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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 64-66

Lingual schwannoma in a 4-year-old female baby


1 Department of Pediatric Surgery, IGIMS, Patna, Bihar, India
2 Department of Pathology, IGIMS, Patna, Bihar, India

Date of Submission08-Jan-2021
Date of Decision30-Jan-2021
Date of Acceptance10-Mar-2021
Date of Web Publication28-Jun-2021

Correspondence Address:
Vinit Kumar Thakur
Additional Professor, Department of Paediatric surgery, 125, Ward Block, Indira Gandhi Institute of Medical Sciences, Patna 800 014, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-9031.302979

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  Abstract 


Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Although a common tumor of the head and neck region, its location in the oral cavity is uncommon. We found lingual schwannoma in a 4-year-old baby. The patient underwent magnetic resonance imaging and complete surgical excision of the mass. Histopathology confirmed the diagnosis.

Keywords: Lingual, pediatric, schwannoma


How to cite this article:
Thakur VK, Rahul SK, Kumar B, Hasan Z, Yadav R, Chaubey D, Prasad R, Keshri R. Lingual schwannoma in a 4-year-old female baby. J Indira Gandhi Inst Med Sci 2021;7:64-6

How to cite this URL:
Thakur VK, Rahul SK, Kumar B, Hasan Z, Yadav R, Chaubey D, Prasad R, Keshri R. Lingual schwannoma in a 4-year-old female baby. J Indira Gandhi Inst Med Sci [serial online] 2021 [cited 2021 Sep 24];7:64-6. Available from: http://www.jigims.co.in/text.asp?2021/7/1/64/302979


  Introduction Top


Schwannoma is a benign tumor of the peripheral nerve sheath, usually present as a solitary, encapsulated, and slow-growing lesion. Approximately 25%–48% of cases are seen in the head and neck region, of which 1% appears in the oral cavity.[1] Lingual schwannomas most commonly occur between the second and fourth decades of life and display no gender predilection. We present a case of a 4-year-old female baby who came with a mass on the posterior aspect of the tongue which was found to be lingual schwannoma.


  Case Report Top


A 4-year-old female baby presented with a mass in the oral cavity progressively increasing in size for 4 months. Parents noticed this swelling during casual examination of the baby's oral cavity; it was small in size and not causing any problem, so parents avoided any further consultation. The baby was brought to a physician when the size of the swelling increased and started to pose problems with swallowing of food and water; nasal prominence of her voice was obvious and choking while sleeping was her latest complaint that compelled her parents to consult a doctor. Because of fearsome look of swelling, she was referred to a tertiary care center.

This baby was of average height and built. There was a painless, exophytic growth of size approximately 5 cm × 4 cm × 3 cm on the posterior expect of the tongue, with bosselated surface and well-defined border [Figure 1]. The growth itself appeared firm but friable, there was hint of bleeding, and so further examination to assess the posterior extent of the swelling was abandoned. The dentition and the adjacent oral mucosa revealed no abnormalities. A provisional diagnosis of vascular malformation was made. Pyogenic granulomas, the minor salivary gland tumor involving tongue, were considered as an alternative diagnosis.
Figure 1: Lesion in the oral cavity

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Hematological investigation and kidney function tests were normal. Magnetic resonance imaging revealed a 35 mm × 28 mm × 33 mm well-defined, lobulated, hyperintense mass in the posterior aspect of the tongue, suggestive of soft tissue mass most likely lymphohemangioma. Fearing sclerotherapy could impede breathing and can cause choking and recurrent aspiration; we decided for subtotal excision and sclerotherapy for residual mass. After thorough workup including preanesthetic check-up, the baby was planned for surgery. Nasal intubation was done to avoid any trauma to mass. Tongue was pulled forward and anchored with a suture to bring mass in surgical field. It was an exophytic mass with a well-defined margin, a good cleavage plane was easily found, and we could resect the mass in toto without much mucosal bleed [Figure 2]. Direct invasion into the adjacent lingual muscle was not evident. Postoperative recovery of this baby was uneventful. On the 2nd postoperative day, she was allowed oral feed and discharged subsequently. The histopathological report was suggestive of neurilemmoma (schwannoma) [Figure 3]. The baby was reviewed after a week, and adequate healing was confirmed. After 3 months of follow-up, there were neither signs of sensory or motor deficit of tongue nor any recurrence. The baby remained asymptomatic.
Figure 2: Excised mass from tongue

