Supraglottic Schwannoma: Dilemma and Challenges in Management

Abstract

Laryngeal schwannomas are rare lesions that represent less than 1.5% of all benign laryngeal tumors. Its slow and submucosal growth may cause a delay in consultation and management. Herein, a case of right supraglottic schwannoma is diagnosed in a 34-year-old lady who was unconcerned about hoarseness for 10 years. She was referred to otorhinolaryngology clinic for assessment when hoarseness was detected during consultation for a gynecology surgery. Apart from hoarseness, there were no noisy breathing, shortness of breath or aspiration symptoms. Flexible nasopharyngolaryngoscopy showed a submucosal bulge at the right vestibular fold obscuring the vocal fold causing an airway concern. Computer tomography scan of the neck revealed a heterogenous enhancing mass centered at the right supraglottis measuring 2.6 × 2.7 × 2.7 cm. There were no erosions of the adjacent thyroid and arytenoid cartilages. Subsequently, complete excision of the lesion was done endoscopically. Definitive diagnosis of schwannoma was obtained via histopathology examination. This paper presents our approach and operative steps in the excision of this lesion using microlaryngoscopy with cold instruments.

Keywords: Larynx; Schwannoma; Supraglottic; Tumor.

Fig. 1

a CT Neck (axial view) showing right paraglottic mass. b CT Neck (coronal view) showing mass obscuring airway

Fig. 2

A submucosal bulge (yellow arrow) was identified at the right vestibular fold extending to paraglottic region obscuring the right vocal fold

Fig. 3

A superficial incision was made through the center of the right vestibular fold bulge

Fig. 4

A well encapsulated mass was discovered beneath the uncapped mucosal surface

Fig. 5

A second incision (yellow arrow) was made lateral to the aryepiglottic fold with intend to extrude it medially

Fig. 6

The right aryepiglottic fold was cut for full mass exposure and excision

Fig. 7

Right true cord and adequate airway visualized

Fig. 8

Histopathological examination. A Haematoxylin & Eosin (H&E) stain showed thin fibrous capsule (arrows) covering the tumour (H&E × 40). B A hypercellular area showing darkly stained nuclei arranged in parallel rows (arrows), alternating with anuclear pink fibrillary processes (*) forming Verocay body (H&E × 100). C A hypocellular area with no specific cellular arrangement (H&E × 40). D Immunohistochemisty (IHC) stain showed brown staining of tumour cells with S100 protein confirmed Schwann cell differentiation (IHC × 40)