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Pham Quang V, Hoang Quoc H, Nguyen B, Ngo Quang C, Nguyen Chi H, Nguyen N. Giant schwannoma on the lower leg: A case report and review of the literature. Int J Surg Case Rep 2023; 109:108468. [PMID: 37437325 PMCID: PMC10362252 DOI: 10.1016/j.ijscr.2023.108468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Peripheral nerve sheath tumors are common neoplasm with different biological features ranging from benign to malignant. The majority of these tumors are smaller than 5 cm, whereas those larger are termed giant schwannomas. When localized in the lower legs, the maximum length of the schwannoma is less than 10 cm. We report a case of giant schwannoma of the leg and its management. CASE PRESENTATION A 11-year-old boy presented with a 13 cm × 5 cm firm, smooth, well-defined margin mass in the posterior-medial aspect of right leg. The tumor was fusiform, well capsulated, multi-lobulated soft tissue with 13 cm × 4 cm × 3 cm in size at the biggest region. On MRI the tumor was low signal, isointense with adjacent tissue on T1S, hyper-intense on T2-FS sequences and surrounded by a thin fat-like intense rim. Biopsy findings were considered most consistent with Schwannoma (Antoni A). Tumor resection was performed. The mass appeared capsulated, white, and glistening with 132 mm × 45 mm × 34 mm in size. Postoperative course was uneventful without neurological deficit. CLINICAL DISCUSSION AND CONCLUSION Schwannomas are the most common peripheral nerve sheath tumors that derived almost entirely from Schwann cells. Schwannomas usually affect the head and neck region, localization in the lower extremity is rare. When located in lower extremity, the maximum diameter of 5 cm is described in most studies. Clinical presentation of schwannomas is unclear and unspecific. Diagnosis is based on ultrasound, MRI, and histology. The recommended treatment for schwannoma is surgical enucleation or resection without damaging the involved nerve.
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Affiliation(s)
- Vinh Pham Quang
- Department of Orthopaedics and Rehabilitation, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, Viet Nam; Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Huy Hoang Quoc
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Bach Nguyen
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Chuong Ngo Quang
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Hieu Nguyen Chi
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Ngoc Nguyen
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
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Abstract
Tumors of the median nerve are difficult to diagnose and median nerve schwannomas are rare. During a ten-year period, we treated eleven median nerve schwannomas found on the hand (nine) and wrist (two). All the tumors were treated by enucleation under loupe magnification and tourniquet application. All had a favorable result at a mean follow up of five years. We present three of our most typical cases, with schwannomas found on the wrist, palm and thumb. We also review the literature offering a wider view on the pathology, diagnosis and treatment of schwannomas in general.
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Muratori F, De Gori M, Campo FR, Bettini L, D'Arienzo A, Scoccianti G, Capanna R. Giant schwannoma of the foot: a case report and literature review. ACTA ACUST UNITED AC 2017; 14:265-268. [PMID: 29263749 DOI: 10.11138/ccmbm/2017.14.2.265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A schwannoma is a rare, benign tumor originating from Schwann cells of peripheral nerve sheath. It commonly occurs in subjects between 20 and 50 years of age, and its malignant transformation is exceptional. While schwannomas usually affect the head and neck region, localization in the lower extremity is exceptionally rare, and even fewer cases have described schwannomas occurring in the foot. We report a case of a giant schwannoma of the foot diagnosed in a 65-year-old woman. A giant schwannoma of the foot is an extremely rare soft tissue tumor. MRI may allow an earlier diagnosis and provide valuable information about the size and possible bone invasion. This case report noted that a complete excision of the schwannoma may prevent the risk of local recurrence, regardless of its size.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | | | - Leonardo Bettini
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Palermo, Palermo, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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Schwannoma of the digital nerve and reconstruction with reverse-flow dorsal metacarpal artery flap: A case report. J Orthop 2016; 13:200-3. [PMID: 27408477 DOI: 10.1016/j.jor.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/01/2015] [Indexed: 11/21/2022] Open
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Ansari MT, Rastogi S, Khan SA, Yadav C, Rijal L. Giant schwannoma of the first metatarsal: a rare entity. J Foot Ankle Surg 2014; 53:335-9. [PMID: 24656765 DOI: 10.1053/j.jfas.2014.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Indexed: 02/03/2023]
Abstract
Schwannomas of osseous origin are rare, and schwannomas of the short tubular bones are even rarer. These benign-looking tumors are difficult to diagnose using imaging alone. However, histopathologic evaluation of a biopsy specimen can establish the diagnosis by identifying Antoni type A and B zones. Curettage and bone grafting will probably be adequate for treatment because malignant changes are unlikely. Large lesions can require en bloc excision and reconstruction. We describe what appears to be only the second case of a schwannoma in the first metatarsal of the foot in a 48-year-old woman. The lesion was poorly contained, with obvious breaks in the cortical shell. The diagnosis was confirmed by pathologic analysis. The lesion was successfully treated with en bloc resection and reconstruction with a nonvascularized fibular graft.
