Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 6  |  Issue : 4  |  Page : 452-454  

Neurilemmoma of nose


1 Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
2 Department of Pathology, Yashwantrao Chauhan Memorial Hospital, Pimpri, Pune, India

Date of Web Publication17-Sep-2013

Correspondence Address:
Pradhan M Pagaro
Department of Pathology, Dr. D. Y.Patil Medical College, Pune-411018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.118286

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  Abstract 

Neurilemmomas are uncommon neoplasms. They are solitary encapsulated benign tumors usually occurring along the course of peripheral, cranial or sympathetic nerve. They are rarely malignant. Nasal and paranasalneurilemmomas are extremely rare and few cases have been reported. We report a case of neurilemmoma of nose because it is rare and it grossly appears similar to the benign mucous polyp of the nose. We report a 32-year-old male complaining of foreign body sensation in nose and difficulty in breathing. On examination it was clinically thought to be a mucous polyp, but on histopathological examination it was found to be neuroilemmoma.

Keywords: Nasal polyp, schwannoma, verocay body


How to cite this article:
Pagaro PM, Patil T, Chaudhari PK, Buch A. Neurilemmoma of nose. Med J DY Patil Univ 2013;6:452-4

How to cite this URL:
Pagaro PM, Patil T, Chaudhari PK, Buch A. Neurilemmoma of nose. Med J DY Patil Univ [serial online] 2013 [cited 2022 Aug 17];6:452-4. Available from: https://www.mjdrdypu.org/text.asp?2013/6/4/452/118286


  Introduction Top


Nasal neurilemmomas are rare and are often confused with nasal polyps. It was first described by Verocay in 1910 who called them neuronomas. Stout, 1935, coined the term neurilemmoma. Schwannomas usually occur in the peripheral nerves as a solitary nodule on sheathed sensory, motor or autonomic nerve. Intraspinal schwannomas are formed as intraduraltumors in the thoracic region. Schwannoma located within the internal auditory canal arise from the vestibular branch of the 8 th cranial nerve. Neurilemmomas are particularly associated with thoracic outlet syndrome where the nerves between the top ribs and collarbone get compressed. This causes head and neck pain and numbness in the finger. Tumors along the sciatic nerve cause low back pain. A neurilemmoma can also be the underlying cause of carpel tunnel syndrome.Exact number of people with neurilemmomas is not known and neither is its cause. Multiple neurilemmomas are usually associated with Von Ricklinghausen ' s disease type 2 which is an inherited disorder indicating the genetic basis of the tumor caused by malfunctioning of gene responsible for cell division. They occur from Schwan cells lining the peripheral nerves. They usually occur in the age group of 20-50 years.


  Case Report Top


A 32-year-old male came complaining of difficulty in breathing since 3 months. Gradually the problem went on increasing. During that period he also complained of feeling of fullness in the nose. Anterior rhinoscopy showed a soft fleshy pinkish non-bleeding polypoid mass. X-ray of the nose showed a hazy soft-tissue shadow occupying the right nasal cavity and the septum was deviated to the left. The hematological and other routine investigations were normal. The mass was surgically removed.Grossly, the tumor was 6 Χ 5 Χ 2.5 cm in dimensions, smooth on one side and irregular on the other side, grey-white and firm in consistency [Figure 1]. Microscopically : t0 he section shows highly cellular areas known as Antoni type A tissue consisting of spindle shaped cells and Verocay body characterized by a palisading arrangement of nuclie or arrangement of nuclie in stacks around an eosinophilicacellular area [Figure 2] and [Figure 3]. The section also shows less cellular areas consisting of myxoid tissue with presence of scattered stellate cells [Figure 4].
Figure 1: Gross picture of neurilemmoma

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Figure 2: Low power view of neurilemmoma showing lining epithelium of the nose (upper right) and tumor lower left

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Figure 3: Microphotograph of neurilemmoma showing Verocay bodies

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Figure 4: Antoni B less cellular myxoid areas and scattered stellate cells

