NEURILEMMOMA (SCHWANNOMA) PRESENTING AS BASE OF TONGUE MASS: A CASE REPORT

Abstract

Background: Schwannomas are benign peripheral nerve sheath tumors arising from Schwann cells. While they commonly occur in the head and neck region, their presence at the base of the tongue is extremely rare. These tumors typically present as slow-growing, painless masses that may lead to airway obstruction, dysphagia, and speech difficulties in advanced cases. Early diagnosis and management are crucial to prevent complications.

Objective: To present a rare case of tongue base schwannoma, emphasizing the diagnostic challenges, imaging findings, surgical management, and histopathological confirmation.

Methods: A 51-year-old male with diabetes mellitus and ischemic heart disease presented with a progressively enlarging, painless mass at the base of the tongue for six years, leading to airway compromise and dysphagia. Clinical examination, fiberoptic nasolaryngoscopy, and imaging (CT and MRI) revealed a well-circumscribed, hypodense lesion (6.0 × 5.7 × 6.0 cm) involving tongue muscles with bilateral level I and II lymphadenopathy. The patient initially refused surgical intervention but returned four years later with worsening symptoms, necessitating emergency tracheostomy followed by transoral excision under general anesthesia. Histopathological and immunohistochemical analysis confirmed the diagnosis.

Results: Histopathology showed spindle-shaped Schwann cells with Antoni A and B areas, degenerative changes, and no malignancy. Immunohistochemistry was positive for S-100 and SOX-10, confirming schwannoma. The patient had an uneventful recovery, with immediate symptomatic relief. Two weeks postoperatively, the tracheostomy tube was removed. At a six-month follow-up, the patient remained asymptomatic, with no recurrence.

Conclusion: Schwannomas of the tongue base are rare and may cause airway compromise in advanced stages. MRI is the imaging modality of choice, while histopathology with immunohistochemistry confirms the diagnosis. Surgical excision remains the definitive treatment with a low recurrence rate. Early intervention is essential for optimal patient outcomes.