Yoshida Haruo, Adachi Tomoyuki, Nishi Hideaki, Kitaoka Kyoko, Kumai Yoshihiko
Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Department of Otolaryngology-Head and Neck Surgery, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Nagasaki 857-0134, Japan.
Radiol Case Rep. 2023 Mar 24;18(5):2019-2023. doi: 10.1016/j.radcr.2023.02.060. eCollection 2023 May.
Few reports have been made on the presentation and treatment of schwannomas originating in the sphenoid sinus due to their rarity. We report the case of a 60-year-old woman who presented with a cyst-like mass in the right sphenoid sinus on magnetic resonance imaging. Computed tomography showed a bone defect in the internal carotid artery (ICA) and enlargement of the round foramen on the affected side. A histopathological diagnosis of schwannoma was made, and endoscopic sinus surgery was performed. The anterior part of the tumor could be easily removed by aspiration; however, its adhesion to the ICA was remarkable, and its boundaries were unclear. Although partial paralysis of the maxillary nerve remained, no recurrence occurred for over 10 years. Careful evaluation should be performed to check for bone defects in the nerve to differentially diagnose schwannoma from cystic masses of the sphenoid sinus. Additionally, excision of masses similar to the presented case may expectedly be difficult because of unclear excisional margins and strong capsule adherence to important organs such as the ICA. Moreover, correct imaging, histopathological diagnosis, and appropriate informed consent are essential before surgery.
由于起源于蝶窦的施万细胞瘤较为罕见，关于其临床表现和治疗的报道较少。我们报告一例60岁女性病例，磁共振成像显示右侧蝶窦有一个囊肿样肿物。计算机断层扫描显示患侧颈内动脉有骨质缺损，圆孔扩大。经组织病理学诊断为施万细胞瘤，并进行了鼻内镜鼻窦手术。肿瘤前部可通过抽吸轻松切除；然而，其与颈内动脉粘连明显，边界不清。虽然上颌神经仍有部分麻痹，但10多年来未复发。应仔细评估以检查神经骨质缺损情况，以便将施万细胞瘤与蝶窦囊性肿物进行鉴别诊断。此外，由于切除边缘不清以及肿瘤包膜与颈内动脉等重要器官紧密粘连，预计切除类似本病例的肿物会很困难。此外，术前正确的影像学检查、组织病理学诊断及适当的知情同意至关重要。