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  Discussion Top


We report a very rare case of nasal neurilemmoma occurring in 32-year-old case presenting with feeling of fullness in nose and gradually increasing breathlessness. Clinal and X-ray examination of the nose showed a mass lesion, which was clinically considered as probably a nasal polyp. The mass was surgically removed and the histopathology examination confirmed the diagnosis of Neurilemmoma. They are generally uncommon lesions, and mainly occur in the peripheral nerves and also sometimes in the intraspinal and inner ear location where it is called acoustic neurilemmoma arising from the 8 th cranial nerve.Very few nasal nerilemmomas, as was our case, have been reported although the exact number of cases reported is not known. These tumors have genetic basis, arise from schwann cells and occur usually in the age group ofg 20-50 years.Neurilemmomas are benign encapsulated tumorsattached to the nerves where they arise in such a way that they can be easily removed without damaging the involved nerve. The other peripheral nerve sheath tumor, known as Neurofibroma is a non-capsulated tumor, has deeper connection to the involved nerve making it difficult to surgically remove. Malignant neurilemmomas are very rare, but they do occur and have been reported.Multiple neurilemmomas are present in patients suffering from Von Recklinghausen disease, neurofibromatosis type 2indicating genetic basis of disease.Histologically thetumor is characteristic of Antoni type A andB tissue and presence of Verocay body consisting of palisading arrangement of nuclie around an acellullareosinophilic area. Symptoms relate to compression of surrounding nerves by tumor and in acoustic schwannoma the patient complains of tinnitus,(ringing noise in ear), vertigo and feeling of fullness in ear.Histologically many types have been described as Ancient, Cellular, Plexiform, Melanotic, Epitheloid, Hybrid, Glandular, Microcystic/Reticular. The benign Neurilemmoma are usually encapsulated and are attached to the nerve and hence they can be easily and successfully treated by surgical removal of the tumor. [1] Individual case reports of neurilemmoma have been reported by .Rekhi, [2] Bogdasarian, [3] Dutt, [4] Dharia et al, [5] and Khnifies et al, [6] Persuad et al reported intranasal neurilemmoma in young woman. [7] . Josephson and others described a neurilemmoma in a pediatric patient presenting as a midline nasal mass. [8] Pediatricneurilemmomas are very rare. Hu et al reported 12 cases of neurilemmoma of nasal cavity and paranasal sinuses. [9] Hegazy HM reported a case of neurilemmoma of nose in a 70-year-old, which is again rare at this age. [10] Ross et al reported a case of massive schwannoma of nose and paranasal sinuses. [11] Leu and Chang reviewed extracranial head and neck schwannomas over an 8 year period and described very few cases of neurilemmoma of nose. [12]


  Conclusion Top


The neurilemmomas of nose are rare but should be considered as one of the differential diagnosis of mass lesions of nose.

 
  References Top

1.Harsh Mohan. The Nervous System. In: Textbook of Pathology. 6 th ed. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd.; 2010. p. 871-895.  Back to cited text no. 1
    
2.RekhiBM, Mehra YN, Banerjee AK.Neurilemmoma of Nose. Indian J Otolaryngol1969;21:138-40.  Back to cited text no. 2
    
3.Bogdasarian,Mand R, Sout AP.Neurilemmoma of nasal septum. Arch Otolaryng 1943:38;62.  Back to cited text no. 3
    
4.Dutt PK. A case of nasal neurilemmoma. J Laryngol Otol 1969;83:1209-13.  Back to cited text no. 4
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5.Dharia A, Karmody CS, Rebeiz EE. Schwannoma of the nasal cavity. Ear Nose Throat J 2007;86:230-1,243.  Back to cited text no. 5
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6.Khnifies R, Fradis M, Brodsky A, Bajar J, Luntz M. Inferior turbinate schwannoma: Report of a case. Ear Nose Throat J 2006;85:384-5.  Back to cited text no. 6
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7.Persaud RA, Hajioff D, Chevretton EB. Intranasal schwannoma in a young woman. Int J Clin Pract 2004;58:426-8.  Back to cited text no. 7
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8.Josephson GD, Patel SA, Duckworth L, Kress M, Goldstein J. Neurilemmoma presenting as a midline nasal mass in a pediatric patient. Ear Nose Throat J 2010;89:221-3.  Back to cited text no. 8
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9.Hu Y, Wan B, Song X, Xie W. Neurilemmoma of the nasal cavity and paranasal sinuses (report of 12 cases). Lin Chuang Er Bi Yan HouKeZaZhi 1999;13:409-10.  Back to cited text no. 9
    
10.Hegazy HM, Snyderman CH, Fan CY, Kassam AB. Neurilemmomas of the paranasal sinuses. Am J Otolaryngol 2001;22:215-8.  Back to cited text no. 10
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11.Ross C, Wright E, Moseley J, Rees R. Massive schwannoma of the nose and paranasal sinuses. South Med J 1988;81:1588-91.  Back to cited text no. 11
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12.Leu YS, Chang KC. Extracranial head and neck schwannomas: A review of 8years experience. Acta Otolaryngol 2002;122:435-7.  Back to cited text no. 12
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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