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Schwannoma of the eyelid. A case report
Schwannoma de párpado, a propósito de un caso
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A case report" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1613 "Ancho" => 1267 "Tamanyo" => 654122 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A: a bajo aumento se reconoce un tumor rodeado por una cápsula fibrosa (flechas continuas). Nótese en la zona inferior glándula de Meibomio (flecha discontinua) (H&E, ×20). B: a mayor aumento, tumor compuesto por células fusadas con bordes angulosos. 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(A and B) External examination with loss of conjugated gaze, ptosis and incongruent ocular movements. Orbit CT (C) showing bilateral metastatic infiltration of both horizontal rectus muscles.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Espinosa-Barberi, C. Alba Linero, F.J. Galván González, E. Álvarez González, A. Rey López, F. Medina Rivero" "autores" => array:6 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Espinosa-Barberi" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Alba Linero" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "Galván González" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Álvarez González" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Rey López" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Medina Rivero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669118303368" "doi" => "10.1016/j.oftal.2018.10.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669118303368?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300088?idApp=UINPBA00004N" "url" => "/21735794/0000009400000005/v1_201904290704/S2173579419300088/v1_201904290704/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Schwannoma of the eyelid. A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "259" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E.I. Abusleme, C.A. Nazar, P. Zoroquiain" "autores" => array:3 [ 0 => array:3 [ "nombre" => "E.I." "apellidos" => "Abusleme" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "C.A." "apellidos" => "Nazar" "email" => array:1 [ 0 => "canazar@uc.cl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Zoroquiain" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Schwannoma de párpado, a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1389 "Ancho" => 1267 "Tamanyo" => 623826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Medium magnification shows peripheral nerve remains in the external portion (arrow) (H&E, 100×). (B) Immunohistochemical study against S-100 protein shows diffuse nuclear and cytoplasmatic positivity in the lesion and adjacent peripheral nerve (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Schwannomas, also known as neurilemmomas, are benign and usuallly solitary peripheral nerve sheath tumors that originate from a proliferation of Schwann cells.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Schwannomas can arise at any age and do not exhibit preference for sex in the general population.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Schwannomas can originate in any anatomical region where Schwann cells are found, i.e., in any myelinized peripheral nerve. However, they are most frequently located in the head and neck. At the periocular level, these tumors are rare and account for approximately 1% of orbital tumors, and are even less frequent in the eyelids.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The case is described of a 57 year-old male with eyelid schwannoma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">Male, 57, without morbid antecedents, with painless left upper eyelid volume increase of one year evolution.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ophthalmological examination showed a smooth and slightly erythematosus nodular lesion in the outer third of the upper left eyelid with a length of 7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm. It was not associated to ptosis, skin changes or madarosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Visual acuity was 1.0 (decimal notation) in both eyes, with correction. Biomicroscopic examination of the anterior pole and funduscopy were normal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Excisional biopsy was performed, during which a solid subcutaneous lesion was identified at the level of the free edge of the upper left eyelid, without associated alterations of the overlying skin. The lesion was dissected and removed. The histological study thereof reported a tumor well-defined by a fibrosis pseudo-capsule comprised by spindle-like cells with angled nuclei, formation of palisades and Verocay bodies. No atypical mitosis or necrosis was found (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In addition, the immunohistochemical study with monoclonal antibodies against S-100 proteins was positive, with diffuse nuclear and cytoplasmic pattern, confirming the schwannoma diagnostic (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">No additional treatment was required after excision. The patient evolved positively, without symptoms or signs of relapse after a one year follow-up (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Schwannomas are described as solid and generally asymptomatic, solitary and slow growing tumors.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> The majority are benign and solitary. However, the presence of multiple schwannomas in the same individual could be associated to neurofibromatosis II, in which case very few cases of malign transformation have been reported.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,6</span></a> The present patient had no familial history or clinical findings of neurofibromatosis and the lesion was solitary.