Encapsulated Sinonasal Schwannoma

Abstract

Extracranial schwannomas are uncommon neoplasms arising from the peripheral nerve sheath. Prior reports have listed the lack of a capsule as a distinctive feature of schwannomas of the sinonasal tract. We report a case of an encapsulated schwannoma arising in the nasal sidewall. A 21-year-old male with no significant past medical history presented to clinic with a 3-year history of progressive rightsided nasal obstruction. Physical examination revealed a firm subcutaneous mass and visible deformity of the right nasal sidewall (Figure 1). His computed tomography scan demonstrated a 2.0 cm 1.5 cm 1.7 cm mildly enhancing mass in the right lateral nasal wall with central hypointensity and no apparent septal or bony involvement (Figure 2). The patient was taken to the operating room for resection and reconstruction using an open septorhinoplasty approach. The right upper lateral cartilage (ULC) was collapsed but intact, and the scroll region had been separated. A spreader graft was used to support the right nasal valve, and the ULC was resuspended to the midvault. The lower lateral cartilage was sutured to the caudal edge of the ULC. A columellar strut was also used. On gross examination, the mass was gelatinous, yellowgray, and appeared encapsulated. Histologic examination revealed a well-encapsulated schwannoma (Figure 3). At 6month follow-up, his nasal obstruction had resolved, there was excellent nasal sidewall symmetry, and there was no evidence of recurrence. Discussion