Sural nerve schwannoma: A case report

A 54-year old female with lateral ankle and foot pain was referred to an orthopaedic specialist clinic. Examination and investigations revealed a painful mass surrounding the sural nerve. Surgical excision confirmed the diagnosis of a sural nerve schwannoma. The following case report discusses this patient’s presentation in further depth, as well as information about schwannomas, their frequency in the lower limb, and recommendations for investigation and management.Level of clinical evidence6     

Abducens nerve schwannoma: case report and review of the literature

Schwannomas of the abducens nerve are extremely rare. The authors report a case with this tumor and discuss its clinical and radiographic characteristics. A 36-year-old man presented with 6-month history of diplopia. Right abducens nerve paresis was noted on neurologic examination. Magnetic resonance imaging revealed a 4-cm sized heterogeneously enhancing mass in the right cerebellopontine angle. Although schwannoma was suggested, no direct radiographic evidences regarding its origin were identified. Instead, the facial and vestibulocochlear nerve complex was found to be displaced posteriorly by the tumor on MR three-dimensional T2-weighted driven equilibrium sequence. Resection of the tumor was carried out via retrosigmoid approach. As the encapsulated partially suckable yellowish tumor was debulked and dissected, the abducens nerve was found to fan along and be attached to the medial surface of the tumor, which was cut at this point. Complete excision of the tumor was accomplished, and reanimation of the nerve was done by end-to-end anastomosis. Histologic feature was typical of schwannoma. Abducens schwannoma, although rare, should be taken into account for differential diagnosis of the cerebellopontine angle tumors. Appreciation of the characteristic clinical and radiographic features may provide an accurate preoperative diagnosis.     

Intraventricular schwannoma: a case report

Ventricular schwannomas are very uncommon. We report such a tumor in the right lateral ventricle of a 16-year-old young man. The various etiopathogenic hypotheses are discussed.     

A parapharyngeal space schwannoma arising from the vagus nerve: A case report

IntroductionTumours of the parapharyngeal space are rare. Only 0.5% of head and neck tumours occur in this space. Surgical excision of parapharyngeal space lesions is challenging because of the anatomical complexity of the area.Presentation of caseA 31-year-old male patient was referred by his general dental practitioner for removal of lower wisdom teeth due to multiple episodes of pericoronitis. At the initial examination, an incidental finding was made of a large fluctuant posterior oropharyngeal swelling. A fluid aspirate was taken from the lesion but this was inconclusive. The patient underwent an urgent MRI and CT neck revealing a large parapharyngeal mass. An incisional biopsy of the lesion confirmed the presence of a vagal nerve schwannoma which was subsequently removed via a transcervical approach.DiscussionDue to their slow growing and painless nature, they are often not detected until they are large enough to palpate or visualise. It may cause secondary symptoms such as dysphagia, hoarseness and nasal obstruction. This case represents a typical presentation of a parapharyngeal schwannoma and reiterates the subtle and often ambiguous nature of the lesion.ConclusionVagal schwannomas in the parapharyngeal space are rare. They usually present in the form of an isolated intraoral or neck mass. A positive diagnosis is made on imaging and confirmed by histopathological examination. Complete surgical excision is the treatment of choice and recurrence rates are low.     

Intracerebral schwannoma: case report

BACKGROUND AND PURPOSE: We report a well-documented case of intracerebral schwannoma, presenting as a cystic and solid parietal mass, arising in a 20-year-old woman. Possible mechanisms underlying the histogenesis of this rare lesion are discussed. METHODS: The clinical, radiological and pathological features are described. The relevant literature is reviewed. RESULTS: The patient presented seizures and elevated intracranial pressure. Neuroradiologic findings showed a right parietal lesion with cystic and tissular components, intensely enhanced after injecting intravenous gadolinium. The tumor was removed through a right parietal craniotomy. Histological and immunochemical features confirmed the diagnostic of intracerebral schwannoma. The patient is alive without progressive local disease or metastasis. The origin of intracerebral schwannomas has been the source of much controversy. The most popular hypothesis argues that these tumors arise from the proliferation of Schwann cells in the perivascular nerve plexii. CONCLUSIONS: Intracerebral schwannoma is an extremely rare benign tumor. About fifty cases have been reported. The importance of recognizing this tumor is stressed, particularly in younger patients, given its benign nature, radiological resemblance to other tumors and favorable response to resection without toxic treatment.     

Paraspinal desmoid tumor: a case report and a literature review

Aim  Paraspinal desmoid tumors are rare and only few cases have been reported in the literature. This report describes a case of successful excision of a parasacral desmoid tumor in a 34 years old female. Methods  The patient presented with a tender mass over her right sacral region. Radiological examination with CT and MRI demonstrated two adjacent well circumscribed masses measuring 4 × 3 and 2.5 × 3 cm, in the subcutaneous fat of the right paravertebral region. At surgery the patient underwent a wide excision of the lesion, and two tumor masses were dissected away from the gluteus and the multifidus muscles. Histopathologic examination of the specimens confirmed the diagnosis of a desmoid tumor. Results  After surgical resection without adjuvant therapy, the patient is recurrence free after 36 months. Conclusions  Despite their benign microscopic appearance, and their insignificant metastatic potential, the tendency of desmoid tumors for local infiltration is potentially significant causing deformity, morbidity and even mortality, especially when present at the paraspinal area, due to the pressure effects to the close neural structures and the spinal canal as well. Early detection of the neoplasm is crucial, in order to achieve radical excision of the neoplasm before it penetrates vital structures.     

