Challenges in diagnosing schwannoma mimicking thyroid neoplasms on frozen section
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Jun 30, 2025
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Abstract
Schwannoma is a benign soft tissue tumor of the nerve sheath, composed of neoplastic cells with Schwann cell differentiation. It predominantly arises from peripheral nerves in the head, neck, and extremities, with a peak incidence in the fourth to sixth decades. Schwannoma is typically a solitary and sporadic lesion, affecting individuals of all ages, with an incidence rate of 4.4-5.23 cases per 100,000 people. The prevalence is around 7% of all primary nervous system tumors, often occurring in the head and neck (20-50%) and affecting cranial nerves such as N. Vagus and N. Sympathetic. This case report involves a 50-year-old female patient presenting with a right neck lump that had been present for 23 years, initially small but growing rapidly in the last 10 years with occasional pain. Initial imaging suggested a thyroid complex cyst, but further investigation, including a CT scan and intraoperative frozen section examination, raised suspicion for a malignant thyroid tumor. However, histopathological analysis confirmed the diagnosis of Schwannoma, distinguishing it from other potential malignant lesions, such as Anaplastic Thyroid Carcinoma (ATC). This case highlights the importance of intraoperative cytology and frozen section techniques for diagnosing Schwannoma. Although Schwannomas share morphological similarities with other tumors, particularly in the thyroid region, a multidisciplinary approach combining clinical, radiological, and histopathological findings is essential for an accurate diagnosis. This case also underscores the need for careful differential diagnosis in nerve sheath tumors located in the neck.
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How to Cite
Ramadhani, R., Mayorita, P., Asri, A., Mulyani, H. and Novianti, H. (2025) “Challenges in diagnosing schwannoma mimicking thyroid neoplasms on frozen section”, Science Midwifery, 13(2), pp. 640-652. doi: 10.35335/midwifery.v13i2.1977.
References
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Behuria, S., Rout, T. K., & Pattanayak, S. (2015). Diagnosis and management of schwannomas originating from the cervical vagus nerve. The Annals of the Royal College of Surgeons of England, 97(2), 92–97.
Borczuk, A. C., Yantiss, R. K., Robinson, B. D., Scognamiglio, T., & D’Alfonso, T. M. (2021). Frozen Section Pathology: Diagnostic Challenges. Springer Nature.
Chand, P., Amit, S., Gupta, R., & Agarwal, A. (2016). Errors, limitations, and pitfalls in the diagnosis of central and peripheral nervous system lesions in intraoperative cytology and frozen sections. Journal of Cytology, 33(2), 93–97.
Chang, K. W., hyun Noh, S., Park, J.-Y., Cho, Y.-E., & Chin, D.-K. (2019). Retrospective study on accuracy of intraoperative frozen section biopsy in spinal tumors. World Neurosurgery, 129, e152–e157.
Covantsev, S., Bumbu, A., Sukhotko, A., Zakurdaev, E., Kuts, I., & Evsikov, A. (2024). Neck schwannoma masking as thyroid tumour: into the deep of diagnostics and anatomy. Diagnostics, 14(20), 2332.
de Bakker, J. K., Witteveen, E., van den Bergh, J., & Daams, F. (2020). Ancient Schwannoma of the gallbladder. ACG Case Reports Journal, 7(2), e00330.
Dean, E., Al-Obaidi, S., & De Andrade, A. D. (n.d.). Introduction (References).
Dey, P. (2018). Basic and advanced laboratory techniques in histopathology and cytology. Springer.
Dosemane, D., Kabekkodu, S., Jaipuria, B., Sreedharan, S., & Shenoy, V. (2022). Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature. Brazilian Journal of Otorhinolaryngology, 88(Suppl 4), S9–S17.
Hwang, S., Hameed, M., & Kransdorf, M. (2023). The 2020 World Health Organization classification of bone tumors: what radiologists should know. Skeletal Radiology, 52(3), 329–348.
Imen, T., Sadok, B. M., Raoudha, A., Ksissa, S., Yosra, B., Yosr, B. A., Meriem, K., Soumaya, B., Nadia, K. B., & Leila, B. (2021). Endobronchial schwannoma in adult: a case report. Respiratory Medicine Case Reports, 33, 101396.
