Case and Research Letters
Schwannoma of the Tongue
Schwannoma de la lengua
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Feltes-Ochoa, R. Maseda-Pedrero, E. Ruíz-Burguillos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R.A." "apellidos" => "Feltes-Ochoa" "email" => array:1 [ 0 => "rofel8a@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Maseda-Pedrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Ruíz-Burguillos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Schwannoma de la lengua" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 995 "Ancho" => 995 "Tamanyo" => 161173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well-defined, erythematous nodule of 2<span class="elsevierStyleHsp" style=""></span>mm diameter on the dorsum of the tongue.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The schwannoma, neurilemmoma, or neurinoma is a benign tumor that arises from the Schwann cells of the cranial and peripheral nerves. It appears in individuals between 20 and 50 years of age and is equally common in men and women.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Schwannomas are usually sporadic, but in some cases they are associated with neurofibromatosis type II, schwannomatosis, Carney complex, or, more rarely, with radiation therapy, with a latency of up to 50 years (acoustic schwannomas).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Around 25% of extracranial schwannomas arise on the head and neck, and approximately 1% are intraoral.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our patient was an otherwise healthy man of 52 years of age, with no past medical history of interest. He presented a single tumor that had appeared 18 months earlier on the dorsum of tongue. The tumor was occasionally painful. There was no history of surgery or trauma to the area. Physical examination revealed a nodule of 2<span class="elsevierStyleHsp" style=""></span>mm diameter on the dorsum of the tongue. The lesion was slightly erythematous, shiny, well-defined, slightly tender, and had a smooth surface and a rubbery consistency (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Simple excision of the lesion was performed and histopathology revealed a clearly circumscribed tumor composed of fascicles of spindle-shaped cells, lying beneath the mucosa of the tongue (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). At higher magnification, elongated cells were visible; the cells did not show atypia and their nuclei were arranged in line forming the typical “Verocay bodies” (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Immunohistochemistry was positive for S100. A diagnosis of classic schwannoma was made based on these findings.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After excision of the lesion, the wound was closed by direct suture and there have been no surgical complications or recurrence after 6 months of follow-up.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Schwannoma is rare on the tongue. Cohen et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> performed a review of schwannomas on the tongue published in journals indexed in PubMed and found 126 cases over a period of 56 years (including 2 cases published in the same article).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Schwannoma presents clinically as a firm, slow-growing tumor that can reach a variable size. Symptoms depend on the site and size, and the tumor can be painful,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> as in the case we have presented, or asymptomatic. When situated on the tongue, some patients describe inflammation, fasciculations, or weight loss associated with difficulty swallowing. Very rarely the lesion can grow rapidly and ulcerate.