A rare case of ancient schwannoma of nasal vestibule causing complete nasal obstruction: A case report and brief review of literature

ABSTRACT Introduction and importance: Schwannomas are benign tumors originating from nerve sheaths. Sinonasal schwannomas account for less than 4 % of head and neck schwannomas, making them a rare entity. Nasal schwannoma arising from the lateral wall is extremely rare, with only few reported cases. Ancient schwannoma is a rare variant of schwannoma that features a degenerative change. This case report is aimed at emphasizing that schwannomas should be entertained as a possibility in patients presenting with nasal vestibular masses. Presentation of case: We reported a 21-year-old female patient who presented with a progressive left nasal mass with complete nasal obstruction. On examination there was a grey-white, non-tender, and smooth mass arising from the nasal ala vestibular aspect. Fine needle aspiration cytology was done, and it was reported as a benign spindle cell lesion. Complete excision of the mass was done, and subsequent histopathologic examination concluded ancient schwannoma. Immunohistochemistry for S100 demonstrated diffuse and strong positivity in the neoplastic cells, which further supported the diagnosis. Clinical discussion: Sinonasal schwannomas account for 25–40 % of head and neck schwannomas. Generally, nasal schwannoma arises from the middle meatus and, in rare cases, the nasal septum. A definitive diagnosis is made via histopathology, and complete excision is the treatment of choice with low risk of recurrence. Conclusion: Even though it is rare, schwannoma should be considered as a differential diagnosis in patients presenting with a benign looking nasal vestibular mass. Highlights