Jindal, A., Diwan, H., Kaur, K., & Sinha, V. D. (2017). Intraoperative squash smear in central nervous system tumors and its correlation with histopathology: 1 year study at a tertiary care centre. Journal of Neurosciences in Rural Practice, 8(2), 221.
Kang, J. Y., Yi, K. S., Cha, S.-H., Choi, C.-H., Kim, Y., Lee, J., & Son, S.-M. (2020). Schwannoma of the thyroid bed: A case report and review of the literature. Medicine, 99(5), e18814.
Kang, M., Chung, D. H., Kim, N. R., Cho, H. Y., Ha, S. Y., Lee, S., An, J., Seok, J. Y., Yie, G.-T., & Yoo, C. J. (2019). Intraoperative frozen cytology of central nervous system neoplasms: an ancillary tool for frozen diagnosis. Journal of Pathology and Translational Medicine, 53(2), 104–111.
KAPTAN, Z., BİLGEN, A. S., ERÇELİK, O., KILIÇ, R., & BAŞARIR, K. (2020). Intraparotideal Facial Nerve Schwannoma. Turkiye Klinikleri Journal of Case Reports, 28(2), 91–94.
Kar, M., Sengupta, M., Sarkar, S., Bera, S., Datta, C., Chatterjee, U., & Ghosh, S. N. (2018). Role of squash cytology in intraoperative diagnosis of spinal lesions. Journal of Cytology, 35(3), 139–142.
Kerr, K. M., & Laing, G. M. (2017). Immunotherapy and lung cancer: programmed death 1 and its ligand as a target for therapy. In Precision Molecular Pathology of Lung Cancer (pp. 257–273). Springer.
Kim, S. H., Kim, N. H., Kim, K. R., Lee, J. H., & Choi, H.-S. (2010). Schwannoma in head and neck: preoperative imaging study and intracapsular enucleation for functional nerve preservation. Yonsei Medical Journal, 51(6), 938–942.
Kobayashi, K., Ando, K., Ito, K., Tsushima, M., Morozumi, M., Tanaka, S., Machino, M., Ota, K., Ishiguro, N., & Imagama, S. (2018). Accuracy of intraoperative pathological diagnosis using frozen sections of spinal cord lesions. Clinical Neurology and Neurosurgery, 167, 117–121.
Kumar, V. (2015). K. Abbas A, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th editio. Philadelphia: Elsevier Masson SAS.
Lee, H. S., & Tihan, T. (2015). The basics of intraoperative diagnosis in neuropathology. Surgical Pathology Clinics, 8(1), 27–47.
Lenzi, J., Anichini, G., Landi, A., Piciocchi, A., Passacantilli, E., Pedace, F., Delfini, R., & Santoro, A. (2017). Spinal nerves schwannomas: experience on 367 cases—historic overview on how clinical, radiological, and surgical practices have changed over a course of 60 years. Neurology Research International, 2017(1), 3568359.
Lester, S. C., & Harrison, B. T. (2022). Diagnostic Pathology: Intraoperative Consultation E-Book: Diagnostic Pathology: Intraoperative Consultation E-Book. Elsevier Health Sciences.
Mitra, S., Kumar, M., Sharma, V., & Mukhopadhyay, D. (2010). Squash preparation: A reliable diagnostic tool in the intraoperative diagnosis of central nervous system tumors. Journal of Cytology, 27(3), 81–85.
Mohammad, A., Iqbal, M. A., & Wadhwania, A. (2020). Schwannomas of the head and neck region: A report of two cases with a narrative review of the literature. Cancer Research, Statistics, and Treatment, 3(3), 517–525.
Moriya, T., Kimura, W., Hirai, I., Takeshita, A., Tezuka, K., Watanabe, T., Mizutani, M., & Fuse, A. (2012). Pancreatic schwannoma: case report and an updated 30-year review of the literature yielding 47 cases. World Journal of Gastroenterology: WJG, 18(13), 1538.
