Journal of Medicine, Radiology, Pathology & Surgery (2016), 2, 20–23 20 Journal of Medicine, Radiology, Pathology & Surgery ● Vol. 2:1 ● Jan-Feb 2016 CASE REPORT Ancient Schwannoma of the tongue Mahima V. Guledgud 1 , Saikrishna Degala 2 , Karthikeya Patil 1 , Meghana Maruthi 1 1 Department of Oral Medicine & Radiology, J.S.S. Dental College & Hospital, J.S.S. University, Mysore, Karnataka, India, 2 Department of Oral & Maxillofacial Surgery, J.S.S. Dental College & Hospital, J.S.S. University, Mysore, Karnataka, India Abstract Ancient Schwannoma is a rare Schwannoma variant which is a painless, slow-growing benign neoplasm of Schwann cell origin. It is relatively a rare tumor in the head and neck region. We report a case of ancient Schwannoma of the tongue in a 38-year-old female patient, who presented with a slowly progressing painless mass over the tongue. Investigatory impression of ultrasonography and fne-needle aspiration cytology of this lesion was suggestive to be a benign tumor of muscle/nerve origin. An excisional biopsy of the mass with primary closure was done. A fnal diagnosis of ancient Schwannoma was given based on histopathological examination. Keywords: Ancient Schwannoma, neurilemmoma, Schwannoma, tongue Correspondence: Dr. Mahima V. Guledgud, Department of Oral Medicine & Radiology, JSS Dental College & Hospital, JSS University, Mysore - 570 015, Karnataka, India. Email: mahimamds@gmail. com Received: 05 November 2015; Accepted: 03 January 2016 doi: 10.15713/ins.jmrps.47 Introduction Schwannoma, otherwise known as neurilemmoma, is a benign neoplasm originating from Schwann cell. [1] It can originate from any nerve covered with Schwann cell sheath, which includes cranial nerves (except for the frst and second cranial nerves), spinal and autonomic nervous system. [2,3] It is relatively uncommon although about 25-48% of all cases manifest in the head and neck region. [1] The most common type is acoustic neuroma afecting the vestibulocochlear nerve. [4] However, about 1-2% occurs intraorally with tongue being the most common site followed by the palate, foor of mouth, oral mucosa, and mandible. [5,6] Ancient Schwannoma is an uncommon Schwannoma variant which is a slow growing encapsulated painless benign neoplasm. [3] Case Report A 38-year-old known hypotensive female patient presented to us with an asymptomatic slow growing swelling on the tip of the tongue crossing the midline, of 20 years duration. Initially, it appeared as a pea sized swelling when the patient was 2 months pregnant at the age of 18 years and gradually increased to the present size. It was painless and there was a loss of clarity of speech. History of occasional bleeding from the swelling was elicited. Clinical examination revealed a conical soft tissue mass measuring about 5 cm × 3 cm × 2.5 cm in its greatest dimension on the dorsal tongue extending inferiorly onto the ventral surface. Dorsally, it appeared pink and was velvety in texture, frm, and hard in consistency except for the tip of the mass which was smooth and soft. Ventrally, the mass was smooth, lobulated, frm, and cystic not fxed to the overlying tissue with dilated vessels [Figures 1 and 2]. It was non-tender, uncompressible, and irreducible on palpation. There was no signifcant weight loss and lymphadenopathy. There was no evidence of similar type mass elsewhere in the body. Routine blood investigation revealed, hemoglobin and red blood corpuscle count to be 9.8 g% and 2.9 million cells/mm 3 , respectively, giving an impression as moderate anemia. Ultrasonography [Figure 3] and fne- needle aspiration cytology (FNAC) were suggestive of benign tumor possibly of muscle/nerve origin. The patient underwent excisional biopsy of the mass under general anesthesia, and the specimen was sent for histopathological examination. The patient was taken up for the excisional biopsy under general anesthesia. Nasoendotracheal intubation was done. The demarcation of the incision was performed with methylene blue. The tongue was pulled out by placing two black braided silk