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| CASE REPORT |
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| Year : 2014 | Volume
: 7
| Issue : 4 | Page : 502-504 |
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Solitary eyelid schwannoma
Renu M Magdum, Radhika Paranjpe, Megha Kotecha, Pallavi Patil
Department of Ophthalmology, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre (Dr. D.Y. Patil Vidyapeeth), Pimpri, Pune, Maharashtra, India
| Date of Web Publication | 25-Jun-2014 |
Correspondence Address:
Renu M Magdum
7, Panchsheel Park, Aundh, Pune - 411 007, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-2870.135286
Schwannomas are rare benign tumors arising from Schwann cells of peripheral nerves that form the neural sheath. While there have been reports of such tumors in the orbit, solitary schwannomas arising from the eyelids are very rare. There are reports of schwannomas being erroneously diagnosed as chalazion, inclusion cysts or even eyelid malignancy. We are reporting a case of a 20-year-old female who presented with a painless, non-tender, slow-growing mass in the upper eyelid of the right eye. The external appearance of the mass was suggestive of an implantation cyst of the eyelid and it could be completely excised as it had a well-defined capsule. Histopathological examination showed characteristic hypercellular and hypocellular areas with fusiform nuclei that tended to form palisades. The purpose of reporting this case of schwannoma in a young female is to recommend the inclusion of this entity as a differential diagnosis of well-defined lid tumors. Keywords: Benign eyelid tumors, histopathology, immunohistochemistry, neurilemmoma
How to cite this article:
Magdum RM, Paranjpe R, Kotecha M, Patil P. Solitary eyelid schwannoma. Med J DY Patil Univ 2014;7:502-4 |
| Introduction | |  |
Schwannoma or neurilemmoma is a rare benign tumor arising from the peripheral nerves due to pure proliferation of Schwann cells. Although reported sometimes from the orbit, [1] conjunctiva, [2] uvea [3] or sclera, [4] it is extremely rare on the eyelids and can be confused with more common conditions like chalazion or inclusion cysts. Hence, schwannomas should be included in the differential diagnosis of well-defined lid swellings. We are reporting a case of a 20-year-old girl who presented with such a finding.
| Case Report | | |
A 20-year-old female presented with a slow-growing, painless mass on the right upper eyelid since 1 year. There was no history of similar nodules or depigmented patches elsewhere over the body. Ocular examination showed a 2 cm × 1.5 cm × 1 cm, well-defined, non-tender, firm, lobulated, non-pigmented, transilluminant swelling on the right upper eyelid [Figure 1] and [Figure 2] with resultant mechanical ptosis and cosmetic deformity. The mass was not adherent to the overlying skin or the underlying tissue. A differential diagnosis of implantation cyst was considered and the patient was posted for excision biopsy of the lesion. | Figure 1: Pre-operative photograph of the swelling in the right eye upper lid
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An excision biopsy of the mass was performed under local anesthesia. No specific technique was used for excision and care was taken to remove the swelling in toto without rupturing the capsule [Figure 3]. A well-defined, encapsulated, non-pigmented tumor was completely dissected out and sent for histopathology. It was not attached to any nerve. Histopathology was performed using the Hematoxylin and Eosin stain. Gross appearance showed a lobulated tumor of 2.0 cm diameter with firm consistency and grayish-white color [Figure 4]. Histopathologic features showed spindle-shaped or fusiform cells arranged in fascicles and forming hypo- and hypercellular areas [Figure 5]. The nuclei were fusiform and tended to form palisades [Figure 6]. These features were typical of schwannomas. It also showed thick-walled vessels, cystic area and myxomatous changes. The patient recovered uneventfully and has not shown any recurrence in 8 months. | Figure 3: Intraoperative picture showing removal of the swelling in toto
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 | Figure 5: Microscopic picture showing hypercellular and hypocellular areas
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| Discussion | | |
Schwann cells lie in the perineural compartment of the peripheral nerves. They serve both in place of astrocytes and oligodendrocytes and are responsible for myelination of individual axons. Multiple tumors arising from Schwann cells may be seen in 1.5% of neurofibromatosis type-1 patients. However, neurofibromas are distinct from neurilemmomas as the latter contain a mixture of Schwann cells, peripheral nerve axons, endoneural fibroblasts and perineural cells. Solitary schwannomas are extremely rare.
Eyelid schwannomas appear as non-tender, non-pigmented masses on the lids. In our case, the tumor probably arose from the supraorbital nerve. They have been confused with chalazion [5] and papillomas, basal cell carcinomas, [6] epithelial inclusion cysts and chronic dacryocystitis.
Schwannomas are well encapsulated by a capsule formed by the perineural cells of nerve radical origin. Hence, they can be easily removed in toto. Incomplete removal may be associated with recurrence and more aggressive behavior. [5],[7] Their appearance has been described as "fish flesh appearance" due to their translucency and friability. Accidental rupture of the tumor can lead to recurrences. The cut surface may show foci of hemmorrhages, yellow discoloration or outright cavity formation.
Microscopically, they show a biphasic pattern with areas of highly cellular (Antoni type A) and myxoid matrix (Antoni type B).
The most important feature is a strong reactivity to S-100 protein by immunocytochemistry, especially in Antoni type 1 areas. However, this was not performed in our case.
The major histopathological differential diagnoses of schwannomas include fibrous histiocytoma and leiomyoma, but both are negative for protein S-100.
Schwannomas very rarely show recurrence after many years, and chances of malignant changes are virtually negligible.
Hence, in spite of being rare, it is recommended that schwannomas be considered as the differential diagnosis of well-circumscribed lid swellings.
| References | | |
| 1. | Rootman J, Goldberg C, Robertson W. Primary Orbital Schwannomas. Br J Ophthalmol 1982;66:194-204. 
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| 2. | Le Marc'hadour F, Romanet JP, Fdili A, Peoc'h M, Pinel N. Schwannoma of the bulbar conjunctiva. Arch Ophthalmol 1996;114:1258-60.
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| 3. | Shields JA, Font RL, Eagle RC Jr, Shields CL, Gass DM. Melanotic Schwannoma of the choroid. Ophthalmology 1994;101:843-9.
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| 4. | Graham CW, Cartney AC, Buckley RJ. Intrascleral Neurilemmoma. Br J Ophthalmol 1989;73:378-81.
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| 5. | Shields JA, Guibor P. Neurilemmoma of the eyelid resembling a recurrent chalazion. Arch Ophthalmol 1984;102:1650.
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| 6. | Patil SB, Kale SM, Jaiswal S, Khare N. Schwannoma of upper eyelid: A rare differential diagnosis of eyelid swellings. Indian J Plast Surg 2010;43:213-5.
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| 7. | Sheilds JA, Kiralti H, Sheilds CL, Eagle RC Jr, Luo S. Schwannoma of the eyelid in a child. J Paediatr Ophthalmol Strabismus 1994;31:332-3.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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