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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 78-79

Nasal septal schwannoma


Department of ENT, ESIC Model Hospital, Beltola, Guwahati, Assam, India

Date of Submission29-Jul-2021
Date of Acceptance16-Sep-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. Soumick Ranjan Sahoo
T9B Protech Park Hengrabari, Guwahati - 781 036, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aiao.aiao_19_21

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  Abstract 


Schwannoma is a benign nerve sheath tumor whose the most common site is the vestibulocochlear nerve. Sinonasal schwannoma is rare and septal schwannoma is even more rarer. We report a endonasal endoscopic-guided excision of the left nasal cavity mass attached at the nasal septum in a 59-year-old female which on histopathological examination was confirmed as schwannoma.

Keywords: Benign, schwannoma, septal


How to cite this article:
Sahoo SR, Sarma M. Nasal septal schwannoma. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2021;5:78-9

How to cite this URL:
Sahoo SR, Sarma M. Nasal septal schwannoma. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2022 Jan 20];5:78-9. Available from: https://www.aiaohns.in/text.asp?2021/5/2/78/332063




  Introduction Top


Schwannoma is a benign nerve sheath tumor which may arise from any myelinated nerve fiber. The eighth cranial nerve (vestibulocochlear nerve) is the most common site of schwannoma in the head-and-neck region.[1] Other sites include the scalp, face, parotid gland, oral cavity, pharynx, larynx, and trachea.[2] Sinonasal schwannoma accounts for about 4% of head-and-neck nerve sheath tumors. Very rarely schwannoma involves the nasal septum, with few cases previously reported.[3] The diagnosis of nasal septal schwannoma is based on the histopathological findings due to a lack of characteristic radiological features.[4] The first case of nasal septal schwannoma was first described by Bogdasian and Stoutin 1943.[5],[6] We describe a case of left-sided nasal mass arising from the nasal septum which was surgically resected and histopathology gave a confirmatory diagnosis of schwannoma.


  Case Report Top


A 59-year-old woman presented with complains of progressively increasing left-sided nasal obstruction and intermittent episodes of epistaxis for 7 months. There was no history of rhinorrhea, facial pain, headache, and anosmia. On clinical examination, a globular pinkish polypoidal mass was noticed filling the left nasal cavity [Figure 1]. The mass was firm in consistency and does not bleed on touch. There was mild deviation of septum to the right side. The right nasal cavity was within the normal limit. The rest of the ear, nose, throat, and oral cavity examination was within the normal limits, and there was no palpable lymphadenopathy. Contrast-enhanced computed tomography nose and Paranasal sinuses show a lobulated soft-tissue density lesion measuring 28 mm × 21 mm × 38 mm in the anterior aspect of the left nasal cavity, attached to septum, the lesion abuts the anterior aspect of the left middle and inferior turbinates [Figure 2]. Preoperative investigations, preanesthetic checkup, and COVID reverse transcription polymerase chain reaction test were done which was negative, and the mass was surgically resected under endoscopic guidance and point of attachment at nasal septum was cauterized. The resected specimen was sent for the histopathological examination which gave a diagnosis of schwannoma [Figure 3].
Figure 1: Clinical examination of the nose showing a mass in the left nasal cavity

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Figure 2: Contrast-enhanced computed tomography of the nose and Paranasal sinuses showing a lobulated lesion left nasal cavity

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Figure 3: Histopathology picture

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  Discussion Top


The posterior septum is the common site of involvement of nasal septal schwannoma. The tumor is likely to arise from the nasopalatine branch of the trigeminal nerve. The presenting symptoms include nasal obstruction, anosmia, deformity of the nasal pyramid, headache, and epistaxis.[7]

The most common causes of unilateral nasal mass include nasal polyposis (22%), antrochoanal polyps (19%), chronic rhinosinusitis (13%), concha bullosa (11%), inverted papilloma (6%), and retention cysts (6%). Fibrous dysplasia, mucocele, lymphoma, schwannoma, ameloblastoma, pleomorphic adenoma, myxoma, and squamous cell carcinoma are the less common potential causes.[3] All these causes were kept as a differential diagnosis.

As there are many pathological causes of unilateral nasal obstruction, it is difficult to make a diagnosis solely on the basis of imaging.[8] Computed tomography may be helpful in evaluating the tumor's origin and extent. Magnetic resonance imaging helps in evaluating the intracranial invasion of the tumor.[9]

The diagnosis of nasal septal schwannoma diagnosis is confirmed on biopsy. A clear illustration of the Antoni A and Antoni B structures on histological examination clinches the diagnosis.[10]

Nasal septal schwannoma is treated by surgical resection of the mass, which can be achieved by lateral rhinotomy or endoscopic endonasal surgery.[7] The endoscopic endonasal approach with or without image guidance is the standard surgical approach for the removal of tumor. The condition is typically curative with rare chances of postoperative recurrence.[11]


  Conclusion Top


Schwannoma even though rare should be kept as a differential diagnosis for unilateral nasal mass should be resected surgically and diagnosis confirmed by the histopathological examination.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alrasheed W, Almomen A, Alkhatib A. A rare case of nasal septal schwannoma: Case report and literature review. Int J Surg Case Rep 2019;55:149-51.  Back to cited text no. 1
    
2.
Gulia JS, Yadav SS, Basur SK, Hooda A. Schwannoma of the membranous nasal septum. Braz J Otorhinolaryngol 2013;79:789.  Back to cited text no. 2
    
3.
Habesoglu TE, Habesoglu M, Surmeli M, Uresin T, Egeli E. Unilateral sinonasal symptoms. J Craniofac Surg 2010;21:2019-22.  Back to cited text no. 3
    
4.
Yu E, Mikulis D, Nag S. CT and MR imaging findings in sinonasal schwannoma. AJNR Am J Neuroradiol 2006;27:929-30.  Back to cited text no. 4
    
5.
Bhaskar M, Sharmistha S, Biswanath P, Mallika P. Schwannoma of nasal septum: A rare case report with iterature review. Egypt J Ear Nose Throat Allied Sci 2012;13:121-5.  Back to cited text no. 5
    
6.
Mohamad Umbaik N, Ramli R, Abdullah B. Endoscopic excision of nasal septal schwannoma: Case report and review of literature. BJMS 2019;18:660-2.  Back to cited text no. 6
    
7.
Mey KH, Buchwald C, Daugaard S, Prause JU. Sinonasal schwannoma – A clinicopathological analysis of five rare cases. Rhinology 2006;44:46-52.  Back to cited text no. 7
    
8.
Valencia MP, Castillo M. Congenital and acquired lesions of the nasal septum: A practical guide for differential diagnosis. Radiographics 2008;28:205-23.  Back to cited text no. 8
    
9.
Fujiyoshi F, Kajiya Y, Nakajo M. CT and MR imaging of nasoethmoid schwannoma with intracranial extension. AJR Am J Roentgenol 1997;169:1754-5.  Back to cited text no. 9
    
10.
Brandon C, Curtis O, Ghassan A. A suprising cause of unilateral nasal obstruction and epistaxis: Nasal septal schwannoma. J Surg Case Rep 2014;3:1-3.  Back to cited text no. 10
    
11.
Batra PS, Luong A, Kanowitz SJ, Sade B, Lee J, Lanza DC, et al. Outcomes of minimally invasive endoscopic resection of anterior skull base neoplasms. Laryngoscope 2010;120:9-16.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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