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   Table of Contents      
ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 1  |  Page : 43-45

Malignant schwannoma of orbit


1 Department of Ophthalmology, Medical College, Aurangabad, India
2 Department of Pathology, Medical College, Aurangabad, India

Correspondence Address:
Vidya Kachole
Department of Ophthalmology, Medical College, Aurangabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 500181

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How to cite this article:
Kachole V, Maria D L, Khalique A, Solanki B R. Malignant schwannoma of orbit. Indian J Ophthalmol 1979;27:43-5

How to cite this URL:
Kachole V, Maria D L, Khalique A, Solanki B R. Malignant schwannoma of orbit. Indian J Ophthalmol [serial online] 1979 [cited 2020 Jul 15];27:43-5. Available from: http://www.ijo.in/text.asp?1979/27/1/43/31547

Schwannoma of orbit is a rare tumour. Its malignant variety, malignant schwannoma (Neurogenic Sarcoma, Malignant neurilem­moma fibrosarcoma of the nerve sheath) is more rare[3]. Instances of malignant schwan­nomas of orbit have been reported by Calvest and Canadau[4], Cerveira[2], Ginde[5] Schiff-Werthe­imer and Loisillier[12], Reese[9] Radnot[10], Emilier[4] and Mortada[8]. Schatz[11] has reported a case where typical benign lesion after presumably incomplete removal underwent sarcomatous transformation.


  Case Report Top


A 28 years old male patient was admitted in Ophthal­mic ward of Medical College, Aurangabad with the complaint of protrusion of left eye for one month. The past, personal and family history did not reveal any significant information. On admission there was uni­lateral axial proptosis with slight chemosis and restric­tion of movements of the eyeball. There was no other positive finding. Visual acuity in both eyes was 6/9 and fundi were normal [Figure - 1]

One week after the admission the visual acuity in left eye was 6/12 and there was evidence of early papil­loedema in the form of hyperemia of optic disc and venous fullness. Proptosis was same.

In further two weeks the vision deteriorated rapidly and visual acuity was reduced to 3/160. The papilloe­dema was frank and chemosis had also increased. Proptosis still remained same.


  Investigations Top


Total haemogram, stool and urine examination did not reveal any abnormality. Post meal blood sugar level was 84 mg.%. Serum K.T. and V.D.R.L. test was negative. X-Rays of skull, orbit and chest were normal. The ear, nose, and throat examination showed deviated nasal septum to the right side.


  Treatment Top


In the beginning the patient was put on antibiotics and corticosteriod to rule out the possibility of pseudo tumour. But there was no response to this treatment. Instead the visual acuity became less. Then Kronleins' orbitotomy was done and a firm mass was removed in two pieces which was surrounding the optic nerve and the proptosis subsided [Figure - 2].

Histopathological examination showed a tumour formed by plump spindle shaped cells. Some of the cells were oval. No pleomorphism was observed. Nuclear pallisading and arrangement of cells in groups was seen [Figure - 3][Figure - 4]. On examination all these cells of tumour showed features of malignancy in the form of anaplasia and hyperchromicity of nuclei. Hence the diagnosis as malignant Schwannoma was made.

Patient was then referred to Tata Memorial Cancer Hospital, Bombay for advice.


  Discussion Top


Schwannoma is the benign tumour occuring any where along peripheral, cranial or sympathetic nerves[8]. Orbit is a rare site. Malignant tumour may be primarily arising in the orbit or following incomplete removal of benign schwannoma of the orbit as reported by Schatz[11]. It may arise in neurofibromatosis[6],[8]. Approximately one half of the malignant schwannomas arise in patients who have von Recklinghausen's disease.

Schwannoma arises from the Schwann cells of the nerve sheath. Histopathologically the malignant Schwannoma is highly cellular tumour consisting of plump spindle shaped or oval cells generally showing little cellular pleomorphism and often is accompanied by collagen fibre. Nuclear pallisading as well as an arrangement of cells in groups, nests, cords, or whorls are diagnostic features. Distant metastasis are frequent in highly cellular form of this tumour.

It is a radioresistant tumour. In the majority of the cases studied by Reese[9] the disease was fatal.


  Summary Top


A rare malignant retrobulbar tumour of orbit confirmed histopathologically as a malignant Schwannoma in a young male is being reported.

 
  References Top

1.
Calvet and Canadau, 1949, System of Ophthal­mology, 13, Part 11, Lacrimal orbital and paraorbital diseases, 1106, 1974, Henry Kimpton, London.  Back to cited text no. 1
    
2.
Cerveira, 1953, System of Ophthalmology, 13, Part II, 1106, 1974, Henry Kimpton London.  Back to cited text no. 2
    
3.
Duke Elder, S., 1974, System of Ophthalmology, 13, 1106, Henry Kimpton, London.  Back to cited text no. 3
    
4.
Emilier, 1965, System of Ophthalmology, 13, 1106, 1974, Henry Kimpton London.  Back to cited text no. 4
    
5.
Ginde, 1953, Tumours of the Eye by Reese, 2nd Edn. 202, 1963, New York.  Back to cited text no. 5
    
6.
Hogan M.J. and Simmerman L.E., Ophthalmic pathology An Atlas and Text Book, 2, 755, Saunders, Peiladelphia and London.  Back to cited text no. 6
    
7.
Hoses, 1931, System of Ophthalmology, 13, Part II 1106, Henry Kimpton London.  Back to cited text no. 7
    
8.
Mortada, 1968, Brit. J. Ophthal, 52, 188, 550  Back to cited text no. 8
    
9.
Reese, 1963, Tumours of Eye, 2nd Edn. 199, New York.  Back to cited text no. 9
    
10.
Rodnot, 1963, System of Ophthalmology, 31, Part 11 1106, 1974, Henry Kimpton London.  Back to cited text no. 10
    
11.
Schatz (1971) Arch. of Ophthal, 86, 208.  Back to cited text no. 11
    
12.
Schiff Wartheimer and Loisillier, 1954, Tumours of Eye by Reese, 2nd Edn. 201, 1964, New York.  Back to cited text no. 12
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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