Neurilemmoma occurs m all parts of the body, but occurrence in the oral and maxillofacial regions is relatively rare. In the oral and maxillofacial region, tumors usually arise on the tongue and rarely on the lip. The upper lip especially is a rare site of occurrence. Recently, we treated a case of neurilemmoma located in the upper lip. The patient, a 48-year-old woman, visited our hospital with a complaint of a mass formation on the left side of the upper lip. Excision of the tumor was done under local anesthesia. Up on examination under the light microscopy, it was found to be Antoni A type neurilemmoma. In addition, immunohistochemical study using S-100 protein antibody showed a positive reactivity in the tumor cell. There was no evidence of recurrence 6 months after the operation.論文http://purl.org/coar/resource_type/c_650

Arakaki, Keiichi

Arasaki, Akira

Hiratsuka, Hiroyoshi

Inoue, Hirofumi

Kano, Takeshi

Makishi, Syoko

Nakama, Jyoji

Nakamori, Kenji

Shinya, Teruyo

Sunakawa, Hajime

Tanaka, Shiho

English

University of the Ryukyus Repository

琉球大学学術リポジトリ[症例報告]Neurilemmoma of the upper lip :literature review言語: English出版者: 琉球医学会公開日: 2010-07-02キーワード (Ja): キーワード (En): Neurilemmoma, upper lip作成者: Kano, Takeshi, Sunakawa, Hajime, Hiratsuka,Hiroyoshi, Arasaki, Akira, Arakaki, Keiichi, Nakamori,Kenji, Shinya, Teruyo, Inoue, Hirofumi, Tanaka, Shiho,Nakama, Jyoji, Makishi, Syokoメールアドレス: 所属: メタデータhttp://hdl.handle.net/20.500.12000/0002016153URLRyukyu Med. J., 22{ 1,2) 59-62, 2003Neurilemmoma of the upper lip : literature reviewTakeshi Kano, Hajime Sunakawa, Hiroyoshi Hiratsuka, Akira ArasakiKenchi Arakaki, Kenji Nakamon, Teruyo Shmya, Hirofumi Inoue, Shiho TanakaJyoji Nakama and Syoko MakishiDepartment of Oral and Maxdlofacial Surgery, School of Medicine,University of the Ryukyus, Okinawa, Japan(Received on February 13, 2003, accepted on May 26, 2003)ABSTRACTNeurilemmoma occurs m all parts of the body, but occurrence in the oral andmaxillofacial regions is relatively rare. In the oral and maxillofacial region, tumorsusually arise on the tongue and rarely on the lip. The upper lip especially is a rare siteof occurrence. Recently, we treated a case of neunlemmoma located in the upper lip.The patient, a 48-year-old woman, visited our hospital with a complaint of a mass for-mation on the left side of the upper lip. Excision of the tumor was done under localanesthesia. Up on examination under the light microscopy, it was found to be AntomA type neurilemmoma. In addition, immunohistochemical study using S-100 protein an-tibody, showed a positive reactivity in the tumor cell. There was no evidence of recur-rence 6 months after the operation. Ryukyu Med. J., 22(1,2) 59-62, 2003Key words: Neurilemmoma, upper lipINTRODUCTIONNeurilemmoma is a benign tumor arising fromSchwann cells. In the oral and maxillofacial region,tumors usually arise on the tongue and rarely onthe lip. A literature search revealed that 5 cases ofneunlemmoma of the upper lip have been previouslybeen reported in Japan1 2. We present a case ofneurilemmoma of the left side of the upper lip.CASE REPORTA48-year-old Japanese woman was referred tothe Oral and Maxillofacial Surgery at the Univer-sity of Ryukyus Hospital for the evaluation of apainless mass on the upper lip. She had noticed themass about 2 months prior but had not soughtmedical treatment because there were no symptoms.Oral examination disclosed a painless mass ofthe upper lip measuring 10 x 10 mm. The mass waslobular with an elastic consistency. The overlyingmucosal surface appeared normal in color and tex-ture (Fig. 1). The clinical impression was a59叫Fig. 1 Nobule on upper lip. Approximatery 1 cm in di-ameter.salivary gland tumor. An examination of the headand neck was otherwise normal.Ultrasonography (US) was performed with alinear scanner 5.0 Mhz (RT-2800: Yokogawa Medi-cal, Tokyo). Imaging showed a heterogeneous masswith hypoechoic features, well-delineated margins,60 Neurilemmoma of the upper lipFig. 