CASE REPORT


A Case of Schwannoma of the Submandibular Region



Babatunde O. Bamgbose1, *, Akiko Sato2, Yoshinobu Yanagi2, 3, 4, Miki Hisatomi2, Yohei Takeshita1, Irfan Sugianto1, Junichi Asaumi1, 2, 3, 4
1 Department of Oral and Maxillofacial Radiology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
2 Department of Dentomaxillofacial Radiology and Oral Diagnosis, Okayama University Hospital, Okayama, Japan.
3 Oral Inspection and Diagnostic Center, Okayama University Hospital, Okayama, Japan.
4 Dental Comprehensive Diagnosis Department, Okayama University Hospital, Okayama, Japan.


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© 2018 Bamgbose et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Oral and Maxillofacial Radiology , Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 5-1, Shikata-Cho, 2-Chome, Kita-Ku, Okayama, Japan 700-8558, Tel: +81(086)235-6621; Fax:700-8558; E-mail: drtundebamgbose@yahoo.com


Abstract

Background:

We herein described a rare case of schwannoma of the hypoglossal nerve in the submandibular region with diagnostic imaging and histopathological findings.

Case Report:

A 31-years-old woman has had a palpable firm, rubbery, freely mobile mass in the submandibular region. Of imaging, MR images showed homogeneous isointensity on T1-weighted imaging (T1-WI), heterogeneous hypointensity on T2-WI, heterogeneous hyperintensity on short T1 inversion recovery (STIR), and heterogeneous enhancement on contrast-enhanced T1-WI. A clear capsule was observed on the margin and showed hypointense on T2-WI. Dynamic MRI showed heterogeneous gradual increased enhancement. The uptake of contrast medium was regionally slow. Diagnostic imaging using CT and MRI was suspected of salivary gland tumor or neurogenic tumor. In consideration of imaging diagnosis, a pleomorphic adenoma or a schwannoma was suspected. Final diagnosis was confirmed on the basis of histopathological finding and intraoperative findings.

Conclusion:

1. Histopathologic examination is inevitable, because MR findings are not specific.

2. Schwannomas were said to have specific MRI properties, including specific signs (split-fat sign, fascicular sign, target sign). However, they are not always observed.

3. This case confirmed the differential diagnosis on the basis of the intraoperative finding that the tumor was continuous with the hypoglossal nerve.

Keywords: Schwannoma, Submandibular region, MRI, Antoni type A, Antoni type B, Heterogeneous hypointensity.