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Journal of Cancer Research and Therapeutics, Vol. 6, No. 4, October-December, 2010, pp. 543-545 Case Report Vocal cord schwannoma: A rare case report SH Chandrashekhara1, AS Bhalla1, KV Kartikeyan2, B Shukla3, R Safaya3 1 Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi - 110 029, India Correspondence Address: A S Bhalla, Department of Radiology, All India Institute of Medical Sciences, New Delhi - 110 029, India, ashubhalla1@yahoo.com Code Number: cr10133 PMID: 21358097 DOI: 10.4103/0973-1482.77063 Abstract Schwannomas of the larynx are rare benign tumors, most commonly involving aryepiglottic folds or false vocal folds. When a tumor involves vocal cord, it causes clinical symptoms like hoarseness of voice and foreign body sensation. We report the CT and magnetic resonance imaging findings in a 19-year-old male patient with vocal cord mass histologically diagnosed as a vocal cord schwannoma.Keywords: Magnetic resonance imaging, multidetector computed tomography, vocal cord schwannoma Introduction Vocal cord schwannomas are rare tumors that are usually found in the false vocal folds and aryepiglottic folds. [1] Only few case reports of vocal cord schwannomas are available in the literature. [2],[3],[4],[5],[6] We report the computed tomography and magnetic resonance imaging findings of a vocal cord schwannoma in a 19-year-old male patient presented with hoarseness of voice and foreign body sensation. Case Report A 19-year-old male patient came to our hospital with hoarseness of voice and foreign body sensation for the last 1 year. He did not have difficulty in swallowing or breathing. No other significant past medical illness was present. Systemic examination was normal. Indirect laryngoscopy showed large submucosal mass in the right vocal fold with vocal cord immobility. A multidetector computed tomography (MDCT) scan of the neck showed a heterogeneously enhancing mass involving the vocal cord on the right side with extension into the laryngeal ventricle. It was extending superiorly involving the aryepiglottic fold and inferiorly extending into the infraglottic region [Figure - 1]. Magnetic resonance imaging (MRI) showed heterogeneous hyperintense mass involving the vocal cord on the right side on T2-weighted imaging [Figure - 2]. Translaryngeal fine-needle aspiration cytology showed densely cellular areas, composed of compact elongated cells with palisading (Antoni A pattern) and a less cellular, loosely texture pattern in which cells often contained lipid (Antoni B pattern). Immunohistochemical studies showed reactivity for S100 protein [Figure - 3]. These features were consistent with schwannoma of the vocal cord. Subsequently, surgical excision of the tumor was done and patient had an uneventful postoperative recovery. Discussion Vocal cord shwannoma is a rare benign tumor arising from the internal branch of the superior laryngeal nerve. [7] Schwannomas affect patients in all age groups, more commonly occurring in sixth and seventh decades. [8] It is more common in females. [2] As they are slow growing tumors, patients usually present late to the hospital. Patients typically present with hoarseness and a globus sensation; they may later develop dyspnea and stridor. They may also present with sore throat, odynophagia, dysphagia, dysphonia, hoarseness, and a foreign body sensation in the throat. In our case, the patient presented with hoarseness of voice with foreign body sensation only. The main differential diagnosis of a laryngeal schwannoma is neurofibroma. Other differentials include other benign tumors like laryngeal cyst, laryngocele, adenoma, and chondroma. Schwannomas must be distinguished from neurofibromas because recurrence and malignant transformation is relatively more in neurofibromas. [9],[10] Schwannoma is a solitary, encapsulated, slow-growing benign tumor and commonly occurs in women. Neurofibromas may be single or multiple. Neurofibromas are intertwined within the nerve fascicles, in contrast to shwannoma which is encapsulated. Schwannomas are diagnosed histologically by a immunohistochemical study for S100 protein reaction and by electron microscopic Antoni A and B patterns. The Antoni A pattern is characterized by compact, spindle-shaped cells, with their nuclei aligned in parallel rows palisade pattern. The Antoni B type is less cellular, loosely organized, with vacuoles and spindle-shaped nuclei. [8],[10] On CT scan, schwannomas show homogenous contrast enhancement when their size is small and heterogeneous enhancement, when the size is large (more than 3 cm). Cystic component may also be seen. [11],[12] Our patient showed heterogeneous enhancement without cystic changes. On MRI T1-weighted images of a schwannoma show variable intensity hyperintensity is seen on T2W images, and intense contrast enhancement on post-gadolinium administration. [11] However, CT and MRI appearances are not diagnostic as such features may also be found in other benign tumors of the larynx like neurofibroma. Squamous cell carcinomas should be considered as a main differential diagnosis for a laryngeal mucosal lesion on CT and MRI, as these are most commonly occurring tumor. Histopathology is the gold standard in the diagnosis of vocal cord shwannoma. Surgical removal is the treatment of choice. Small tumors can be removed by endoscopic excision and large tumors by an external surgical approach. [3],[6] Recurrence or malignant sarcomatous changes following surgical treatment are extremely rare. References
Copyright 2010 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr10133f1.jpg] [cr10133f3.jpg] [cr10133f2.jpg] |
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