Multinodular neurilemmoma of the tongue: a case report with differential immunohistochemical profile

Neurilemmoma is a distinctive, encapsulated, benign tumor, derived from Schwann cells. It is the most common neurogenic tumor, eventually occurring in the mouth, particularly the tongue. It occurs most often during the second or third decades of life, with predilection in females. Clinically, neurilemmomas present as a solitary circumscribed nodule, rarely being multinodular. We report a case of a 46 year-old female who presented a multinodular neurilemmoma of the tongue. She had a sessile nodule with two months of evolution. The presumptive diagnosis was of a benign mesenchymal neoplasm and an excisional biopsy was performed. During the excision it was found that the lesion was formed by two well-delimitated firm yellowish-white nodules. Histopathologic evaluation revealed an encapsulated benign tissue, formed by spindle cells forming irregular Antoni A and Antoni B patterns, not easily recognizable. Immunostaining was strongly positive for S-100 protein and negative for neurofilament. The lesion was excised and after 12 months of follow-up there was no recurrence.