What is your diagnosis?
Case for diagnosis. Infraorbital schwannoma
Irving Llibrán Reyna-Rodríguez, Sonia Chavez-Alvarez, Jorge Ocampo-Candiani
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Dermatology Department, Faculty of Medicine, Hospital Universitario “Dr. Jose E. Gonzalez”, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Infraorbital schwannoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "358" "paginaFinal" => "361" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Irving Llibrán Reyna-Rodríguez, Sonia Chavez-Alvarez, Jorge Ocampo-Candiani" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Irving Llibrán" "apellidos" => "Reyna-Rodríguez" ] 1 => array:2 [ "nombre" => "Sonia" "apellidos" => "Chavez-Alvarez" ] 2 => array:4 [ "nombre" => "Jorge" "apellidos" => "Ocampo-Candiani" "email" => array:1 [ 0 => "jocampo2000@yahoo.com.mx" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Department, Faculty of Medicine, Hospital Universitario “Dr. Jose E. Gonzalez”, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1297 "Ancho" => 3175 "Tamanyo" => 253256 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Skin-colored papule on the right cheek. (B) Polarized dermoscopic image showing non-characteristic features.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old male, with an unremarkable personal and family history, presented for evaluation of an asymptomatic papule located on his right cheek that had been present since childhood. He had not received any treatment. Physical examination revealed a solitary, circumscribed, firm, skin-colored, 4–6 mm papule (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopic (polarized mode, Dermlite) examination demonstrated non-specific erythema, normal pigmentary network without follicular plugging (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). An excisional biopsy of the lesion was performed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Histopathology (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> A and B) revealed an encapsulated neoplasm within the dermis; on higher magnification, we could see narrow, elongated, and wavy cells with an ill-defined cytoplasm, dense chromatin and tapered ends interspersed with collagen fibers. Immunohistochemical stains for S-100 and (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> A and B) and Glial Fibrillary Acidic Protein (GFAP) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> C and D) were positive. Pathologic findings were consistent with tissue of Antoni B pattern. The patient had good healing of the site of excisional biopsy.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis?</span><p id="par0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Dermal nevus</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Sebaceous hyperplasia</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Infraorbital schwannoma</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Trichoepithelioma</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Schwannomas, also called neurilemmomas, are benign ectodermal neoplasms originated from peripheral, cranial, or autonomic nerve Schwann cell sheaths.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Male: Female ratio is 1:1 but some authors consider that women are more affected.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Most of the extracranial schwannomas are present in the head and neck (25%–45%).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> These can develop from any of the 12 cranial nerves (mainly auditory nerve); except optic and olfactory (because they lack Schwann cells in their sheaths).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The trigeminal nerve is rarely associated with schwannomas; especially in the infraorbital nerve area. <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> They present as a slow-growing mass, without pain or a neurological deficit.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Diagnosis is made with histopathology and clinical correlation. Histopathologically, Schwann cells can be seen as spindle-shaped cells in parallel rows forming a typical palisading pattern of Verocay bodies. Classification is based on cellularity: Antoni A (hypocellular) or Antoni B (hypercellular).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> No fibroblasts, mast cells, neurilemmal, or endoneurial cells are present.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Possible clinical differential diagnoses in this location include dermal nevus, dermoid cyst, sebaceous hyperplasia, trichoepithelioma, and palisaded encapsulated neuroma (PEN). On histopathology the principal differential diagnosis is PEN (contains axons), both tumors are S-100 positive, schwannoma is positive for GFAP and negative for neurofilament while PEN is just the opposite.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Other less possible histopathological differential diagnoses are neurofibroma (lacks a capsule, contains mucopolysaccharide ground substance and fewer axons with myelin sheaths), traumatic neuroma (axonal and Schwann cells in addition to scarring and inflammatory cells), and leiomyoma (spindle cell lesion composed of muscle cells).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Extracranial schwannomas have a good prognosis with exclusively surgical treatment (approach according to size, extent, and anatomical location).