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Affiliation(s)
- Mohammed Tahir Ansari
- Assistant Professor of Orthopaedics, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Shishir Rastogi
- Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Chandershekhar Yadav
- Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Laxman Rijal
- Orthopaedic Surgeon, Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
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Ribeiro da Silva M, Vidinha V, Negrão P. Nerve tumour as a rare cause of anterior interosseous nerve palsy. J Hand Surg Eur Vol 2013; 38:562-3. [PMID: 22837554 DOI: 10.1177/1753193412454801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - V. Vidinha
- Orthopaedic and Traumatology Department, Hospital São João, Porto, Portugal
| | - P. Negrão
- Orthopaedic and Traumatology Department, Hospital São João, Porto, Portugal
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Inukai T, Uchida K, Baba H. A large neurinoma originating from the anterior interosseous nerve. ACTA ACUST UNITED AC 2012; 17:375-7. [PMID: 23061949 DOI: 10.1142/s0218810412720355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report an interesting case of a neurinoma originating from the anterior interosseous nerve. Magnetic resonance (MR) images showed an egg-shaped, well-circumscribed mass on the volar side of the forearm. On the enhanced three-dimensional computer tomography (3D-CT), it was clearly demonstrated that the tumour had arterial feeding from the anterior interosseous artery. The enhanced 3D-CT angiography was useful in the pre-operative diagnosis and surgical planning of peripheral neurinomas.
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Affiliation(s)
- Tomoo Inukai
- Department of Orthopaedics, National Hospital Organization, Fukui National Hospital, Fukui, Japan.
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Lesic A, Bumbasirevic M, Atkinson HDE, Maksimovic R, Sopta J, Atanackovic M. Malignant intraosseous peripheral nerve sheath tumour of the proximal femur: a case report. J Orthop Surg (Hong Kong) 2006; 14:84-9. [PMID: PMID: 16598095 DOI: 10.1177/230949900601400119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of an intraosseous malignant peripheral nerve sheath tumour of the femoral head and neck. The tumour presented as a well-defined radiolucent lesion on plain radiography. Computed tomography showed aggressive destruction of the bone with no involvement of the adjacent soft tissues. Magnetic resonance imaging revealed an isointense signal intensity on T1-weighted images, hyperintensity on T2-weighted images, and non-homogeneously increased signal intensity after administration of contrast media. The final diagnosis was based on pathohistologic analyses due to the non-specific nature of the lesion.
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Affiliation(s)
- A Lesic
- Institute for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro
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Ozdemir O, Ozsoy MH, Kurt C, Coskunol E, Calli I. Schwannomas of the hand and wrist: long-term results and review of the literature. J Orthop Surg (Hong Kong) 2005; 13:267-72. [PMID: 16365490 DOI: 10.1177/230949900501300309] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review the long-term results of 14 cases of histopathologically confirmed schwannoma of the hand and wrist treated with intracapsular tumour removal. METHODS All operations were performed under loupe magnification and microsurgical dissection, and the tumour was removed after capsular (including endoneurium) incision. Patients were assessed for any residual symptoms. Sensory testing of light touch and pain was carried out. RESULTS The mean age of the patients at the time of operation was 38.4 years (range, 11-78 years), and the mean follow-up period was 12.6 years (range, 3-36 years). Ten of the tumours were located in the median nerve distribution, whereas 4 in the ulnar nerve distribution. Four tumours were at the wrist level, 3 at the palm level, and 7 at the digital level (3 in the index finger). Only 5 patients were correctly diagnosed preoperatively. Neurological loss was not recovered in one patient in whom the tumour was resected with the digital nerve. No recurrence or muscle atrophy was noted at the latest follow-up. CONCLUSION Meticulous dissection with magnification can achieve complete tumour removal without neurological loss or recurrence. Intracapsular tumour removal provides good results with a low complication rate.