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The location of a schwannoma in the eyelid is extremely infrequent. For this reason it is not usually included in the differential diagnostic of a palpebral lesion. This gives rise to the possibility of confusing shwannomas with other eyelid volume increases such as chalazion and epithelial inclusion cysts.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4–7</span></a> To date, only 15 cases of schwannoma have been reported in said location.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In theory, palpebral schwannomas could originate in any of the nerves found in the periocular region. However, the majority of the described cases assume that the origin is in the supra-orbital, supra-trochlear and infra-orbital nerves.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In order to carry out a diagnostic, a detailed histopathological and immunohistochemical study is crucial. At the histopathological level, schwannomas exhibit a combination of 2 characteristic patterns: Antoni type A, corresponding to areas comprising compact spindle cells arranged in palisades, the so-called Verocay bodies, and Antoni type B corresponding to areas in which tumor cells are dispersed in a mixoid matrix. In addition, a positive reaction for S-100 protein is the most important characteristic for diagnosing schwannoma.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The histopathological differential diagnostic includes neurofibroma, in which undulating collagen fibers can be identified in the stroma as well as the absence of Verocay bodies and fibrous capsules. The malign counterparts thereof, i.e., malign peripheral nerve sheath tumor, is characterized by marked nuclear atypia, numerous mitotic figures and loss of S-100 protein expression.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the management of eyelid schwannoma, the complete excision of the tumor enables healing with excellent prognosis because it prevents lesion recurrence. In contrast, in excision has been associated to recurrence with increased aggressiveness.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,4,5</span></a> No cases of malign transformation have been reported in eyelid schwannoma.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,7,8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The case presented herein reinforces the idea that schwannomas should be always included in the differential diagnostic of any solid palpebral lesion.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare the absence of any commercial interest or financial support.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1184817" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1104927" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1184816" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1104926" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-17" "fechaAceptado" => "2018-10-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1104927" "palabras" => array:5 [ 0 => "Eyelid tumors" 1 => "Schwannoma" 2 => "Eyelid schwannoma" 3 => "Eyelid margin" 4 => "Histopathology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1104926" "palabras" => array:5 [ 0 => "Tumores de párpados" 1 => "Schwannoma" 2 => "Schwannoma de párpado" 3 => "Margen palpebral" 4 => "Histopatología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The case is presented of a 57 year-old man with a one-year history of enlargement of the left upper eyelid. An excisional biopsy was performed, and the histological and immunohistochemical study confirmed the diagnosis of schwannoma. Schwannomas are benign peripheral nerve sheath tumors, derived from a Schwann cells proliferation. Eyelid involvement is extremely uncommon. To make the diagnosis, a detailed histopathological and immunohistochemical study is essential. This case suggests that schwannomas should be included within the differential diagnosis of any solid eyelid lesion.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hombre de 57 años con historia de aumento de volumen del párpado superior izquierdo de un año de evolución. Se realizó biopsia escisional de la lesión. Posteriormente, el estudio histológico e inmunohistoquímico confirmó el diagnóstico de schwannoma. Los schwannomas son tumores benignos de las vainas de los nervios periféricos, derivados de una proliferación de las células de Schwann. La ubicación palpebral es extremadamente infrecuente. Para realizar el diagnóstico, es fundamental un estudio histopatológico e inmunohistoquímico detallado. El caso presentado refuerza la idea de que los schwannomas deben incluirse siempre en el diagnóstico diferencial de cualquier lesión palpebral sólida.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abusleme EI, Nazar CA, Zoroquiain P. Schwannoma de párpado, a propósito de un caso. Arch Soc Esp Oftalmol. 2019;94:257–259.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 612 "Ancho" => 2000 "Tamanyo" => 245656 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A, B) Lesion at the level of the free edge of the upper left eyelid, similar to that of chalazion. (C) Eyelid one week after tumor resection. It can be appreciated that the lesion was completely removed.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1613 "Ancho" => 1267 "Tamanyo" => 654842 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Low magnification shows a tumor surrounded by a fibrous capsule (full arrows). Meibomium glands can be seen in the lower area (broken arrow) (H&E, 20×). (B) Higher magnification shows the tumor with spindle cells and sharp edges. The palisade arrangement of nuclei can be seen (full arrow), alternating with hypocellular areas (Verocay bodies, broken arrow) (H&E, 200×).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1389 "Ancho" => 1267 "Tamanyo" => 623826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Medium magnification shows peripheral nerve remains in the external portion (arrow) (H&E, 100×). 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