International Journal of Otorhinolaryngology and Head and Neck Surgery

Yadav V et al. Int J Otorhinolaryngol Head Neck Surg. 2026 Jun;12(3):457-460

https://www.ijorl.com

pISSN 2454-5929 | eISSN 2454-5937

Case Report

DOI: https://dx.doi.org/10.18203/issn.2454-5929.ijohns20261518

Schwannoma of the tongue: a case report and review of literature

Vishav Yadav, Jasmeet Kaur*, Sakshi Kapoor

Department of Otorhinolaryngology and Head and Neck Surgery, GMC, Rajindra Hospital, Patiala, Punjab, India

Received: 29 January 2026

Accepted: 20 May 2026

*Correspondence:

Dr. Jasmeet Kaur,

E-mail: jasmeetpunia90@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Schwannomas are rare slow growing benign tumors arising from Schwann cells lining the nerve sheaths of myelinated nerves. Only 25 to 48% of the cases occur in the head and neck region with only 1% showing an intraoral origin. We present a case of lingual schwannoma in a 20 year old patient who presented with painless mass on right ventral surface of tongue, which was excised. The final histopathology report revealed a schwannoma. We report this case owing to rarity of disease. Tongue Schwannomas are rare, benign tumors with an excellent prognosis. Histology remains the gold standard for its diagnosis and Malignant transformation is rare after complete surgical excision. Schwannomas should be considered in the differential diagnosis whenever a benign looking mass is seen inside the oral cavity.

Keywords: Schwannomas, Schwann cells, Transoral resection, Nerve sheath tumor

INTRODUCTION

Schwannomas also known as neuromas, neurilemmomas or neurinomas of ‘Verocay’, are benign, well encapsulated peripheral nerve sheath tumors composed of Schwann cells derived from the neural crest.1 Only approximately 1-12% of the head and neck schwannomas occur intraorally with the tongue being the most common site followed by the roof of the mouth, the floor of the mouth, the buccal mucosa, the gingiva, the lips and the vestibular mucosa.2 Symptoms of tongue schwannoma may range from none to a painless lump, with larger tumours (more than 3 cm) causing dysphonia, snoring, dysphagia or voice changes.3 Transoral resection is the standard approach for the treatment of the vast majority of these tumours, and histology remains the gold standard for its diagnosis.4

CASE REPORT

A 20-year-old male patient presented with complaints of a slow growing, painless lump on the right under surface of the tongue since last 6 months. No significant personal or family medical history were reported. Intraoral clinical examination revealed the presence of a firm, non-mobile, irregular mass (1.5×1 cm) attached to the ventral surface of tongue (Figure 1). Cervical lymph nodes were not palpable. A CE-MRI oral cavity was performed to characterize the lesion, which showed the presence of a well-defined, lobulated exophytic lesion 1.4×1.2×1.8 cm arising from the ventral surface of anterior tongue in the right paramedian location (Figure 2).

Figure 1: Pre op pic.
Figure 1: Pre op pic.
Figure 2 (A and B): CE-MRI oral cavity.
Figure 2 (A and B): CE-MRI oral cavity.

CE-MRI oral cavity showing the presence of a well-defined, lobulated exophytic lesion 1.4×1.2×1.8 cm arising from the ventral surface of anterior tongue in the right paramedian location. The lesion appears isotense on T1W1 and hyperintense on T2W1.

Figure 3: Excised mass.
Figure 3: Excised mass.
Figure 4: Post op pic.
Figure 4: Post op pic.

There was minimal intraoperative bleeding The mass was excised completely (Figure 3) under local Anaesthesia via transoral approach (Figure 4) and sent for histopathological examination which showed a well circumscribed, unencapsulated tumor comprising of hypercellular and myxoid hypercellular areas. The hypercellular areas show nuclear palisading and formation of verrocay bodies consistent with Schwannoma.

Patient was given liquid diet for a week. Post op period was uneventful without any complications. No recurrence was noted after 3 months of follow up.

DISCUSSION

Schwannomas of the tongue most commonly occur between the second and fourth decades of life and display no gender or racial predilection.5 Most often these tumors are solitary but can occur in multiple areas also. Multiple occurrences are usually associated not only with neurofibromatosis II but also schwannomatosis. Cytogenetic abnormality of chromosome 22 is seen in 50% cases, and those are associated with neurofibromatosis II.6

Schwannomas of the tongue arise from the hypoglossal nerve, but it is difficult to distinguish between tumors of the lingual, hypoglossal and glossopharyngeal nerve due to proximity of nerves.7 Even though tongue is the most common intraoral tumour location of schwannoma, less than 50 cases of lingual schwannomas have been reported in the literature in the past 20 years.8 Most common site affected is anterior 2/3rd of tongue (66%) vs 34% in the posterior two thirds. High prevalence of schwannomas in the tongue may be due to the higher incidence of trauma to the tongue and the role of Schwann cells in repair of injured neurons.9

The imaging modality of choice for lingual schwannomas is MRI. The better tissue contrast of the MRI, compared to CT, allows a more precise localization and better visualization of the relations to other structures, as well as a more accurate measurement of tumour size.3

Schwannomas pose a diagnostic challenge as they are clinically indistinguishable from other soft tissue tumors. The differential diagnosis for a lingual schwannoma includes other benign and malignant tumors like lymphangiomas, hemangiomas, neurofibromas, lingual thyroid and carcinomas.10

Hence biopsy and histological examination are essential for a confirmative diagnosis. Schwannomas are characterized by strong and diffuse immunoreactivity for S-100 protein.11 Complete surgical excision is the treatment of choice with solitary lesion. Schwannomas of oral tongue can be managed with transoral surgical excision. On the other hand, schwannomas at the base of the tongue are usually approached by cervical access (transhyoid or submandibular) or rarely via transoral CO2 laser excision.12 The recurrence rate of lingual schwannoma is very low and malignant transformation is very rare.13

Table 1: ROL of anterior schwannoma tongue patients.
Table reproduced from source PDF page 3
Table 2: Differential diagnosis for tongue schwannomas.
Table reproduced from source PDF page 3

CONCLUSION

Schwannomas should be considered in the differential diagnosis whenever a benign looking mass is seen inside the oral cavity.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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