2 Ultrasonography showsing a heterogeneous masswith hypoechoic features, well-delineated margins,and an enhancement of posterior echo.Fig. 3 Tumor cells aligned in places to form a charac-teristic palisading patten (Hematoxyline eosin stain.Original magnification x 200).and an enhancement of the posterior echo (Fig. 2 ).Excision was performed under local anesthesia.The excised tissue was friable and of a grayish yel-low color. Sutures were removed 1 week after theprocedure. No post operative complications oc-curred, and there has been no sign of recurrence atr,u- 1「一一t: -Tr-チ:　　　　　　一I定を >;i崩lT、H満i,vty**-　　　　　　　　　　　　　　　　　　　　-　　　　　　- 1/( ).Jft怒・サ.t-zmmFig. 4 Tumor cells showing strong S-100 reactivity ( ×200).6 months post surgery.Microscopic examination showed compactlyarranged spindle cells oriented parallel to one an-other, forming interlacing bundles. There was nu-clear palisading of Antoni A type (Fig. 3). Thenuclei were not malignant. A confirmatory S-100immunoperoxidase stain was positive (Fig. 4). Thetumor had a thm connective tissue capsule. The finaldiagnosis was neurilemmoma.DISCUSSIONThe neurilemmoma, also called schwannoma orneurmoma, is a benign tumor of the peripheralnerve sheath believed to originate from Schwanncells. Schwannoma was first established as a path0-logic entity in 1910 by Verocay . Embryologically,Schwann cells arise during the fourth week ofdevelopment from a specialized population ofectomesenchymal cells of the neural crest, whichthen detach from the neural tube and migrate intothe embryo. Schwann cells form a thm barrieraround each extracramal nerve fiber and wraplarger fibers with an insulating membrane, themyelm sheath, to enhance nerve conductance. Asnerves exist m the bram and spinal cord, there is achange m the myelmation by Schwann cells.Neurilemmoma arise when proliferating Schwanncells form a tumor mass encompassing motor andsensory peripheral nerves4In a study of soft tissue tumors by Enjojiet al5 , there were 825 neurilemmomas out of 8,806cases, a frequency close to that of hemangiomaand lipoma. Das Gupta et al , reported thatKano T. et al.of a series of 136 tumors of the head and neck oc-curred either withm or around the oral cavity.Neurilemmoma is a relatively rare benign oraltumor.It is generally agreed that in the oral cavity,the tongue is involved most frequently. As for otheroral locations, the palate and buccal mucosa are thenext most common sites . Slow growing, painfulor painless lumps in and around the mouth arefrequently found. A literature search revealed that5 cases of neurilemmoma of the upper lip have beenpreviously reported in Japanl . Neurilemmoma inthe lower lip exceeds that of the upper lip by a ratioof 3.4-5.0:ll'2　. The reason for this difference isthought to be due to the differences in embryonicdevelopment of the upper and lower lips. It has alsobeen postulated that potential tumor cells are de-stroyed by the continuous presence of inflammatorycells in the lower lip induced by frequent traumaticepisodes . No clear reason for this difference hasbeen proven. Neunlemmoma has been reported to be 2to 4 times more common in women than in menllIt has also been reported however by Williams et al,that 83% of a group of 12 paitents were malelIntraoral neurilemmomas in soft tissue appear assmooth submucosal swellings, thus resemblingother lesions like mucocoeles, fibroepithelial polyps,fibromas, lipomas and benign salivary gland tu-mors.Histologically, neurilemmoma is an umlocularmass surrounded by a capsule of epmeurium and re-sidual nerve fibers, often with the peripheral nerveattached to the edge of the neoplasml . Onhistologic examination the neunlemmoma appearsas a well-defined fibrous lesion that may presenttwo different patterns. One pattern is the Antoni Atype, which is characterized by cells that havealigned nuclei, simulating a palisade, and surroundan anamorphous homogenous substance calledVerocay body. The other pattern is the Antoni Btype, which is characterized by cells that are ar-ranged in a random fashion and are surrounded bycollagenous fibersl . S-100 protein is useful inconhrmg the diagnosis of neurilemmoma. Thisacidic protein, common to supporting cells of thecentral and peripheral nervous system, can be con-sistently demonstrated m neurilemmomas