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The definitive diagnosis is histological, by observation of a well-defined, encapsulated tumor formed of spindle-shaped cells that can be arranged in 2 patterns. The “Antoni A areas”, which are more cellular and contain the characteristic Verocay bodies, formed of elongated cells with no atypia; the cell nuclei are arranged in line and their cytoplasm is fused into eosinophilic masses. The “Antoni B areas” contain randomly distributed cells in a myxomatous stroma.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–6</span></a> Immunohistochemistry is positive for S100. Depending on the morphological variant, schwannomas can be classified into classic, cellular, plexiform, ancient (degenerated), and melanotic.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Loss of function of the merlin protein (coded by gene <span class="elsevierStyleItalic">NF2</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a>) appears to be the cause of the appearance of schwannomas. This protein has complex functions that are essential to various pathways in the nucleus and in the cell membranes. Loss of merlin function in the nucleus leads to an increased expression of membrane proteins, including integrins and growth factor receptors. These growth factors are usually inhibited by cell-cell contact. The absence of merlin favors their activation, stimulating mitogenic and survival pathways and favoring a lack of cell polarization. These alterations cause schwannoma cells to be unable to bind to an axon.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis includes those lesions that present as a well-encapsulated tumor: granular cell tumor, salivary gland tumor, leiomyoma, neurofibroma, lymphangioma, hemangioma, cyst, lipoma, and others.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment is surgical and is more complex in those tumors situated on the base of the tongue.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Malignant change and recurrence are rare.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We have presented this case as schwannoma is uncommon on the mucosa of the tongue but it is included in the differential diagnosis of benign tumors of the oral mucosa. As occurs with many of these tumors, the final diagnosis is made on histology of the surgical specimen.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Feltes-Ochoa RA, Maseda-Pedrero R, Ruíz-Burguillos E. Schwannoma de la lengua. Actas Dermosifiliogr. 2015;106:512–514.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 995 "Ancho" => 995 "Tamanyo" => 161173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well-defined, erythematous nodule of 2<span class="elsevierStyleHsp" style=""></span>mm diameter on the dorsum of the tongue.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 643 "Ancho" => 995 "Tamanyo" => 204424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology revealed a clearly-circumscribed submucosal tumor (hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×2).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 749 "Ancho" => 995 "Tamanyo" => 241541 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cells grouped in palisade, forming the structures called Verocay bodies (hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Schwannoma of the tongue: Two case reports and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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Ostoviæ" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcms.2010.10.004" "Revista" => array:6 [ "tituloSerie" => "J Craniomaxillofac Surg" "fecha" => "2011" "volumen" => "39" "paginaInicial" => "441" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21041099" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Schwannoma of the tongue: An unusual presentation in a child" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.S. Naidu" 1 => "S.M. Sinha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0970-9290.70790" "Revista" => array:6 [ "tituloSerie" => "Indian J Dent Res" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "457" "paginaFinal" => "459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20930365" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical