dent Res Dent Clin Dent Prospect 2014; 8 (02) 114-117
  • 35 Aboh IV, Chisci G, Cascino F. , et al. Giant palatal schwannoma. J Craniofac Surg 2014; 25 (05) e418e20
  • 36 Parhar S, Singh HP, Nayyar A, Manchanda AS. Intra-oral schwannoma- a case report. J Clin Diagn Res 2014; 8 (03) 264-265
  • 37 Sahoo PK, Mandal PK, Ghosh S. Schwannoma of the hard palate. Natl J Maxillofac Surg 2014; 5 (01) 39-41
  • 38 Kudoh M, Harada H, Matsumoto K, Sato Y, Omura K, Ishii Y. Massive Neurilemoma of the Hard Plate in Which Preoperative Diagnosis Was Difficult. Case Rep Surg 2015; 2015: 638025
  • 39 Meundi MA, Anekar J, , A C R, Patil US, Mustafa SM. Intraosseous schwannoma of the maxilla mimicking a periapical lesion: a diagnostic challenge. J Clin Diagn Res 2015; 9 (03) ZD01-ZD04
  • 40 Tibbetts KM, Cheng J. Pediatric palate schwannoma. Int J Pediatr Otorhinolaryngol Extra 2014; 9: 122-124
  • 41 Yaga US, Mengji AK, Besta R, Gollamudi N. Rare case of palatal schwannoma: Case report and review of literature. J Indian Acad Oral Med Radiol. 2015; 27: 484-487
  • 42 Karataş M, Sarıkaya Y, Doğan S, Erdoğdu İH, Bulut HT, Yücetaş SC. A Slow Growing Mass of Hard Palate: Schwannoma-Case Report. J Clin Med Case Reports. 2015; 2 (01) 1-4
  • 43 Morgan GK, Packiaraj I, Rajan A, Rahman A. Rare case of schwannoma in anterior palate. J Indian Acad Dent Spec Res. 2015; 2: 30-33
  • 44 Sicca C, Cistaro A, Quartuccio N, Sardo E, Berrone M. Correlation of MRI Pattern and Histological Features in a Schwannoma of the Soft Palate in a 13-Year-Old Girl. OMICS J Radiol 2015; 4 (01) 177
  • 45 Barhmi I, Tazi N, Mahdoufi R, Abada R, Rouadi S. Schwannoma palate in children: rare case. J Case Rep Stud. 2016; 4: 202
  • 46 Shi LL, Justicz N, Panella NJ, Henriquez OA. Soft Palate Schwannoma: A Rare Case of an Intraoral Mass. Ann. Clin Case Rep 2016; 1: 1057
  • 47 Eroglu CN, Keskin Tunc S, Gunhan O. Soft Tissue Schwannomas of the Hard Palate and the Mandibular Mentum. Case Rep Dent 2017; 2017: 7401631
  • 48 Poonja PA, Sattur AP, Burde KN, Hallikeri K, Anehosur VS. An unusual case of neural palatal swelling. Int J Health Sci (Qassim) 2017; 11 (03) 71-73
  • 49 Vera-Sirera B, Fernades-Ciacha L, Floria LM, Vera-Sempere F. Palatal ancient schwannoma: optical, immunohistochemical and ultrastructural study with literature review. Eur Arch Otorhinolaryngol 2017; 274 (12) 4195-4202
  • 50 Gueiros LA, Barkokebas A, Carvalho AT, Leão JC. Small palatal swelling: an uncommon presentation of intraoral schwannoma. Gen Dent 2017; 65 (03) 58-61
  • 51 Melo CA, Almeida-Júnior P, de Carvalho Melo AU. , et al. Giant schwannoma of the hard palate: a literature review and report of an uncommon case. Gen Dent 2018; 66 (01) 62-65
  • 52 Khalele BA. Schwannoma of the hard palate: A case report and a systematic review of literature. Future Dental Journal 2018; 1-6
  • 53 Murakami N, Fukuya Y. Surgically excising an intraoral schwannoma of the soft palate using a buccinator flap: A case report. Int J Surg Case Rep 2018; 49: 17-20
  • 54 Kawakami R, Kaneko T, Kadoya M. , et al. Schwannoma in the sublingual space. Dentomaxillofac Radiol 2004; 33 (04) 259-261
