Schwannoma of the columellar area – a case report

Introduction Schwannomas are benign tumours of the Schwann cells. 25-45% originate in the head and neck region, only 4% of schwannomas are located in the sinunasal region and involvement of the septum is very rare.

Case report 62-year-old patient with painless swelling of the columella, constant in volume for 12 months. The mass was displaceable at the columella, covered with mucosa and without telangiectasia. No obstruction, epistaxis, rhinorrhoea or hyposmia. No schwannomas or neurofibromatosis type II known in the patient's history. Dermoid and sarcoma were considered as differential diagnoses, therefore indication for extirpation of the mass via hemitransfixational incision was made without biopsy. Intraoperatively, a tumour measuring 15*8*6mm was found macroscopically, no nerve exposure possible, the fragment was encapsulated and nodularly bulging, no nerve deficits postoperatively. Microscopically, spindle cell proliferates in a fascicular arrangement appeared. The histopathological result revealed a regressively transformed schwannoma which has been removed in toto. Immunohistological analysis demonstrated staining for S100 protein and Ki-67 (>5%).

Discussion and Outlook Endonasal schwannomas are rare tumours of the sinonasal tract. Symptoms are characterised heterogeneously. Open septorhinoplasty is the currently recommended approach for extirpation and should be considered for masses≥10 mm. MRI can be used to identify the preoperative extent. The differential diagnoses include dermoid, leiomyomas or sarcomas and neurofibromas. N. trigeminus branches or autonomic nerves are hypothesised to be the nerve origin. An association with neurofibromatosis type II is significant when taking a patient's history.

Publication History

Article published online:
19 April 2024