Silent Growth: A Case Series on the Intriguing Journey of Sinonasal Schwannomas

Sinonasal schwannomas are rare benign tumours arising from Schwann cells, comprising less than 4% of all head and neck schwannomas. Their clinical presentation is often non specific, leading to frequent misdiagnosis. The authors present three cases of sinonasal schwannomas to illustrate the diagnostic and therapeutic challenges associated with these tumours. The patients, including two adult females and one adolescent male, presented with unilateral or bilateral nasal obstruction and associated symptoms such as nasal discharge, epistaxis and snoring. Imaging using Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) revealed well-defined, enhancing soft-tissue masses confined to the nasal cavity and paranasal sinuses, without evidence of orbital or intracranial extension. Provisional diagnoses included juvenile nasopharyngeal angiofibroma and antrochoanal polyp. All patients underwent complete tumour excision via a transnasal endoscopic approach. Histopathological examination {Haematoxylin & Eosin (H&E)} confirmed the diagnosis of schwannoma in all cases, demonstrating the characteristic biphasic Antoni A and Antoni B patterns with Verocay bodies. One case was diagnosed as an ancient schwannoma. There were no significant intraoperative or postoperative complications and no recurrences were observed during follow-up periods ranging from 6 to 12 months. These cases underscore the importance of considering schwannoma in the differential diagnosis of unilateral nasal masses. While imaging aids in assessing the extent of the lesion, definitive diagnosis relies on histopathological examination. Endoscopic surgical excision is a safe and effective treatment option, offering excellent outcomes with minimal morbidity.