approaches for tongue base schwannoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Ying" 1 => "S. Zhu" 2 => "Y. Qiao" 3 => "W. Ye" 4 => "A. Maimaiti" 5 => "J. Hu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Craniofac Surg" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "9" "paginaFinal" => "11" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000006/v1_201506260207/S1578219015001328/v1_201506260207/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000006/v1_201506260207/S1578219015001328/v1_201506260207/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001328?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 9 | 19 |
| 2024 Octubre | 86 | 42 | 128 |
| 2024 Septiembre | 85 | 23 | 108 |
| 2024 Agosto | 141 | 48 | 189 |
| 2024 Julio | 119 | 44 | 163 |
| 2024 Junio | 83 | 48 | 131 |
| 2024 Mayo | 79 | 37 | 116 |
| 2024 Abril | 69 | 28 | 97 |
| 2024 Marzo | 82 | 26 | 108 |
| 2024 Febrero | 83 | 28 | 111 |
| 2024 Enero | 98 | 39 | 137 |
| 2023 Diciembre | 64 | 17 | 81 |
| 2023 Noviembre | 77 | 29 | 106 |
| 2023 Octubre | 89 | 14 | 103 |
| 2023 Septiembre | 76 | 27 | 103 |
| 2023 Agosto | 64 | 16 | 80 |
| 2023 Julio | 72 | 36 | 108 |
| 2023 Junio | 69 | 19 | 88 |
| 2023 Mayo | 109 | 24 | 133 |
| 2023 Abril | 79 | 15 | 94 |
| 2023 Marzo | 83 | 23 | 106 |
| 2023 Febrero | 88 | 29 | 117 |
| 2023 Enero | 62 | 41 | 103 |
| 2022 Diciembre | 79 | 41 | 120 |
| 2022 Noviembre | 62 | 23 | 85 |
| 2022 Octubre | 36 | 24 | 60 |
| 2022 Septiembre | 46 | 47 | 93 |
| 2022 Agosto | 66 | 45 | 111 |
| 2022 Julio | 68 | 37 | 105 |
| 2022 Junio | 36 | 21 | 57 |
| 2022 Mayo | 50 | 34 | 84 |
| 2022 Abril | 57 | 27 | 84 |
| 2022 Marzo | 69 | 43 | 112 |
| 2022 Febrero | 41 | 29 | 70 |
| 2022 Enero | 68 | 40 | 108 |
| 2021 Diciembre | 36 | 25 | 61 |
| 2021 Noviembre | 43 | 43 | 86 |
| 2021 Octubre | 68 | 56 | 124 |
| 2021 Septiembre | 37 | 36 | 73 |
| 2021 Agosto | 40 | 34 | 74 |
| 2021 Julio | 37 | 31 | 68 |
| 2021 Junio | 46 | 28 | 74 |
| 2021 Mayo | 36 | 35 | 71 |
| 2021 Abril | 83 | 50 | 133 |
| 2021 Marzo | 65 | 33 | 98 |
| 2021 Febrero | 63 | 22 | 85 |
| 2021 Enero | 42 | 11 | 53 |
| 2020 Diciembre | 40 | 21 | 61 |
| 2020 Noviembre | 18 | 19 | 37 |
| 2020 Octubre | 32 | 9 | 41 |
| 2020 Septiembre | 22 | 11 | 33 |
| 2020 Agosto | 20 | 11 | 31 |
| 2020 Julio | 28 | 15 | 43 |
| 2020 Junio | 26 | 40 | 66 |
| 2020 Mayo | 28 | 20 | 48 |
| 2020 Abril | 28 | 15 | 43 |
| 2020 Marzo | 20 | 25 | 45 |
| 2020 Febrero | 4 | 7 | 11 |
| 2020 Enero | 4 | 8 | 12 |
| 2019 Diciembre | 0 | 10 | 10 |
| 2019 Noviembre | 0 | 5 | 5 |
| 2019 Octubre | 6 | 3 | 9 |
| 2019 Septiembre | 1 | 3 | 4 |
| 2019 Agosto | 0 | 13 | 13 |
| 2019 Julio | 4 | 12 | 16 |
| 2019 Junio | 0 | 13 | 13 |
| 2019 Mayo | 4 | 16 | 20 |
| 2019 Abril | 2 | 9 | 11 |
| 2019 Marzo | 0 | 5 | 5 |
| 2019 Febrero | 4 | 4 | 8 |
| 2018 Diciembre | 0 | 5 | 5 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 5 | 1 | 6 |
| 2018 Febrero | 37 | 1 | 38 |
| 2018 Enero | 32 | 5 | 37 |
| 2017 Diciembre | 36 | 9 | 45 |
| 2017 Noviembre | 25 | 4 | 29 |
| 2017 Octubre | 32 | 7 | 39 |
| 2017 Septiembre | 24 | 7 | 31 |
| 2017 Agosto | 21 | 5 | 26 |
| 2017 Julio | 20 | 9 | 29 |
| 2017 Junio | 19 | 11 | 30 |
| 2017 Mayo | 24 | 14 | 38 |
| 2017 Abril | 21 | 8 | 29 |
| 2017 Marzo | 16 | 44 | 60 |
| 2017 Febrero | 17 | 11 | 28 |
| 2017 Enero | 17 | 5 | 22 |
| 2016 Diciembre | 29 | 8 | 37 |
| 2016 Noviembre | 36 | 9 | 45 |
| 2016 Octubre | 30 | 12 | 42 |
| 2016 Septiembre | 0 | 11 | 11 |
| 2016 Agosto | 0 | 2 | 2 |
| 2016 Julio | 6 | 3 | 9 |
| 2016 Junio | 11 | 2 | 13 |
| 2016 Mayo | 9 | 9 | 18 |
| 2016 Abril | 8 | 2 | 10 |
| 2016 Marzo | 9 | 8 | 17 |
| 2016 Febrero | 15 | 1 | 16 |
| 2016 Enero | 6 | 2 | 8 |
| 2015 Noviembre | 0 | 1 | 1 |
| 2015 Octubre | 0 | 5 | 5 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 1 | 1 | 2 |
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