Analysis of Clinical, Radiographic, and Treatment Profile of 10 Cases of Neurogenic Tumors and Tumor-Like Lesions of the Oral and Maxillofacial Region: An Observational Study.

BACKGROUND: Soft tissues of the head and neck areas are a very frequent site of occurrence of certain benign tumors of the peripheral nerve sheath, especially the neurofibromas. Hence, the present study was conducted for assessing clinical, radiographic, and treatment profile of 10 cases of neurogenic tumors and tumor-like lesions of the oral and maxillofacial region.
MATERIALS AND METHODS: Data records of a total of 10 patients who were diagnosed with tumors of neurogenic origin were enrolled in the present study. Data files were analyzed over a time period of 2 years, and complete clinical and radiographic details were evaluated. All the patients in which incomplete information was present in the record files were excluded from the present study. The assessment of the histopathologic reports was done, and final diagnosis was recorded separately in the master chart.
RESULTS: Neurofibroma was the diagnosis in two cases. In another set of two cases, final diagnosis of traumatic neuroma was achieved. A single case Schwannoma of mandible depicting multilocular radiolucency was present. Granular cell tumor was present in three cases. It was present clinically in the form of swelling, ulcerative nodule, and nodular growth in the three respective cases. Surgical excision was carried out in all the cases, and follow-up records did not depict any case of recurrence of complication posttreatment.
CONCLUSION: Neurogenic tumors of oral and maxillafacial region are a rare phenomenon and mainly present in the form of benign neoplasm. However, careful recognition and diagnosis of these lesions are necessary to rule any possible malignant changes. Copyright:

INTRODUCTION

Soft tissues of the head and neck areas are a very frequent site of occurrence of certain benign tumors of the peripheral nerve sheath, especially the neurofibromas. The chances of occurrence of intraosseous neurofibromas are a very rare presentation owing to the lack of myelinated nerves in the medullary space of bones. Maxillofacial region may be the site of occurrence of various tumors and tumor-like lesions of neural origin, though this occurrence may be very rare. Reactive lesions and benign and malignant neoplasm are the three broad categories into which these pathologies can be segregated.[123] Malignant peripheral nerve sheath tumors (MPNST) are a term used to encompass malignant tumors originating from the peripheral nerves or presenting a varying degree of differentiation of different components of the nerve sheath. They can substitute a lot of tumors which were earlier referred to as malignant schwannomas, neurofibrosarcomas, and neurogenic sarcomas. Although there is an unclear picture regarding the diagnostic criteria of this tumor, still MPNST includes all those sarcomas which originate from a peripheral nerve or present as a preexisting neurofibroma.[45] Hence, the present study was conducted for assessing clinical, radiographic, and treatment profile of 10 cases of neurogenic tumors and tumor-like lesions of the oral and maxillofacial region.

MATERIALS AND METHODS

The present study was undertaken for assessing the clinical, radiographic, and treatment profile of 10 cases of neurogenic tumors and tumor-like lesions of the oral and maxillofacial region. Data records of a total of 10 patients who were diagnosed with tumors of neurogenic origin were enrolled in the present study. Data files were analyzed over a time period of 2 years, and complete clinical and radiographic details were evaluated. Following were the diagnosis of lesions on the histopathologic examination was evaluated:

Neurofibroma

Schwannoma

Granular cell tumor

Traumatic neuroma

Palisaded encapsulated neuroma

All the patients in which incomplete information was present in the record files were excluded from the present study. The assessment of the histopathologic reports was done, and final diagnosis was recorded separately in the master chart. Analysis of all the results was done by the SPSS software version 20.0 (IBM, Armonk, New York).

RESULTS

The assessment of ten patients with neurogenic tumors and tumor-like lesions was done. Among these ten patients, neurofibroma was the diagnosis in two cases. In another set of two cases, final diagnosis of traumatic neuroma was achieved. A single case Schwannoma of mandible depicting multilocular radiolucency was present as shown in Table 1. Granular cell tumor was present in three cases. It was present clinically in the form of swelling, ulcerative nodule, and nodular growth in the three respective cases. One case of granular cell tumor (out of four) was present on palate and depicted unilocular radiolucency. Palisaded encapsulated neuroma was present in two cases; one on upper lip and other on buccal mucosae. Surgical excision was carried out in all the cases, and follow up records did not depict any case of recurrence of complication posttreatment as shown in Table 2.