  • 55 Leu YS, Chang KC. Extracranial head and neck schwannomas: a review of 8 years experience. Acta Otolaryngol 2002; 122 (04) 435-437
  • 56 Williams HK, Cannell H, Silvester K, Williams DM. Neurilemmoma of the head and neck. Br J Oral Maxillofac Surg 1993; 31 (01) 32-35
  • 57 Lucas RB. Pathology of tumors of the oral tissue. New York, NY: Churchill Livingstone; 1984
  • 58 Hatziotia JC, Asprides H. Neurilemoma (schwannoma) or the oral cavity. Oral Surg Oral Med Oral Pathol 1967; 24 (04) 510-526
  • 59 Enzinger IM, Weiss SW. Soft Tissue Tumours. 3rd ed. St Louis, MO: Mosby; 1995: 821-850
  • 60 de Lacerda SA, Brentegani LG, Rosa AL, Vespúcio MVO, Salata LA. Intraosseous schwannoma of mandibular symphysis: case report. Braz Dent J 2006; 17 (03) 255-258
  • 61 Hribernik SJ, Gould AR, Alpert B, Jones JL. Well-circumscribed mass of the lateral floor of the mouth. J Oral Maxillofac Surg 1992; 50 (07) 741-746
  • 62 Erlandson RA. Peripheral nerve sheath tumors. Ultrastruct Pathol 1985; 9 (1-2): 113-122
  • 63 Wright BA, Jackson D. Neural tumors of the oral cavity. A review of the spectrum of benign and malignant oral tumors of the oral cavity and jaws. Oral Surg Oral Med Oral Pathol 1980; 49 (06) 509-522
  • 64 Oh JE, Choi YW, Choi HY, Myung KB. A case of cellular schwannoma of the lower lip. Korean J Dermatol 2008; 46: 1282-1284
  • 65 Woodruff JM, Godwin TA, Erlandson RA, Susin M, Martini N. Cellular schwannoma: a variety of schwannoma sometimes mistaken for a malignant tumor. Am J Surg Pathol 1981; 5 (08) 733-744
  • 66 Nonaka D, Chiriboga L, Rubin BP. Sox10: a pan-schwannian and melanocytic marker. Am J Surg Pathol 2008; 32 (09) 1291-1298
  • 67 Fine SW, McClain SA, Li M. Immunohistochemical staining for calretinin is useful for differentiating schwannomas from neurofibromas. Am J Clin Pathol 2004; 122 (04) 552-559
  • 68 Park JY, Park H, Park NJ, Park JS, Sung HJ, Lee SS. Use of Calretinin, CD56, and CD34 for Differential Diagnosis of Schwannoma and Neurofibroma. J Pathol Transl Med 2011; 45 (01) 30-35
  • 69 Chrysomali E, Papanicolaou SI, Dekker NP, Regezi JA. Benign neural tumors of the oral cavity: a comparative immunohistochemical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84 (04) 381-390
  • 70 Chauvin PJ, Wysocki GP, Daley TD, Pringle GA. Palisaded encapsulated neuroma of oral mucosa. Oral Surg Oral Med Oral Pathol 1992; 73 (01) 71-74
  • 71 Yamazaki H, Kaneko A, Ota Y, Tsukinoki K. Schwannoma of the mental nerve: usefulness of preoperative imaging: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97 (01) 122-126
  • 72 Colreavy MP, Lacy PD, Hughes J. , et al. Head and neck schwannomas--a 10 year review. J Laryngol Otol 2000; 114 (02) 119-124
  • 73 Gomez-Brouchet A, Delisle MB, Cognard C. , et al. Vestibular schwannomas: correlations between magnetic resonance imaging and histopathologic appearance. Otol Neurotol 2001; 22 (01) 79-86
  • 74 Ghosh BC, Ghosh L, Huvos AG, Fortner JG. Malignant schwannoma. A clinicopathologic study. Cancer 1973; 31 (01) 184-190
  • 75 Bansal R, Trivedi P, Patel S. Schwannoma of the tongue. Oral Oncology EXTRA. 2005; 41 (02) 15-17