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Affiliation(s)
- O Ozdemir
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Ege University, Izmir, and First Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, Turkey.
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Josty IC, Sykes PJ. An unusual schwannoma of the median nerve: effects on the motor branch. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:71-3. [PMID: 11121324 DOI: 10.1054/bjps.2000.3455] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An unusual case of a schwannoma of the median nerve is presented where pressure due to the tumour on the motor branch to the thenar muscles caused weakness and wasting of the abductor pollicis brevis muscle, a previously unreported phenomenon. The patient achieved a full functional recovery after enucleation, which is also unusual considering the patient's age. Aspects of schwannoma biology, differential diagnosis, investigation and treatment are discussed.
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Affiliation(s)
- I C Josty
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Abstract
Neurilemmomas are benign tumors that arise from Schwann cells. They are rarely found on bone. We describe a neurilemmoma in a 45-year-old patient that affected the distal metaphysis of the radius. Only 1 previous case has been described in the literature. We discuss the clinical presentation, the radiographic aspect, particularly the magnetic resonance imaging characteristics, and the microscopic findings.
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Affiliation(s)
- J Giné
- Departments of Orthopedic Surgery and Pathological Anatomy and the Hand Surgery Section, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain
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Joist A, Joosten U, Wetterkamp D, Neuber M, Probst A, Rieger H. Anterior interosseous nerve compression after supracondylar fracture of the humerus: a metaanalysis. J Neurosurg 1999; 90:1053-6. [PMID: 10350251 DOI: 10.3171/jns.1999.90.6.1053] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a metaanalysis of reports of anterior interosseous nerve syndrome, a rare nerve compression neuropathy that affects only the motor branch of the median nerve. This syndrome is characterized by paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index finger, and the pronator quadratus, with weakness on flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger without sensory loss. METHODS The authors reviewed reports of 34 cases of anterior interosseous nerve syndrome combined with supracondylar fractures of the humerus in children. They have added a new case identified in a 7-year-old boy in whom a diagnosis was made from the clinical findings and whose treatment and outcome are analyzed. The ages of patients reported in the literature ranged from 4 to 10 years. Ten patients (29%) were treated with closed reduction and application of a cast, whereas 25 patients (71%) were treated with open reduction and fixation of the fracture. CONCLUSIONS All patients regained full flexion and strength after 4 to 17 weeks. The fractures that were surgically treated showed no entrapment of the anterior interosseous nerve.
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Affiliation(s)
- A Joist
- Department of Trauma and Hand Surgery, Westphalian Wilhelms-University, Muenster, Germany
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Abstract
Over a 22-year period, operations were performed on 263 patients for 288 primary benign tumors of major peripheral nerves. The tumors included 85 schwannomas, 197 neurofibromas, and six plexiform neurofibromas. Total removal was achieved in 83 of the 85 schwannomas, and 76 of these patients were available for follow-up evaluation. Motor function either improved or was unchanged in 87% of these patients and 85% of those with pain in the distribution of the involved nerve had either total or partial resolution of their symptoms. Of the neurofibromas, 123 occurred in 121 patients without von Recklinghausen's disease. All tumors within this group were completely excised using a fascicular approach to the tumor. Of the 99 patients available for follow-up evaluation, 90% had either improved or unchanged motor function and 88% had partial or complete resolution of pain syndromes. Fifty-nine patients with von Recklinghausen's disease had 80 tumors removed: 74 fusiform tumors (58 of which were completely removed) and six plexiform tumors. Forty-eight of the 58 patients with gross total removal of fusiform tumors were available for follow-up evaluation, of whom 83% had improved or unchanged motor function and 74% had partial or complete resolution of pain syndromes. All six patients with plexiform tumors had progression of symptoms postoperatively. One brachial plexus schwannoma recurred and was re-excised without subsequent recurrence at the 5-year follow-up evaluation. Several incompletely excised plexiform neurofibromas have recurred with a symptomatic presentation.
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Affiliation(s)
- T R Donner
- Department of Neurosurgery, Louisiana State University School of Medicine, New Orleans
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