Pala, E. E., Doğan, E., Ekmekçi, S., Özamrak, B. G., & Çamlar, M. (2022). Diagnostic Value of Smears and Frozen Sections in Neuropathology Practice: Institutional Experience. The Journal of Tepecik Education and Research Hospital, 32(1), 51–57. https://doi.org/10.4274/terh.galenos.2021.23245
Prayson, R. A., & Napekoski, K. M. (2010). Frozen section library: central nervous system (Vol. 6). Springer Science & Business Media.
Saekhu, M., Siregar, N. C., Gunawan, K., & Nugroho, S. W. (2020). Nine-segment laminectomy is safe for the resection of a schwannoma extending from C-2 to T-3: a rare case report. Medical Journal of Indonesia, 29(3), 326–331.
Sarkar, S., Sengupta, M., Datta, C., Chatterjee, U., & Ghosh, S. N. (2017). Evaluation of intraoperative cytological smears for diagnosis of brain tumors with special reference to immunohistochemistry. Indian Journal of Medical and Paediatric Oncology, 38(03), 296–301.
Behuria, S., Rout, T. K., & Pattanayak, S. (2015). Diagnosis and management of schwannomas originating from the cervical vagus nerve. The Annals of the Royal College of Surgeons of England, 97(2), 92–97.
Borczuk, A. C., Yantiss, R. K., Robinson, B. D., Scognamiglio, T., & D’Alfonso, T. M. (2021). Frozen Section Pathology: Diagnostic Challenges. Springer Nature.
Chand, P., Amit, S., Gupta, R., & Agarwal, A. (2016). Errors, limitations, and pitfalls in the diagnosis of central and peripheral nervous system lesions in intraoperative cytology and frozen sections. Journal of Cytology, 33(2), 93–97.
Chang, K. W., hyun Noh, S., Park, J.-Y., Cho, Y.-E., & Chin, D.-K. (2019). Retrospective study on accuracy of intraoperative frozen section biopsy in spinal tumors. World Neurosurgery, 129, e152–e157.
Covantsev, S., Bumbu, A., Sukhotko, A., Zakurdaev, E., Kuts, I., & Evsikov, A. (2024). Neck schwannoma masking as thyroid tumour: into the deep of diagnostics and anatomy. Diagnostics, 14(20), 2332.
de Bakker, J. K., Witteveen, E., van den Bergh, J., & Daams, F. (2020). Ancient Schwannoma of the gallbladder. ACG Case Reports Journal, 7(2), e00330.
Dean, E., Al-Obaidi, S., & De Andrade, A. D. (n.d.). Introduction (References).
Dey, P. (2018). Basic and advanced laboratory techniques in histopathology and cytology. Springer.
Dosemane, D., Kabekkodu, S., Jaipuria, B., Sreedharan, S., & Shenoy, V. (2022). Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature. Brazilian Journal of Otorhinolaryngology, 88(Suppl 4), S9–S17.
Hwang, S., Hameed, M., & Kransdorf, M. (2023). The 2020 World Health Organization classification of bone tumors: what radiologists should know. Skeletal Radiology, 52(3), 329–348.
Imen, T., Sadok, B. M., Raoudha, A., Ksissa, S., Yosra, B., Yosr, B. A., Meriem, K., Soumaya, B., Nadia, K. B., & Leila, B. (2021). Endobronchial schwannoma in adult: a case report. Respiratory Medicine Case Reports, 33, 101396.
Jindal, A., Diwan, H., Kaur, K., & Sinha, V. D. (2017). Intraoperative squash smear in central nervous system tumors and its correlation with histopathology: 1 year study at a tertiary care centre. Journal of Neurosciences in Rural Practice, 8(2), 221.
Kang, J. Y., Yi, K. S., Cha, S.-H., Choi, C.-H., Kim, Y., Lee, J., & Son, S.-M. (2020). Schwannoma of the thyroid bed: A case report and review of the literature. Medicine, 99(5), e18814.
Kang, M., Chung, D. H., Kim, N. R., Cho, H. Y., Ha, S. Y., Lee, S., An, J., Seok, J. Y., Yie, G.-T., & Yoo, C. J. (2019). Intraoperative frozen cytology of central nervous system neoplasms: an ancillary tool for frozen diagnosis. Journal of Pathology and Translational Medicine, 53(2), 104–111.
