Clinical Analysis Of 12 Cases Of Sinonasal Schwannomas

ObjectiveThe aim of this article is to have a systematically retrospective analysis for these patients with schwannoma in the nasal cavity and paranasal sinuses. Making a summary of their clinical characteristics to improve the understanding, do early diagnosis and Reduce the rate of recurrence. MethodsA retrospective study from Jan 2008 to Dec 2014 in the second Hospital of Jilin University. 12 schwannoma cases in the sinonasal tract were studied. The contents include age, sexual distinction, clinical manifestation, physical sign, pathology, image data,surgical procedure. and many other aspects. These patients were treated with different operative methods according to the size of the lesions, involving the scope. Then follow up, we clean up the cavity with nasal endoscope during the follow-up period. We sometimes have a CT or MRI scan when necessary in order to reduce the probability of recurrence. Results12 nonasal schwannoma cases including 4 male and 8 female.Age 11-76 years. The course from 1 month to 8 years. 11 cases occurred unilateral and 1 case appearred bilateral. The presenting symptoms included nasal obstruction(7/11), headache(3/11), facial numbness(2/11), also can appear exophthalmos, diplopia, and decreased vision eye symptoms(3/11), early discovery of no symptom(1/11).Nasal endoscopy show smooth surface lumps as pale(3/11), pink(3/11) or cyst(1/11).The CT performance show soft tissue density shadow of clear boundaries; 5 cases had bony destruction; 3 cases infringed the skull base, including 1 case happenned cerebro-spinal fluid rhinorrhea during the operation.11 caces cured by minimally invasive endoscopic sinus surgery and none recurrenced. 1 case cured by nasal endoscopy combined nasal lateral incision surgery, recurrenced 2 years later and did endoscopic sinus surgery again;and there is no signs of recurring for a year.Pathological results were all benign, only 2 cases was confirmed schwannoma preoperatively through regular pathology combined with immunohistochemistry.8 cases sent to rapid pathological, identified as source of mesenchymal tumors, considered as a schwannoma.Only 2 cases confirmed as schwannoma directly by regular pathology, other 10 cases confirmed schwannoma by regular pathology combined with immunohistochemistry. Conclusions1. Benign and malignant schwannoma all can happen in the nasal cavity and paranasal sinuses,but malignant schwannoma is rare in this area.2. The sinonasal schwannoma preference happen unilateral.3. The diagnosis of sinonasal schwannoma should comprehensive clinical symptoms, signs, nasal endoscopic examination and sinus CT or MRI image, the final diagnosis depends on pathology, simple routine pathology is often not diagnosed, immunohistochemical is the gold standard for diagnosis.4. The treatment of best choice is surgical removal.Schwannoma is not sensitive to radiation and chemotherapy, surgical resection is the only effective treatment methods.The operation of main choice is endoscopic surgery or combining open surgery if necessary.