Primary Neurilemmoma of the Thyroid Gland in a 12-Year-Old Girl
By Maciej Baglaj, Alicja Markowska-Woyciechowska, Krystyna Sawicz-Birkowska, and Urszula Dorobisz
A case of a neurilemmoma of the thyroid gland in a 12-year-
old girl is reported. The tumor was noted as a asymptomatic
left lower neck swelling 9 months before admission. Ultra-
sound scan showed the solid lesion of predominantly hypo-
echoic structure measuring 17.2 ϫ 12 ϫ 26 mm within the left
lobe. Pathologic examination of the excised lobe was con-
sistent with neurilemmoma with both Antoni A and Antoni B
histologic patterns. To date only 14 cases of this nonepithe-
lial tumor of the thyroid gland have been described in the
literature, and all occurred in adult patients. This is the ﬁrst
report of thyroid neurilemmoma in a child.
J Pediatr Surg 39:1418-1420. © 2004 Elsevier Inc. All rights
INDEX WORDS: Neurilemmoma, thyroid gland.
HE INDICATIONS for operative management of
nodular goiter in children are predominantly based
on higher risk of malignancy in this age group. Among
thyroid neoplastic lesions, benign and malignant tumors
of epithelial origin constitute a majority. Other tumors
are exceedingly rare in pediatric patients. In adults they
represent less than 1% of all thyroid tumors.
neurilemmoma of the thyroid gland was ﬁrst reported in
1964 by Delaney and Fry.
Since then, only 14 cases of
this nonepithelial thyroid tumor have been described in
the literature. All tumors occurred in adult patients.
We present a case of primary thyroid neurilemmoma in
a 12-year-old girl. To our knowledge, this is a ﬁrst report
of this unusual tumor in a child.
A 12-year old girl was referred to the Department of Pediatric
Endocrinology by a family physician because of a lower neck mass.
The lesion had been ﬁrst noted 9 months before referral and had slowly
increased in size. In this period, recurrent episodes of upper respiratory
tract infection were reported, otherwise the lesion was asymptomatic.
The mother of the patient had been operated on for nodular goiter in the
past. On physical examination, an oval, moderately mobile, nontender,
ﬁrm nodule of 2.5 cm was noted in the left lower neck. There was no
cervical lymphadenopathy. Ultrasound scan conﬁrmed that the lesion
occupied almost the entire the left lobe of the thyroid. Its dimensions
were 17.2 ϫ 12 ϫ 26 mm. It presented sonographically as a well
delineated solid nodule of predominantly hypoechoic structure. The
right lobe was normal. Hormonal studies showed normal serum levels
of TSH, FT4, and FT3. A concentration of antithyroid peroxidase
antibodies was within normal limits. Other laboratory results were
unremarkable. Fine-needle aspiration biopsy had been performed in a
local hospital before admission. It showed highly cellular aspirate with
numerous foci of elongated and spindle-shaped cells. Provisional di-
agnosis of fusocellular tumor of the thyroid had been made.
Subsequently, the girl was referred to the department of pediatric
surgery for an operative treatment. She underwent a left total lobec-
tomy. Intraoperatively, a recurrent laryngeal nerve was identiﬁed and
did not appear to be involved by the well-encapsulated tumor. The
postoperative course was uneventful.
On histologic examination, the tumor was found to be composed of
fusiform spindle-shape cells densely arranged in fascicules. It was
sharply demarcated from the adjacent thyroid tissue by a ﬁbrous
connective tissue capsule. Two growth patterns were seen within the
lesion; a predominantly cellular area composed of spindle-shaped
Schwann cells with little stromal matrix (Antoni type A tissue), and a
less cellular myxoid area with microcyst formation (Antoni B type
tissue). Classical Verocay bodies were seen in former areas as nuclear-
free zones. The tumor cells were positively stained with anti–S-100
protein antibody (Figs.1&2).
Neurilemmomas (Schwannomas) are peripheral nerve
tumors originating from neuronal sheath cells (Schwann
cells). Their highest incidence has been reported between
40 to 60 years of age. Nerilemmomas are benign tumors
with clinical picture depending mainly on their anatomic
site and size. They can occur anywhere in the body, but
those originating in the head and neck account for nearly
half of the cases.
Neurilemmomas of the cervical re-
gion arise from the cranial nerves with the vagal nerve or
its branches being the most frequently affected. Other
potential sites of origin are the brachial plexus, cervical
nerve roots, and cervical sympathetic chain.
of neurilemmoma within the thyroid gland is extremely
rare. Until now there have been 14 cases reported in the
literature. Eleven of these patients were the subject of
detailed clinical description.
All tumors occurred in
adult patients ranging in age from 20 to 57 years. We
From the Departments of Pediatric Surgery, Pathology, and
Radiology, Wroclaw Medical University, Wroclaw, Poland.
Address reprint requests to Maciej Baglaj, MD, Department of
Pediatric Surgery, Wroclaw Medical University, M. Sklodowska 52,
50-369 Wroclaw, Poland.
© 2004 Elsevier Inc. All rights reserved.
1418 Journal of Pediatric Surgery, Vol 39, No 9 (September), 2004: pp 1418-1420