Clinical Challenge: Firm Nodule on Nose - MPR

Clinical Challenge: Firm Nodule on Nose

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A 72-year-old woman is transported from an extended care facility for evaluation of a growth on her nose, which she describes as a “growing mass.” Examination reveals a 1.5cm, firm, flesh-colored nodule that is fixed to underlying tissue. Scattered keratoses are noted on her trunk and arms.

Biopsy of the lesion is performed, and pathologic examination reveals schwannoma. Also known as neurilemmomas, these tumors originate from Schwann cells situated in nerve sheaths. They usually present as painless, solitary, firm, and well-circumscribed tumors. The majority of tumors arise...

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Biopsy of the lesion is performed, and pathologic examination reveals schwannoma. Also known as neurilemmomas, these tumors originate from Schwann cells situated in nerve sheaths. They usually present as painless, solitary, firm, and well-circumscribed tumors. The majority of tumors arise within the head and neck region; rare sites of involvement include the tongue and gastrointestinal tract.1,2  The neoplasms are slow growing and benign; however, a few studies have documented rare malignant transformation.3,4

Diagnosis is based on histopathology that most commonly reveals compacted cells with distinctive spindled and ovoid nuclei.5 Surgical excision is curative, although this can be challenging depending on location and involvement of underlying neural tissue.6

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1.  Ulkü CH, Demir H, Yeşildemir HS, Esen H. [Lingual schwannoma]. Kulak Burun Bogaz Ihtis Derg. 2014;24(2):97-99.

2. Singh A, Mittal A, Garg B, Sood N. Schwannoma of the stomach: a case reportJ Med Case Rep. 2016;10:4.

3. Colreavy MP, Lacy PD, Hughes J, et al. Head and neck schwannomas – a 10 year reviewJ Laryngol Otol. 2000;114(2):119-124.

4. Kragh LV, Soule EH, Masson JK. Benign and malignant neurilemmomas of the head and neckSurg Gynecol Obstet. 1960;111:211-218.

5. Rosai J. Ackerman’s Surgical Pathology. 8th ed. Mosby-Year Book, Inc: St. Louis, MI; 1995:2264-2266.

6.  Sá Â, Nobre Azevedo L, Cunha L. [Schwannoma of the upper extremity: retrospective analysis of 17 cases]Acta Med Port. 2016;29(9):519-524.