Schwannoma of the Tongue-Diagnostic Challenge and Role of Intraoperative Frozen Section: A Case Report

Abstract

Lingual schwannoma is an uncommon benign tumour arising from Schwann cells of the peripheral nerve sheath. Its occurrence at the tip of the tongue is rare, and its clinical and radiological features may overlap with benign, vascular, or malignant oral cavity lesions. This case report describes a 44-year-old male patient with asthma who presented with a progressively enlarging mass at the tip of the tongue that had evolved over 4 years. Clinical examination revealed a soft, mobile, non-ulcerated mass, slightly lateralised to the right side, measuring approximately 3 cm in greatest diameter, with no palpable cervical lymphadenopathy. Facial magnetic resonance imaging showed a well-defined lesion measuring approximately 34 × 28 mm, hypointense on T1-weighted images and hyperintense on T2-weighted images, with intense contrast enhancement and areas described as necrosis. Because of the suspected vascular nature of the lesion, preoperative biopsy under local anaesthesia was avoided. After multidisciplinary discussion, surgical excision with intraoperative frozen section examination was performed. Frozen section analysis indicated lingual schwannoma, allowing conservative excision without further extensive resection. The postoperative course was uneventful, and healing was satisfactory. At 3 years of follow-up, the patient remained clinically well, with no local recurrence or functional impairment. This case highlights the diagnostic difficulty of lingual schwannoma and the value of intraoperative pathological assessment in guiding conservative surgical management.