Subglottic Schwannoma : Case Report

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: Os schwannomas são tumores benignos e encapsulados, que surgem a partir da bainha das células de Schwann. Habitualmente, são solitários e esporádicos, sendo a sua localização mais comum, na esfera ORL, no sistema nervoso central, surgindo a partir da porção vestibular do VIII par craniano. Os schwannomas com localização laríngea são muito raros e geralmente apresentam-se como massas supraglóticas.Caso Clínico: Apresentamos o caso de uma doente com um schwannoma laríngeo, localizado na região subglótica. A doente iniciou um quadro de tosse e dispneia, sem resposta a terapêutica broncodilatadora instituída por Pneumologia, com evolução de 8 meses. Posteriormente, desenvolveu outros sintomas, tais como disfonia e dispneia associada a estridor. Após realização de uma TC torácica foi detetada uma lesão lobulada na região subglótica, localizada entre o bordo inferior da cricóide e o primeiro anel da traqueia, que condicionava uma redução significativa do lúmen traqueal. Foi realizada a excisão cirúrgica da lesão pela Otorrinolaringologia e posterior análise anatomopatológica da peça operatória, que permitiu estabelecer o diagnóstico histológico de um schwannoma laríngeo.Conclusão: A localização laríngea do schwannoma trata-se de uma raridade por si só. No caso apresentado, a disposição do mesmo na laringe é atípica, assumindo uma posição subglótica. Por isso, é importante documentar a sua apresentação clínica, localização anómala e o tratamento subsequente, de forma a orientar possíveis casos futuros semelhantes.Introduction: Schwannomas are benign and encapsulated tumors, which arise from the sheath of Schwann cells. They are usually solitary and sporadic, being their most common location in the central nervous system, arising from the vestibular portion of the the vestibulocochlear nerve. Schwannomas with a laryngeal location are very rare and often present themselves as supraglottic masses.Case Report: We’re presenting the case of a patient with a laryngeal schwannoma, located in the subglottic region. The patient has started a dry cough and dyspnea, without response to bronchodilator therapeutic, with an evolution of 8 months. Furthermore, developed other symptoms such as dysphonia and stridor. After a chest CT scan, a lobulated lesion has been spotted in the subglottic region, located between the lower edge of the cricoid and the first ring of the trachea, which was conditioning a significant reduction in the tracheal lumen.The excision of the lesion and subsequent anatomopathological analysis of the operative specimen were performed, which allowed the histological diagnosis of a laryngeal schwannoma to be assessed.Conclusion: The laryngeal location of schwannoma is a rarity in itself. In the case we are presenting, its arrangement in the larynx is atypical, taking an subglottic position. It is therefore important to document its clinical presentation, anomalous location and subsequent treatment in order to guide possible future similar cases.Introduction: Schwannomas are benign and encapsulated tumors, which arise from the sheath of schwann cells. They are usually solitary and sporadic, being their most common location in the central nervous system, arising from the vestibular portion of the the vestibulocochlear nerve. Schwannomas with a laryngeal location are very rare and often present themselves as supraglottic masses.Case Report: We’re presenting the case of a patient with a laryngeal schwannoma, located in the subglottic region. The patient has started a dry cough and dyspnea, without response to bronchodilator therapeutic, with an evolution of 8 months. Furthermore, developed other symptoms such as dysphonia and stridor. After a chest CT scan, a lobulated lesion has been spotted in the subglottic region, located between the lower edge of the cricoid and the first ring of the trachea, which was conditioning a significant reduction in the tracheal lumen.The excision of the lesion and subsequent anatomopathological analysis of the operative specimen were performed, which allowed the histological diagnosis of a laryngeal schwannoma to be assessed.Conclusion: The laryngeal location of schwannoma is a rarity in itself. In the case we are presenting, its arrangement in the larynx is atypical, taking an subglottic position. It is therefore important to document its clinical presentation, anomalous location and subsequent treatment in order to guide possible future similar cases