Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Ancient Schwannoma of the Nasal Cavity Arising From the Piriform Aperture: A Rare Case Report

Document Type : Case Report

Authors
Vito Sala 1
Francesco Lorusso 1
Francesco Dispenza 1
Salvatore Gallina 1
Angelo Immordino 1
Antonino Giulio Giannone 2
Frank Rikki Canevari 3
Federico Sireci 4
1 Otorhinolaryngology section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo Italy.
2 Pathology Unit, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
3 IRCCS Ospedale Policlinico San Martino, Genoa, Italy Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy.
4 Otorhinolaryngology section, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
10.22038/ijorl.2026.97040.4198
Abstract
Introduction:
Schwannoma is a benign peripheral nerve sheath tumour arising from Schwann cells. Although head and neck schwannomas are common, their occurrence in the sinonasal tract is rare. Ancient schwannoma is an uncommon histopathological variant characterised by long-standing degenerative changes. Owing to its rarity and nonspecific clinical and radiological presentation, ancient schwannoma poses a diagnostic challenge.

Case Report:
We report the case of a 36-year-old man with a five-year history of nasal obstruction, initially left-sided and subsequently bilateral, associated with hyposmia progressing to anosmia, epistaxis, left-sided serous rhinorrhoea and headache. Nasal endoscopy revealed a bilobed, smooth-surfaced mass occupying the left nasal cavity. A preliminary biopsy was non-diagnostic; therefore, complete endoscopic excision was performed. Histopathological examination revealed an ancient schwannoma characterised by predominantly hypocellular Antoni B areas, the absence of cytological atypia and mitotic activity, a sclerohyaline stroma, and foci of intralesional osseous metaplasia. Immunohistochemistry showed positivity for S100 and SOX10, with a Ki-67 proliferation index of <1%. The postoperative course was uneventful. At the 15-month follow-up, the patient’s symptoms had completely resolved, with no evidence of disease recurrence.

Conclusion:
Ancient schwannoma of the nasal cavity is a rare entity that should be considered in the differential diagnosis of benign sinonasal masses. Radiological findings are not pathognomonic; however, the presence of a well-circumscribed lesion with smooth bony remodelling and degenerative features may suggest a slow-growing benign process. Complete surgical excision, preferably via an endoscopic approach, is the treatment of choice and is associated with an excellent prognosis.
Keywords
Ancient schwannoma
Sinonasal schwannoma
Paranasal sinuses
Subjects
1.                   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. doi:10. 1308/ rcsann. 2020.7104.
2.                   Magro G, Broggi G, Angelico G, et al. Practical approach to histological diagnosis of peripheral nerve sheath tumors: an update. Diagnostics (Basel). 2022;12(6):1463. doi:10.3390/diagnostics12061463.
3.                   Venkataramana CG, Gupta S, Nayak R, Sinchana KM, Rai S, Rao R. Comprehensive study of ancient schwannoma: exploring histomorphological diversity and diagnostic challenges. Rare Tumors. 2024; 16: 20363613241274259.doi:10.1177/20363613241274259.
4.                   K V A, Multani M, Shenoy SV, Sreeram S, Kudlu K, Reddy N. Ancient schwannoma—an unusual sinonasal tumour. Indian J Otolaryngol Head Neck Surg. 2025;77(5):2168-2172. doi:10.1007/s12070-025-05463-y.
5.                   Reta BK, Tesfay AG, Gebrecherkos YB, Dojamo DD, Gebremichael YL, Gebremedhin DM. A rare case of ancient schwannoma of nasal vestibule causing complete nasal obstruction: a case report and brief review of literature. Int J Surg Case Rep. 2025;133:111623. doi:10.1016/j.ijscr.2025.111623.
6.                   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. doi:10.1016/j.ijscr.2022.107165.
7.                   Kim TH, Shin JH, Kwak EK. A case of a schwannoma in the nasal columella. SAGE Open Med Case Rep. 2019;7:2050313X18823091. doi:10.1177/2050313X18823091.
8.                   Kim YS, Kim HJ, Kim CH, Kim J. CT and MR imaging findings of sinonasal schwannoma: a review of 12 cases. AJNR Am J Neuroradiol. 2013; 34(3): 628-633. doi:10.3174/ajnr.A3257.
9.                   Venkatasamy R, Mohan Singh AS, Arasu K, Husain S, Mianxin C. Nasal septal ancient schwannoma: ancient and rare. Cureus. 2023; 15(8): e44294. doi:10.7759/cureus.44294.
10.                Muthukumar R, Gowthame K, Rajasekaran S, et al. A rare case report of nasal schwannoma. Indian J Otolaryngol Head Neck Surg. 2024;76(6):5852-5856. doi:10.1007/s12070-024-04910-6.
11.                Yaprak Bayrak B, Yaylacı A, Ozturk M. Clinicopathological findings of surgically treated nasal cavity schwannomas: a case series. Ear Nose Throat J. Published online July 24, 2024. doi: 10. 1177/01455613241261004.
12.                Kodama S, Okamoto T, Suzuki M. Ancient schwannoma of the nasal septum associated with sphenoid sinus mucocele. Auris Nasus Larynx. 2010;37(4):522-525. doi:10.1016/j.anl.2009.09.015.
13.                Crist J, Hodge JR, Frick M, Leung FP, Hsu E, Gi MT, et al. Magnetic resonance imaging appearance of schwannomas from head to toe: a pictorial review. J Clin Imaging Sci. 2017;7:38. doi: 10. 4103/ jcis. JCIS_40_17.
14.                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(Suppl 2):766-772. doi:10.1007/s12070-020-01813-0.
15.                Reta BK, Tesfay AG, Gebrecherkos YB, Dojamo DD, Gebremichael YL, Gebremedhin DM. A rare case of ancient schwannoma of nasal vestibule causing complete nasal obstruction: A case report and brief review of literature. Int J Surg Case Rep. 2025;133:111623. doi:10.1016/j.ijscr.2025.111623
16.                Liao JY, Lee HS, Kang BH. Nasal cavity schwannoma—a case report and review of the literature. Ear Nose Throat J. 2024;103(1):19-24. doi:10.1177/01455613211034598.
Iranian Journal of Otorhinolaryngology
Volume 38, Issue 6
November and December 2026
Pages 427-432