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Kim, Chung, Park, Kim, Lee, Kim, Lim, Yeom, and Kim: Ancient schwannoma in oral cavity: a report of two cases
Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(6):530-534.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.6.530

Ancient schwannoma in oral cavity: a report of two cases

Na Rae Kim1, Dong Hae Chung1, Dae-Song Park2, Dong-Woo Kim2, Sang-Chil Lee2, Sung-Yong Kim2, Ho-Yong Lim2, Hak-Yeol Yeom2, Hyeon-Min Kim2

1Department of Pathology, Gachon University Gil Hospital, Incheon, Korea

2Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital, Incheon, Korea

Hyeon-Min Kim Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital 1198, Guwol-dong, Namdong-gu, Incheon 405-760, Korea TEL: +82-32-460-3373 FAX: +82-32-460-3101 E-mail: jumincw@gilhospital.com

Received 24 July 2011       Revised 5 September 2011       Accepted 12 October 2011

Copyright © 2011 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This paper reports two cases of schwannomas arising from the oral cavity. One is an intraoral ancient schwannoma located at the left cheek, which evolved over a period of 13 years. The tumor was a well-demarcated buccal mass, which was located in the left lower first premolar area, with an obliterated the buccal vestibule, leaving the overlying mucosa intact. The second case was a central intraosseous schwannoma located from the left lower 1st molar periapical area to the left 3rd molar periapical area. Pathologically, the first mass was composed of the spindle shaped tumor cells with wavy nuclei beneath the fibroconnective tissue of the gingiva but second case mass was not. Occasional nuclear pleomorphism was observed but mitosis or necrosis was absent. There were Antoni A and B areas along with strong, diffuse staining with the S-100 protein. Ancient schwannomas were diagnosed. Schwannoma is a slow-growing benign tumor, and an ancient schwannoma that shows cellular atypism is a variant of a schwannoma caused by purely degenerative changes. To date, only limited cases of ancient schwannomas in the oral cavity have been reported.

Keywords: Neurilemmoma, Mouth, S100 proteins

References

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Fig. 1.
Axial (A) and coronal (B) computed tomography of Case 1 reveals an ill defined lesion at the left mandibular body (arrows). Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-530f1.tif
Fig. 2.
The well circumscribed protruding mass over the first premolar area near the mental foramen is seen in Case 1. Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-530f2.tif
Fig. 3.
A. The relatively well marginated mass consists of spindle shaped tumor cells with buckling nuclei (H & E staining, ×40). B. The mass comprises the Antoni A area with the nuclear palisading patterns forming occasional Verocay bodies (arrow). Note the paucicellular myxoid Antoni B area (left upper portion, H & E staining, ×200). Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-530f3.tif
Fig. 4.
Panoramic view of Case 2 showed well-defined homogeneous low density about 3.0×1.5×2.0 cm-sized cystic mass which is including inferior alveolar nerve in left mandible body. Left lower 1st molar distal root and 2nd molar root were resorption state. Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-530f4.tif
Fig. 5.
A well-defined homogenous low density cystic mass in left mandible body. Definite root resorptions of molars were seen in left mandible. Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-530f5.tif
Fig. 6.
The biopsied specimen is composed of spindle cells with twisted nuclei (H & E staining, ×100). Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-530f6.tif
Table 1.
Summary of the intraoral ancient schwannomas including the presented two cases
No Authors Age, sex Location Size (cm) Symptoms Follow up
1 Eversole and Howell5, 1971 58, F Floor of mouth and ventral tongue 2.5 Nil No follow up data
2 Marks et al.6, 1976 65, F Right floor of mouth 3.5 Nil No complication, and no follow
3 McCoy et al.7, 1983 36, F Maxillary posterior vestibule 2.0 Nil up data No follow up data
4 Dayan et al.8, 1989 52, F Left maxillary vestibule 0.9 Nil No recurrence during one year of follow up
5 Nakayama et al.9, 1996 40, F Floor of mouth and ventral tongue 5.5 Asymptomatic swelling for 2 months No recurrence during 2 years of follow up
6 Ledesma et al.10, 1999 21, F Floor of mouth and ventral tongue 3.0 Asymptomatic swelling for 5 month Not available
7 Kim et al.11, 2000 29, F Origin of the lingual nerve 4.0 Swelling for 4 years No recurrence during 1 year of
8 Chen et al.12, 2006 34, M Floor of mouth 3.0 Asymptomatic swelling for 18 years follow up No recurrence during 2 years of follow up
9 Subhashraj et al.13, 2009 18, M Posterior vestibule of the mandible near the mental foramen 3.1 for 18 years Asymptomatic swelling for 8 months follow up Transient neurapraxia for four weeks with no recurrence during 18 months of follow up
10 Amirchaghmaghi, et al.14, 2010 14, M Gingiva 1.5 Asymptomatic swelling for one year Not described
11 Bilici et al.15, 2011 45, M Tip of the tongue 3.0 Disturbance in articulation and swallowing Not available
12 Humber et al.16, 2011 82, F Upper lip extending from the midline to the canine 2.0 Firm mass and intermittent mild paresthesia for about No recurrence during 5 years of follow up
13 Kim et al, 2011 (the present case) 66, F the midline to the canine eminence Posterior vestibule of the left mandible near the 2.0 mild paresthesia for about 2 years Asymptomatic swelling for 13 years follow up Paresthesia and no recurrence during 9 months of follow up
14 Kim et al, 2011 (the present case) 35, F mental foramen Left Mandible body 3.0 Asymptomatic Dead with car accident before excision

(F: female, M: male)

Na Rae Kim et al: Ancient schwannoma in oral cavity: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011

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