An Unusual Site for an Intraoral Schwannoma: A Case Report Hasan Nedim Arda, MD,* Ozgur Akdogan, MD,* Nilufer Arda, MD,† and Yasin Sarikaya, MD* Schwannomas are benign tumors that are rarely found in the oral cavity. We presented a schwannoma arising from the parasympathetic fibers of the lingual nerve, which is the first in the literature to our knowledge. Its borders in computerized tomography are not well defined despite the contrast medium. (Am J Otolaryngol 2003;24:348-350. © 2003 Elsevier Inc. All rights reserved.) Schwannomas are benign tumors arising from Schwann cells of sheaths of peripheral nerves. They are solitary and encapsulated tumors and rarely show malignant degenera- tion. Schwannomas in the extracranial head and the neck region mostly originate from the vagus nerve and sympathetic fibers. About 10% to 40% of extracranial schwannomas was not identified with the nerve origin. 1,2 A rare site for schwannoma is oral cavity. In the review of literature in 1977, Gallo et al 3 re- ported that the tongue was the most common site of occurrence in the 157 cases of oral schwannoma. Other common locations for oral cavity are buccal mucosa, intramedullary bone of maxilla or mandibula floor of mouth, palate, gingiva, lips, and vestibular mucosa, in that order. 3 In this case, we report a case of schwan- noma of sublingual gland that originated from the parasympathetic fibers of the lingual nerve. CASE REPORT A 34-year-old woman presented with a 3-month history of painless mass beneath the tongue on the left side. Her family and medi- cal histories were not contributory. On phys- ical examination, a 3  3-cm solid mass was noted on the left submaxillary triangle. The mass appeared to be freely movable. There was no sign of inflammation, and the salivary flow was normal. The physical examination and laboratory data were normal. Computed tomography, with contrast medium, showed a heterogeneous and lightly hypodense lesion in the left sublingual area (Fig 1). Fine-needle aspiration biopsy (FNAB) was performed, but the specimen was inconclusive for diagnosis. A surgical exploration was performed un- der general anesthesia. The intraoral surgical approach for excision of the mass was per- formed. On the floor of the mouth, a 5-cm incision was made. The tumor was located posterosuperior to the sublingual gland. It was dissected from the mylohyoid muscle by blunt dissection easily at first and then from its tiny fibrous attachment by sharp dissec- tion. Lingual nerve was seen; there was no attachment to the tumor. But only a few nerve fibers, which were thought to be the parasym- pathetic nerve of the sublingual gland, had been attached to the tumor (Fig 2). The mass was totally excised (Fig 3). The recovery after surgery was uneventful. Macroscopic exami- nation of the tumor revealed an encapsulated lesion that measured 5.0  4.5  4.0-cm. A cross-section revealed a gray-white encapsu- lated solid mass. Histopathologically, numer- ous elongated nuclei arranged in a streaming fashion were seen in routine hematoxylin and eosin-stained sections. In this case, Verocay bodies in Antoni type A tissues are composed of Schwann cells whose nuclei are largely arranged in palisading rows (Fig 4). From the *Department of Otorhinolaryngology, An- kara Numune Research and Education Hospital; and †Department of Pathology, Ankara Dr. Sami Ulus Chil- dren’s Hospital, Ankara, Turkey. Address correspondence to: Hasan Nedim Arda, MD, Mesnevi Sokak 26/9, C ¸ ankaya, Ankara, Turkey. E-mail: nedard@yahoo.com. © 2003 Elsevier Inc. All rights reserved. 0196-0709/03/2405-0000$30.00/0 doi:10.1016/S0196-0709(03)00064-4 348 American Journal of Otolaryngology, Vol 24, No 5 (September-October), 2003: pp 348-350