Hypoglossal schwannoma in the submandibular region

Hypoglossal nerve schwannomas originating extracranially and mimicking a submandibular salivary gland tumour are extremely rare. A 55-year-old woman presented with a painless, gradually increasing swelling in the right submandibular region for the past 1 year. Fine-needle aspiration cytology and contrast-enhanced CT of the swelling showed features of submandibular gland malignant lesion. Intraoperatively, the right submandibular gland with a hypoglossal nerve swelling was noticed. Right submandibular gland along with the hypoglossal swelling were excised with adequate margins. However, the postoperative histopathology was reported as hypoglossal nerve schwannoma and a normal salivary gland. Accurate preoperative diagnosis of hypoglossal schwannomas may be challenging. A high level of suspicion must be sought for in cases with unusual clinical presentations and imaging characteristics. Herein, we report a rare presentation of submandibular hypoglossal schwannoma along with its clinical features and its management.

Hypoglossal schwannoma masquerading as a submandibular gland tumor: a case report

Background: Hypoglossal nerve schwannoma in the submandibular space is rare. This case report presents the treatment of a young patient affected by an unusual hypoglossal nerve schwannoma at the right side of the submandibular region. Case representation: A 31-year-old female presented to our department with complaints of a right-sided submandibular region mass. None calculi was observed by CBCT. An MRI of the neck demonstrating a 18×12mm mass located at the submandibular region. Based on clinical presentation and imaging, a diagnosis of a submandibular gland tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the submandibular gland. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion: Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a submandibular space mass. During operation, it might be better to explore the mass before managing the submandibular gland.

Hypoglossal Schwannoma Masquerading as a Submandibular Gland Tumor: a Case Report

Background: Hypoglossal nerve schwannoma in the submandibular space is rare. This case report presents the treatment of a young patient affected by an unusual hypoglossal nerve schwannoma at the right side of the submandibular region. Case representation: A 31-year-old female presented to our department with complaints of a right-sided submandibular region mass. None calculi was observed by CBCT. An MRI of the neck demonstrating a 18×12mm mass located at the submandibular region. Based on clinical presentation and imaging, a diagnosis of a submandibular gland tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the submandibular gland. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion: Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a submandibular space mass. During operation, it might be better to explore the mass before managing the submandibular gland.

Cervical myeloradiculopathy with Hypoglossal Schwannoma mimicking Amyotrophic lateral sclerosis: a Case report

Background: A presentation of upper motor and lower motor clinical signs without sensory impairment may suggest Amyotrophic lateral sclerosis, especially when it involves limbs and bulbar regions. However, co-existence of two or more unrelated pathologies can give rise to a clinical picture similar to Amyotrophic lateral sclerosis. Case presentation: A 45 year old lady presented with slowly progressive right upper limb weakness for 6 months and mild left upper limb weakness for 2 months associated with muscle twitching. Her family members have noticed a change in character of her speech for few weeks. She couldn’t recall a radicular pain at any given time. On examination, her right deltoid was wasted with numerous fasciculations over right proximal muscles. Right shoulder movements were weak. Her left deltoid was slightly wasted and fasciculations were appreciated. Her both biceps and supinator jerks were normal with exaggerated triceps jerks and positive Hoffman sign. Sensory and proprioception examinations were unremarkable. Both lower limbs were hypertonic with exaggerated knee and ankle jerks. Ankle clonus was absent and plantar responses were equivocal. Her tongue was deviated to right side with fascicuations and wasting of right side. Palatal movements and Jaw jerk were normal. She was clinically diagnosed as possible amyotrophic lateral sclerosis. Electromyography showed denervation changes in deltoids and biceps with right predominance and right genioglossus muscle too showed denervation changes. Magnetic resonant imaging of brain stem was undertaken especially because her tongue wasting and fasciculations were unilateral and it showed a right sided hypoglossal schwannoma. Magnetic resonant imaging of cervical spine revealed degenerative disk disease with mild cord compression and exit foramina narrowing at multiple levels. Conclusions: Pure motor symptoms with a mixture of upper motor and lower motor signs may suggest a clinical diagnosis of Amyotrophic lateral sclerosis. However, when there are rare manifestations of a relatively common disease, such as unilateral tongue involvement as in the above scenario, a higher degree of clinical suspicion is needed to think of a dual pathology. Keywords: Hypoglossal schwannoma, cervical myeloradiculopathy, Amyotrophic lateral sclerosis, dual pathology.