as themajority of cells withm neunlemmomas have theantigemc phenotype of Schwann cells. In our case,lmmunostammg was particularly strong in the61Antoni A areas while less so in the Antoni B areas,a consistent feature in the neunlemmoma.As a diagnostic and treatment tool, US, CT, orMRI may be helpful for the estimation of tumormargins and determination of whether there is mill-tration into the surrounding structures. However,because most tumors of the upper lip present asrelatively small lesions, a differential diagnosis isestablished using CT, MRI should not be consideredas routine or necessary. We believe, therefore, thatusing US is useful in examining the upper lip.Few reports have described the characteristics ofneurilemmoma on US　. Chinn et al were thefirst to report the ultrasonographic characteristicsof neurilemmoma. The US imaging showed hetero-geneous, hypoechoic features and posterior acousticenhancement consistent with previous reportsOur findings were similar to these previous reportsreported.Treatment is always surgical, and complete ex-cision results in no recurrence . To our knowledge,no other reports have described malignant transfor-mation of neurilemmoma in the upper lip1 2ACKNOWLEGEMENTWe are grateful to Prof. N.Yoshimi of the De-partment of Pathology, School of Medicine, Univer-sity of the Ryukyus for his help m evaluating thehistological material.REFERENCES1 ) Chu H., Kitamura K., Hirano Y., Kobayashi T.,Tagawa T. and Murata M∴ A case of Schwannomaof the lower lip, Review of the literature inJapan and histogenesis. J. Jpn. Stomatol Soc.41: 181-187, 1992 (in Japanese).2 ) Yanagisawa T., Ishikawa T., Honda K., Natsumi Y.,Maeda N. and Yoshioka W. Neurilemmoma ofthe lower lip:Report of a case. Jpn. J. OralMaxillofac. Surg. 34: 56-58,1988 (in Japanese).3 ) Verocay J∴ Zur Kenntnis der Neurofibroma.Beitr Path Anat 48: 1, 1910.4 ) Pfeifle R., Baur D.A., Paulino A. and Helman J∴Schwannoma of the tongue, report of 2 cases. JOral Maxillofac Surg 59: 802-804, 2001.5 ) Enjoji M., Iwasaki H. and Komatsu K.: Benignsoft-tissue tumors in Japan: A statistic analysisof 8,086 tumors. Jpn J Cancer Clm 20: 594-609,62 Neurilemmoma of the upper lip1974 (in Japanese).6 ) Das Gupta, T.K., Bras field, R.D., Strong, E.W.and Hadju, Sエ: Benign solitary schwannomas(neurilemmomas). Cancer 24: 355-366, 1969.7 ) Sigurds O., Krolls J., Perry McGinnis, N., KogoM. and Daniel Quon. Multmodular versusplexiform nenlemoma of the hard palate, reportof a case. ORAL SURG ORAL MED ORALPATHOL. 77: 154-157, 1994.8 ) Adachi M., Naitoh S., Inamoto H., Matsushita H.,Takehana S. and Kameyama Y∴ Neurilemmomaof the upper lip, Report of a case. Jpn. J. OralMaxillofac. Surg. 35 :1646-1649,1989 (in Japa-nese).9 ) Krolls SO. and Hicks JL : Mixed tumors of thelower lip. Oral surgery. 35: 212, 1973.10) Barnes,L., Peel, R.L. and Verbin, R.S∴ Tumorsof the nervous system. In: Surgical Pathologyof Head and Neck., L.Barnes (ed). p662. NewYork: M. Dekker Inc.ll) H.K. Williams, H. Cannell, K. Silvester and S.M.Williams: Neunlemmoma of the head and neck.Brit. J. Oral Maxillofac. Surg 31: 32-35, 1993.12) Villanueva J., Gigoux C. and Sole F. : Centralneunlemmoma of the maxilla, a case report.ORAL SURG ORAL MED ORAL PATHOL. 79:41-43, 1995.13) Asaumi J., Konouchi H.and Kishi K.: Schwannomaof the upper lip, ultrasound, CT, and MRI find-ings. J Oral Maxillofac Surg 58: 1173-1175, 2000.14) Chinn DH, Filly RA and Callen PW: Unusualultrasonographic appearance of a solid schwannoma.J Clin Ultrasound 10: 243-245, 1982.15) Kodama N., Sekiguchi T., Honma K., KodamaS.,Nagai I. and Kohama G.: A case of Neunlemmomain the oral floor. J Jpn Soc Oral Tumor 7:1995 (in Japanese).16) Tsuji T., Noguchi M., Hiratsuka H., SekiguchiT., Kojima T., Kon. H, Soma K., Odajima T. andKohama G.: A case of Schwannoma of thetongue; Usefulness of MRI m preoperative diag-nosis Jpn. J. Oral Maxillofac. Surg. 37: 87-91,1991 (in Japanese).

[症例報告]Neurilemmoma of the upper lip : literature review

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[症例報告]Neurilemmoma of the upper lip : literature review

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