KAPTAN, Z., BİLGEN, A. S., ERÇELİK, O., KILIÇ, R., & BAŞARIR, K. (2020). Intraparotideal Facial Nerve Schwannoma. Turkiye Klinikleri Journal of Case Reports, 28(2), 91–94.
Kar, M., Sengupta, M., Sarkar, S., Bera, S., Datta, C., Chatterjee, U., & Ghosh, S. N. (2018). Role of squash cytology in intraoperative diagnosis of spinal lesions. Journal of Cytology, 35(3), 139–142.
Kerr, K. M., & Laing, G. M. (2017). Immunotherapy and lung cancer: programmed death 1 and its ligand as a target for therapy. In Precision Molecular Pathology of Lung Cancer (pp. 257–273). Springer.
Kim, S. H., Kim, N. H., Kim, K. R., Lee, J. H., & Choi, H.-S. (2010). Schwannoma in head and neck: preoperative imaging study and intracapsular enucleation for functional nerve preservation. Yonsei Medical Journal, 51(6), 938–942.
Kobayashi, K., Ando, K., Ito, K., Tsushima, M., Morozumi, M., Tanaka, S., Machino, M., Ota, K., Ishiguro, N., & Imagama, S. (2018). Accuracy of intraoperative pathological diagnosis using frozen sections of spinal cord lesions. Clinical Neurology and Neurosurgery, 167, 117–121.
Kumar, V. (2015). K. Abbas A, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th editio. Philadelphia: Elsevier Masson SAS.
Lee, H. S., & Tihan, T. (2015). The basics of intraoperative diagnosis in neuropathology. Surgical Pathology Clinics, 8(1), 27–47.
Lenzi, J., Anichini, G., Landi, A., Piciocchi, A., Passacantilli, E., Pedace, F., Delfini, R., & Santoro, A. (2017). Spinal nerves schwannomas: experience on 367 cases—historic overview on how clinical, radiological, and surgical practices have changed over a course of 60 years. Neurology Research International, 2017(1), 3568359.
Lester, S. C., & Harrison, B. T. (2022). Diagnostic Pathology: Intraoperative Consultation E-Book: Diagnostic Pathology: Intraoperative Consultation E-Book. Elsevier Health Sciences.
Mitra, S., Kumar, M., Sharma, V., & Mukhopadhyay, D. (2010). Squash preparation: A reliable diagnostic tool in the intraoperative diagnosis of central nervous system tumors. Journal of Cytology, 27(3), 81–85.
Mohammad, A., Iqbal, M. A., & Wadhwania, A. (2020). Schwannomas of the head and neck region: A report of two cases with a narrative review of the literature. Cancer Research, Statistics, and Treatment, 3(3), 517–525.
Moriya, T., Kimura, W., Hirai, I., Takeshita, A., Tezuka, K., Watanabe, T., Mizutani, M., & Fuse, A. (2012). Pancreatic schwannoma: case report and an updated 30-year review of the literature yielding 47 cases. World Journal of Gastroenterology: WJG, 18(13), 1538.
Pala, E. E., Doğan, E., Ekmekçi, S., Özamrak, B. G., & Çamlar, M. (2022). Diagnostic Value of Smears and Frozen Sections in Neuropathology Practice: Institutional Experience. The Journal of Tepecik Education and Research Hospital, 32(1), 51–57. https://doi.org/10.4274/terh.galenos.2021.23245
Prayson, R. A., & Napekoski, K. M. (2010). Frozen section library: central nervous system (Vol. 6). Springer Science & Business Media.
Saekhu, M., Siregar, N. C., Gunawan, K., & Nugroho, S. W. (2020). Nine-segment laminectomy is safe for the resection of a schwannoma extending from C-2 to T-3: a rare case report. Medical Journal of Indonesia, 29(3), 326–331.
Sarkar, S., Sengupta, M., Datta, C., Chatterjee, U., & Ghosh, S. N. (2017). Evaluation of intraoperative cytological smears for diagnosis of brain tumors with special reference to immunohistochemistry. Indian Journal of Medical and Paediatric Oncology, 38(03), 296–301.