Soft palate mass: An unusual case
A 15 year old female reported to our Out Patient Department with a mass over the soft palate in the oral cavity for 2 months which gradually increased in size. It was not associated with pain, dysphagia, or oral bleeding. On examination of the oral cavity there was a bulge on the left side of the soft palate. On palpation the mass was about 2 × 2 cm in diameter with firm consistency, smooth surface margins, non-tender, and there was no breach in the mucosa. There was no loss of sensation over the swelling and the surrounding region. Palatal movements and gag reflex were intact. On panendoscopy there was no extension of the mass in the nasal cavity or the pharynx. Fine Needle Aspiration was increased number of vessels, monolayer of non-atypical endothelial cells with ill-defined cytoplasm suggestive of benign lesion.
Computed Tomography scan suggested a well-defined cystic lesion in the soft palate with central brightly enhancing component within the lesion with homogenous enhancement during venous phase. Feature highly suggestive of vascular lesion.
On Magnetic Resonance Imaging of oral cavity with Neck angiography a well-defined oval lesion of size 2.6 × 1.8cm in axial plain was seen in soft palate. The lesion was intensely hyperintense on T2 Weighted and Short TI Inversion Recovery (STIR) images and hypointense on T1 Weighted images. No abnormal feeder was seen to the mass on Magnetic Resonance angiography.
Surgical excision of the lesion was done under general anesthesia. The mass was removed in total and wound was closed using absorbable suture (vicryl 4-0). The specimen was sent for pathology.
Microscopic:Capsulated neoplasm composed of predominantly hypercellular areas. Spindle cells with wavy nuclei and eosinophilic cytoplasm seen arranged in whorled pattern with verrocay body formation. It showed occasional Antoni A and Antoni B areas. Few blood vessels seen scattered within the lesion with lymphocytes and hemosiderin laden macrophages.
A case of Neurilemmoma of the head and neck region was first described by Bogdasanian and Stout.Verocay in 1908 described schwannoma as a benign encapsulated nerve sheath neoplasm composed of Schwann cells. Stout (1935) coined the term neurilemmoma believing that this tumor arises from cells of sheath of Schwann which may also develop in any part of the body.
Schwannoma is a benign nerve sheath tumor arising from perineural Schwann cells which develop during the 4th week of gestation. Schwann cell is a type of glial cell of the peripheral nervous system that helps separate and insulate nerve cells. The tumor is frequently located in the head and neck region (25–48%) but only few (1%) are intraoral showing a predilection for the mobile portion of the tongue. Schwannoma of the palatal mucosa is extremely rare. Schwannomas are known to occur as solitary masses and they occur with a wide age range of first to eighth decades of life (average age 34 years) and with a definite female predilection. In some instances they are multiple and occur in association with neurofibromatosis type 2.
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