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Figure 3: Histopathological features

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  Discussion Top


Schwannomas (neurilemmomas) are benign, encapsulated, slow-growing, and usually solitary tumor originating from Schwann cells of the peripheral nerve sheath.[1] Approximately 25%–45% of all schwannomas are seen in the head and neck.[2] Of these, approximately 1%–12% occur intraorally with the tongue being the most common site.[3] Of these, 50% of tumors have been shown to have a direct relation with a nerve.[4] Schwannomas of the tongue typically present in the third decade of life (33%), display no gender predilection (52.8% female; 47.2% male),[5] and often present as a painless mass (69.6%). Exophytic lingual schwannoma of considerably large size (4 cm × 3.5 cm × 3 cm) in a 4-year-old baby makes this case more interesting. Schwannomas are likely to elicit distressing symptoms when present on the posterior aspect of the tongue like in this case; the baby had a history of difficulty in swallowing and recurrent choking. Recurrent aspiration of the saliva may cause lower respiratory tract infection that must be evaluated. Ulceration of overlying mucosa is uncommon and generally the result of trauma. Blood ooze from surfaces is common in pyogenic granuloma and lymphangiohemangioma, not usually seen in schwannomas.[6]

Magnetic resonance imaging is the best investigation for the soft tissue lesion involving oral cavity.[7] It gives clear details of the extent of tumors and correlates well with operative finding. However, in this case, the report was misguiding directing toward hemangiolymphangioma arising the need to proceed with caution. Fine needle aspiration cytology may be helpful in making preoperative diagnosis; in pediatric age group, intraoperative assessment of the lesion is a must before surgical excision as preoperative evaluation remains mostly incomplete. Schwannomas are managed by complete surgical excision.[8] Chances of recurrence are low, so wide excision is unwarranted. The definitive diagnosis of mass requires histopathological examination.[9]


  Conclusion Top


Lingual schwannomas should be kept as a differential diagnosis, while evaluating a soft tissue lesion involving tongue. Malignant transformation of schwannomas is extremely rare, so one can expect a satisfactory result without any recurrence after successful transoral excision.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Naidu GS, Sinha SM. Schwannoma of the tongue: An unusual presentation in a child. Indian J Dent Res 2010;21:457-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Abreu I, Roriz D, Rodrigues P, Moreira Â, Marques C, Alves FC. Schwannoma of the tongue-A common tumour in a rare location: A case report. Eur J Radiol Open 2017;4:1-3.  Back to cited text no. 2
    
3.
Lukšić I, Müller D, Virag M. Schwannoma of the tongue in a child. J Craniomaxillofac Surg 2011;39:441-4.  Back to cited text no. 3
    
4.
Enoz M, Suoglu Y, Ilhan R. Lingual schwannoma. J Cancer Res Ther 2006;2:76-8.  Back to cited text no. 4
    
5.
Manna F, Barbi E, Murru F, Bussani R. Lingual schwannoma in pediatric patients. J Craniofac Surg 2012;23:e454-6.  Back to cited text no. 5
    
6.
Gallesio C, Berrone S. Schwannoma located in the tongue. A clinical case report. Minerva Stomatol 1992;41:583-90.  Back to cited text no. 6
    
7.
Bansal R, TrivediP, Patel S. Schwannoma of the tongue. Oral Oncol Extra 2005;41:15-7.  Back to cited text no. 7
    
8.
Lee EY, Kim JJ, Seok H, Lee JY. Schwannoma of the tongue: A case report with review of literature. Maxillofac Plast Reconstr Surg 2017;39:17.  Back to cited text no. 8
    
9.
Thompson LD, Koh SS, Lau SK. Tongue schwannoma: A clinicopathologic study of 19 cases. Head Neck Pathol 2019;019:01071-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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