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Malignant transformation is extremely rare when presenting as an isolated lesion.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The incidental finding of rare tumors like this infraorbital nerve schwannoma should make clinicians consider a greater spectrum of differential diagnosis for a unilateral skin-colored papule on the cheek of healthy middle-age patients.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors' contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Irving Llibrán Reyna-Rodríguez: Study conception and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; critical literature review.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Sonia Chavez-Alvarez: Study conception and planning; critical literature review; effective participation in research orientation; approval of the final version of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Jorge Ocampo-Candiani: Study conception and planning; critical literature review; effective participation in research orientation; approval of the final version of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1521070" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1379246" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "What is your diagnosis?" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors' contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-06-29" "fechaAceptado" => "2020-08-26" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1379246" "palabras" => array:4 [ 0 => "Infraorbital schwannoma" 1 => "Neurilemmoma" 2 => "Schwannoma" 3 => "Tumor" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We report a 40-year-old man, with an unremarkable personal and family history, who presented for evaluation of an asymptomatic papule located on his right cheek. Histopathology revealed an encapsulated neoplasm within the dermis; composed by narrow, elongated, and wavy cells with an ill-defined cytoplasm, dense chromatin and tapered ends interspersed with collagen fibers. Pathologic findings were consistent with tissue of Antoni B pattern. The diagnosis was an infraorbital schwannoma. The incidental finding of rare tumors like this, should make clinicians consider a greater spectrum of differential diagnoses for a unilateral skin-colored papule on the cheek of patients.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Reyna-Rodríguez IL, Chavez-Alvarez S, Ocampo-Candiani J. Case for diagnosis. Infraorbital schwannoma. An Bras Dermatol. 2021;96:358–61.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Department, Faculty of Medicine, Hospital Universitario “Dr. Jose E. Gonzalez”, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1297 "Ancho" => 3175 "Tamanyo" => 253256 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Skin-colored papule on the right cheek. (B) Polarized dermoscopic image showing non-characteristic features.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1287 "Ancho" => 3175 "Tamanyo" => 889568 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) A well-defined encapsulated tumor in the dermis (Hematoxylin & eosin, ×100). (B) Spindle Schwann cells with Verocay bodies, Anthony B pattern (Hematoxylin & eosin, ×200).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2921 "Ancho" => 3175 "Tamanyo" => 1670624 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A and B) Positive immunohistochemistry exam for S100. (C and D) Positive immunohistochemistry exam for GFAP.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Schwannoma of the upper lip: ultrasound, CT, and MRI findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Asaumi" 1 => "H. Konouchi" 2 => "K. Kishi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/joms.2000.9584" "Revista" => array:6 [ "tituloSerie" => "J Oral Maxillofac Surg." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 8 | 27 |
| 2024 October | 98 | 91 | 189 |
| 2024 September | 145 | 134 | 279 |
| 2024 August | 161 | 139 | 300 |
| 2024 July | 153 | 123 | 276 |
| 2024 June | 131 | 82 | 213 |
| 2024 May | 109 | 78 | 187 |
| 2024 April | 120 | 86 | 206 |
| 2024 March | 129 | 72 | 201 |
| 2024 February | 153 | 84 | 237 |
| 2024 January | 109 | 53 | 162 |
| 2023 December | 75 | 57 | 132 |
| 2023 November | 90 | 78 | 168 |
| 2023 October | 78 | 72 | 150 |
| 2023 September | 69 | 73 | 142 |
| 2023 August | 59 | 39 | 98 |
| 2023 July | 111 | 43 | 154 |
| 2023 June | 107 | 54 | 161 |
| 2023 May | 78 | 21 | 99 |
| 2023 April | 58 | 21 | 79 |
| 2023 March | 87 | 49 | 136 |
| 2023 February | 71 | 42 | 113 |
| 2023 January | 60 | 43 | 103 |
| 2022 December | 72 | 43 | 115 |
| 2022 November | 88 | 57 | 145 |
| 2022 October | 109 | 62 | 171 |
| 2022 September | 66 | 72 | 138 |
| 2022 August | 54 | 55 | 109 |
| 2022 July | 58 | 61 | 119 |
| 2022 June | 73 | 67 | 140 |
| 2022 May | 93 | 48 | 141 |
| 2022 April | 87 | 65 | 152 |
| 2022 March | 70 | 65 | 135 |
| 2022 February | 47 | 53 | 100 |
| 2022 January | 79 | 91 | 170 |
| 2021 December | 74 | 61 | 135 |
| 2021 November | 69 | 85 | 154 |
| 2021 October | 83 | 93 | 176 |
| 2021 September | 77 | 64 | 141 |
| 2021 August | 72 | 54 | 126 |
| 2021 July | 73 | 60 | 133 |
| 2021 June | 139 | 100 | 239 |
| 2021 May | 102 | 96 | 198 |
| 2021 April | 284 | 329 | 613 |
| 2021 March | 50 | 60 | 110 |
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