Table 1

Profile of the patients with neurogenic tumors and tumor-like lesions of the oral and maxillofacial region

Patient	Diagnosis	Gender	Age (years)	Site	Size (cm)
One	Neurofibroma	Female	32	Gingiva	3
Two	Traumatic neuroma	Male	39	Gingiva	4.5
Three	Schwannoma	Female	54	Mandible	2.5
Four	Granular cell tumor	Male	45	Palate	3
Five	Traumatic neuroma	Female	29	Tongue	2
Six	Granular cell tumor	Male	33	Floor of the mouth	2
Seven	Neurofibroma	Male	46	Buccal mucosa	2.5
Eight	Palisaded encapsulated neuroma	Female	41	Tongue	3.5
Nine	Granular cell tumor	Male	35	Palate	1.5
Ten	Palisaded encapsulated neuroma	Female	59	Upper lip	2.5

Table 2

Clinical, radiographic, and treatment profile

Patient	Diagnosis	Clinical presentation	Radiographic	Treatment
One	Neurofibroma	Swelling	-	Surgical excision
Two	Traumatic neuroma	Nodule	-	Surgical excision
Three	Schwannoma	Swelling	Multilocular radiolucency	Surgical excision
Four	Granular cell tumor	Swelling	Unilocular Radiolucency	Surgical excision
Five	Traumatic neuroma	Ulcerative nodule	-	Surgical excision
Six	Granular cell tumor	Ulcerative nodule	Surgical excision
Seven	Neurofibroma	Nodule	-	Surgical excision
Eight	Palisaded encapsulated neuroma	Nodule	-	Surgical excision
Nine	Granular cell tumor	Nodule	Radiolucency	Surgical excision
Ten	Palisaded encapsulated neuroma	Ulcerative nodule	-	Surgical excision

DISCUSSION

Deviations or variations from the basic architecture of these tissues or their precursors can be referred to as neurogenic lesions are the alterations from the normal pattern of these tissues or their precursors. They have different clinical and biological presentations despite having a similar nerve tissue origin.[6] Tumors of the nerve tissue comprise only 12% of nonspreading tumorous growths and 8% of spreading cancers of all the soft-tissue cancers. These growths can be segregated into two groups: “pseudotumors,” for example, the neuromas and “true” tumors. A few examples of true tumors are growths that develop from nonspecified nervous tissue components are fibrolipoma and intraneural perineurioma.[789] Hence, the present study was conducted for assessing clinical, radiographic, and treatment profile of 10 cases of neurogenic tumors and tumor-like lesions of the oral and maxillofacial region.

In current analysis, assessment of 10 patients with neurogenic tumors and tumor-like lesions was done. Among these ten patients, neurofibroma was the diagnosis in two cases. In another set of two cases, final diagnosis of traumatic neuroma was achieved. A single case Schwannoma of mandible depicting multilocular radiolucency was present. Alotaibi and Al Sheddi carried out a review study to assess the epidemiological figures of neurogenic growths of head and neck region which had been sent to the laboratory spread over a duration of 31 years. A total of 31 cases were incorporated in this review which accounted for only 0.6% of all collections. Traumatic neuromas were the most frequent finding (35.5%). Their study concluded that nerve tissue tumors of the head and neck region were a very rare finding, and most of these were nonmalignant.[6]

In the current study, granular cell tumor was present in three cases. It was present clinically in the form of swelling, ulcerative nodule, and nodular growth in the three respective cases. One cases of granular cell tumor (out of four) was present on palate and depicted unilocular radiolucency. Tamiolakis et al. carried out a study to show the profile of oral neural tumors (ONTs). The data and specimens of 157 ONTs which were reported over a period of 44 years were assembled and re-diagnosed from stained sections of the existing tissues. It was seen that the ONTs represented only a very small proportion of all the biopsied samples (0.4%). Granular cell tumor was the most prevalent, whereas the nerve sheath myxoma was least prevalent. They concluded that ONTs are very rare.[10]

In the present study, palisaded encapsulated neuroma was present in two cases; one on upper lip and other on buccal mucosae. Surgical excision was carried out in all the cases, and follow-up records did not depict any case of recurrence of complication posttreatment. Alotaiby et al. carried out a study with the help of a big biopsy center to assess the neural tumors of oral origin. The study incorporated 340 samples of these tumors which were collected over a period of 22 years. These comprised only 0.2% of all the specimens. The data showed that the mean age of patients was 43.3 years. Of these, 44% were males, and the rest of them were females. The most common found lesion among the studied specimens was neurofibroma. They represented 123 cases out of all the samples. Schwannomas were only 17%. Two percent specimens fell into the category of nonmalignant nerve tissue growths.[11] Franco et al. presented a detailed data of OPNSTs which were witnessed among a certain section of the Brazilian population. It was observed that only 0.2% of all the biopsied samples were OPNSTs. Of all the samples, there were only eight cases of neurofibromas. Schwannomas presented with only seven cases, whereas only four cases of PEN were seen. A women predilection was seen. 60.6% of the studied samples were of women. The most common site was the tongue followed by lips. S-100 reactivity was observed in all the cases (100%). Their study concluded that there was a very rare occurrence of OPNSTs, and most of them are nonmalignant.[12]

CONCLUSION

Neurogenic tumors of the oral and maxilla-facial region are a rare phenomenon and mainly present in the form of benign neoplasm. However, careful recognition and diagnosis of these lesions are necessary to rule any possible malignant changes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.