International Journal of Oral & Maxillofacial Pathology. 2012;3(3):22-25 ISSN 2231 – 2250 Available online at http://www.journalgateway.com or www.ijomp.org ©2012 International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved Cellular Schwannoma of Oral Cavity: A Case Report Sudhir Bhalerao, Ranit Chhabra, Avinash Tamgadge, Sandhya Tamgadge Abstract Neurilemmoma or Schwannoma are typically solitary, slow growing, encapsulated neoplasm that originate in a nerve and are composed of Schwann cells in a collagenous matrix. The frequency of multiplicity is apparently 2 - 6% in the body which has been given the term Schwannomatosis. Unlike classical schwannoma, cellular schwannoma discloses a markedly increase in cellularity, comprising fascicles of spindle cells which can occasionally be associated with herringbone or storiform pattern. We report here a case of intraoral multiple schwannoma of oral cavity showing histopathological findings of cellular schwannoma, in a 38 year old female patient. Keywords: Neurilemmoma;Schwannoma;Nerve Sheath;Neoplasms;Neuroma;Neuroendocrine Tumors;Germ Cell and Embryonal. Sudhir Bhalerao, Ranit Chhabra, Avinash Tamgadge, Sandhya Tamgadge. Cellular Schwannoma of Oral Cavity: A Case Report. International Journal of Oral & Maxillofacial Pathology; 2012:3(3):22-25. ©International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved. Received on: 08/03/2012 Accepted on: 09/09/2012 Introduction Schwannoma is a benign, encapsulated perineural tumor, that originates from the Schwann cells of the nerve sheath derived from the neuroectoderm. 1 It was first described by Verocay in 1910. 2,3 The tumor is solitary, with a smooth surface, slow asymptomatic growth; and the clinical symptomatology depends on the nerve of origin. 1,4 The reports of multiple intraoral schwannoma have been very few. This multiplicity can or cannot be associated with Von Recklinghausen’s Syndrome. 5 We report here a case of multiple schwannoma which is not associated with any syndrome in a 38 year old female patient. Case Report A 38 year old female patient presented with multiple swelling in the right quadrant of both jaws since six months. According to the patient, the lesion was always been asymptomatic, with no associated pain or paresthesia. The patient’s medical history was noncontributory and has not undergone any surgery before. The clinical examination revealed multiple swellings; the largest being measured approximately 3 x 3 cm in dimension extending from distal of tooth #14 to tuberosity region (Figure 1a). On palpation it was firm in consistency and nontender. Swelling was also noted in the tooth #13, #21, #41, #42, #43 region involving gingiva on the labial side. A provisional diagnosis of pyogenic granuloma was given. Since the lesions were multiple, small and appeared to be benign, the surgeons chose to excise it for therapeutic purpose. The patient’s postoperative course was uneventful and follow up for one year has shown no recurrence. Microscopic examination revealed marked cellularity, comprising fascicles of spindle cells which in some areas are associated with herringbone pattern. Compact and hypercellular fascicles recapitulating Antoni-A areas are identified but not showing typical Verocay bodies (Figure 1b). In some areas it displayed short intersecting fascicles and whorls of Schwann cells (Figure 1c). Cells were also arranged in Antoni B type pattern with haphazard arrangement showing xanthomatous areas (Figure 1d). Areas of dense inflammatory cell infiltrate were also seen (Figure 1e). Because of the hypercellularity and lack of Verocay bodies we called it as “Cellular Variant of Schwannoma”. Cellular schwannoma are known to be diffusely positive for S 100 and markedly positive for vimentin. Immunohistochemical staining with vimentin was performed which showed marked positivity (Figure 1f). On the basis of routine hematoxylin and eosin staining along with immunohistochemical evaluation, the above said diagnosis of Cellular Variant of Schwannoma was confirmed. Lack of necrosis, hyperchromatism and atypical features helped in differentiating from other spindle cell tumors like fibrosarcoma and malignant peripheral nerve sheath tumor. The patient healed uneventfully with no Case Report