Schwannoma of the nasal columella: a rare presentation and surgical management through open rhinoplasty

INTRODUCTION

Schwannomas are benign tumors that originate from Schwann cells, which form the sheath of cranial, peripheral, and autonomic nerves. They are slow-growing neoplasms with a predilection for the head and neck region, accounting for 25–45% of all schwannomas. However, only 4% of these occur in the nasal cavity and paranasal sinuses.¹

The most common site for nasal schwannomas is the nasal septum, with approximately 31 cases reported to date.² Schwannomas, also known as neurilemmomas, typically present between the fifth and sixth decades of life and show no gender or racial predilection.³ They usually arise from the trigeminal nerve (especially ophthalmic or maxillary branches) or autonomic nerves, but never from the optic or olfactory nerves, which lack Schwann cell sheaths.⁴

Clinically, sinonasal schwannomas cause nonspecific symptoms such as unilateral nasal obstruction, epistaxis, headache, or altered olfaction, depending on tumor size and location.⁵ Radiologic imaging including sinonasal computed tomography (CT) and magnetic resonance imaging (MRI) helps assess lesion extension, but histological analysis remains essential for diagnosis.⁶ Histologically, schwannomas demonstrate Antoni A and B patterns and positive immunostaining for S-100 protein.⁷ The treatment of choice is complete surgical excision, with the endoscopic or open approach determined by lesion site and size. Recurrence is rare, and long-term follow-up may not be necessary.^8-11

CASE REPORT

A 64-year-old female presented with a one-year history of progressive left-sided nasal obstruction caused by a firm, non-tender mass. The lesion was slow-growing and located in the left nasal vestibule, arising from the membranous septum (Cottle area I). The patient had a history of right breast cancer treated with total mastectomy and lymphadenectomy in 2013, followed by an unspecified dose of tamoxifen, discontinued three years ago. She was also under surveillance for a probable frontal meningioma and a suspected metastasis at the bulbomedullary junction, for which she underwent radiotherapy in 2024.

Physical examination revealed a mesorrhine nose with a central columella. Nasal endoscopy showed an approximately 1×1 cm firm, regular, non-painful lesion in the left vestibule, partially obstructing the airway by about 50% (Figure 1).

CT imaging confirmed a 14×12 mm well-defined, hypodense nodular mass (26 UH) in the anterior septal region (Cottle area I) (Figure 5).

Surgical excision was performed under general anesthesia using an open rhinoplasty approach. A soft, well-encapsulated mass was found between the medial crura of the lower lateral cartilages. The lesion was completely excised without adhesion to surrounding structures and measured approximately 1.5×1.2 cm (Figures 2 and 3).

Figure 4 shows postoperative basal view showing complete resolution of the columellar swelling with restoration of nasal symmetry.

Histopathological examination revealed a stacked arrangement of two rows of elongated palisade nuclei alternating with acellular zones composed of cytoplasmic processes of schwann cells, also known as Verocay bodies in Antoni A pattern. Immunohistochemistry was positive for S-100 protein and vimentin, confirming the diagnosis of schwannoma. The patient’s postoperative course was uneventful, with no evidence of recurrence at follow-up (Figure 6).

DISCUSSION

Schwannomas of the nasal cavity are rare, and those located in the nasal columella are even less common, with only a handful of cases described in the literature.^1,2,4 This case aligns with the demographic and clinical pattern of sinonasal schwannomas, which typically affect individuals between 50 and 60 years of age and present with nonspecific symptoms.

In this case, the mass caused partial nasal obstruction and was initially suspected to be a benign vestibular tumor. Radiologic findings were nonspecific, and definitive diagnosis required histopathological confirmation. The tumor’s positivity for S-100 protein and vimentin is consistent with previous reports, reinforcing the value of immunohistochemistry in differentiating schwannomas from other sinonasal tumors.⁷

The surgical approach was selected based on tumor location. While endoscopic resection is standard for many sinonasal lesions, an external approach via open rhinoplasty allowed optimal visualization and ensured complete excision without compromising nasal aesthetics or function. This technique has been advocated for anterior lesions when cosmesis is a concern.¹⁰

Our case contributes to the limited literature on columellar schwannomas and highlights the importance of including them in the differential diagnosis of anterior nasal masses. It also supports the use of open rhinoplasty as a safe and effective surgical strategy in selected cases.

CONCLUSION

This case demonstrates that schwannomas, though rare in the nasal columella, should be considered in the differential diagnosis of anterior nasal masses. Histopathological and immunohistochemical analysis remain the cornerstone for accurate diagnosis. Open rhinoplasty provides excellent access and cosmetic results, supporting its use in the management of anterior sinonasal lesions.

ACKNOWLEDGEMENTS

Authors would like to thank the pathology department for their support in the histological and immunohistochemical diagnosis of this case.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

1. 1. Kim TH, Shin JH, Kwak E. A case of a schwannoma in the nasal columella. SAGE Open Med Case Rep. 2019;7:1-4.
2. 2. Bouayyad S, Ong JH, Ellis MP, Sloan P. An unusual finding of schwannoma in the columellar area-A case report. Int J Surg Case Rep. 2018;46:16-9.
3. 3. Gupta M, Rao N, Kour C, Kaur I. Septal Schwannoma of the Nose: A Rare Case. Turk Arch Otorhinolaryngol. 2017;55(1):41-3.
4. 4. Freeman E, Hecht L, Crum J, Lutz M. Anterior Nasal Schwannoma: A Rare Sinonasal Neoplasm. Cureus. 2023;15(7):e41300.
5. 5. Roy R, Patel B, Gahlot GPS. An Extensive Unilateral Nasal Mass: Septal Schwannoma-Case Report. Indian J Otolaryngol Head Neck Surg. 2022;74:1540-3.
6. 6. Brahmbhatt P, Kumar T, Bhatt AA, Vibhute P, Patel V, Desai A, et al. Sinonasal Schwannomas: Imaging Findings and Review of Literature. Ear Nose Throat J. 2025;104(10):645-50.
7. 7. Venkatasamy R, Mohan Singh AS, Arasu K, Husain S, Mianxin C. Nasal Septal Ancient Schwannoma: Ancient and Rare. Cureus. 2023;15(8):e44294.
8. 8. Galzignato PF, Chirumbolo S, Cestaro W, Scapinello A, Bertossi D, Nocini R. Surgical and histological evidence of case reports showing Schwannomas in the nasal area. Int J Surg Case Rep. 2022;94:107165.
9. 9. Singh A, Haq M, Gautam P, Gautam D, Handa AC, Handa KK. The Varied Presentations of Sinonasal Region Schwannomas: Apropos of Four Cases. Indian J Otolaryngol Head Neck Surg. 2022;74:766-72.
10. 10. Hachicha A, Chouchane H, Turki S. Schwannoma of the nasal cavity: A case report and review of the literature. SAGE Open Med Case Rep. 2024;12:2050313X241272687.
11. 11. Lee CW, Grammatopoulou V, Bagwan I, Sunkaraneni V. Schwannoma of the sinonasal tract: case report with review of the literature. Ann R Coll Surg Engl. 2021;103(7):e216-e222.