Measuring of the compensation of a nerve root in a cervical schwannoma: a case report

A 64-year-old woman experienced numbness and hypesthesia of the right C6 dermatome a year ago. Enhanced magnetic resonance imaging of the cervical spine revealed an enhanced tumor continuing into the foramen from the spinal cord at the C5/6 intervertebral level. It was thought to be an Eden type 2 schwannoma. Right unilateral laminectomy was performed on C5. The tumor was present in the intradural area and arose from the right C6 anterior root. Compound muscle action potentials (CMAPs) from the deltoid, biceps, and extensor carpi radial (ECR) muscles were recorded following electric cervical nerve root stimulation (0.2ms duration, and 7mA intensity). CMAPs of large amplitude were obtained from the deltoid, biceps, and ECR muscles following C5 root stimulation, but those following C6 root stimulation were small. As a result it was determined that the right C6 root was not associated with the nerve distribution for these muscles, so it was resected en bloc with the tumor. No apparent loss of motor function was observed. Standard needle electromyography showed no denervation potentials or decrease in motor unit potentials in either the deltoid or biceps muscles. Intraoperative investigation for compensation of nerve root is clinically useful for determining whether resection of a nerve root results in muscle weakness after surgery for a cervical schwannoma.     

A case of isolated giant plexiform neurofibroma involving all branches of the common peroneal nerve

Plexiform neurofibroma is generally considered as a component of neurofibromatosis 1, and a great majority of the cases with plexiform neurofibroma display other symptoms related to neurofibromatosis. Plexiform neurofibromas occur frequently in the head and neck region due to the rich innervation of the area, however appear rarely in the extremities. We report here an isolated giant plexiform neurofibroma involving the common peroneal nerve branches without symptoms related to neurofibromatosis in a 5-year-old case. Surgical excision was performed due to pain and numbness in the leg, and against the possibility of malignant transformation due to sudden growth observed in the tumor. One month following the excision of all the reachable tumoral tissues, tendon transfer surgery was performed for the ankle and toe extensions. Our case stands as the only reported case of isolated giant plexiform neurofibroma involving the common peroneal nerve in the pediatric age.     

Misdiagnosis of plexiform neurofibroma of the medial plantar nerve: Case report

Plexiform neurofibromas are benign tumors of the peripheral nerve. Diagnosis may be challenging, if they present mimicking other peripheral nerve pathologies.We report the case of a patient who had severe foot pain, which progressively hampered her walking ability, erroneously attributed to recurrent Morton's neuroma. Diagnosis of plexiform neurofibroma of her right medial plantar nerve was made 15 years after the appearance of symptoms.Pain and function recovered after radical neurotomy of the medial plantar nerve. A correct diagnosis is an essential starting point in the treatment of neurofibromas and a misdiagnosis may lead to an inappropriate treatment.     

Subcutaneous plexiform schwannoma of the forearm. A case report

Plexiform schwannoma is an exceptional schwannoma subtype. It's a benign nerve sheath tumor. Mainly, it's solitary, asymptomatic and slowly growing nodule that occurs in the subcutis or dermis. Histology gives the diagnosis. The authors report a case of solitary superficial plexiform schwannoma of the right forearm of a patient aged 22. A review of literature is done.     

机器人辅助神经鞘瘤切除日间手术一例报道

神经鞘瘤是一种常见的后纵隔占位性病变,通常发生于脊神经根,具有一定的恶变可能性。临床上对于后纵隔占位性病变,若无禁忌证,均应考虑外科治疗。手术方式根据肿瘤的大小和位置分为开胸手术以及胸腔镜手术。尽管后纵隔肿瘤切除术通常被认为是一种安全的、低风险的手术,但患者术后仍需要住院观察。随着手术机器人技术的开发,机器人辅助手术可以保护周围组织减少术后出血的可能性,以达到日间手术的标准。本文介绍了一例接受机器人辅助后纵隔肿瘤切除日间手术的患者,手术效果满意,患者在24h内顺利出院。     

Primary intrasellar schwannoma with intratumoral hemorrhage mimicking pituitary apoplexy: A case report

Tumours growing in the sella turcica are mostly pituitary adenomas. We describe a rare case of primary intrasellar schwannoma with intratumoral bleeding. A 38-year-old man presented with headache in association with bilateral supratemporal quadrantopsia. MRI showed an intrasellar mixed signal mass lesion with suprasellar extension. The majority of the pituitary hormones were normal. He was diagnosed as non-functional pituitary adenoma with pituitary apoplexy. Subtotal resection was achieved eventually via an endoscopic transnasal trans-sphenoidal approach. The histopathologic diagnosis was schwannoma. It is the first intrasellar schwannoma with intratumoral hemorrhage in literature to date. It implied that the primary intrasellar schwannoma has potential risk of intratumoral bleeding, which should be considered in the differential diagnoses of sellar lesions.     

Spinal schwannoma causes acute subarachnoid haemorrhage: A case report and literature review

BackgroundSpinal schwannomas that arise from spinal nerve root sheaths are the most common intradural extramedullary spinal tumours and are often accompanied by nerve roots or spinal cord irritation symptoms. The phenomenon of spinal schwannoma causing subarachnoid haemorrhage (SAH) is rare, with ependymoma of the conus medullaris accounting for most cases.Case reportA 45-year-old man was admitted to our hospital due to progressive lower limb weakness and sudden back pain after hard physical work. The patient had not been able to walk for 2 hours upon admission. An emergency magnetic resonance imaging (MRI) scan showed that the spinal cord at the C6-T4 level was severely compressed by a subdural mass. During the emergency operation, exploration of the dura and arachnoid mater revealed a fresh blood clot covering a tumour located on the ventral side of the spinal cord. The size of the tumour was approximately 3 × 2 × 1 cm without adhesion to the surrounding tissue, but the drainage vein was ruptured. Postoperative pathology showed that the tumour was a schwannoma with areas of fresh haemorrhage and focal necrosis.ConclusionsSpinal schwannomas presenting with SAH are rare events. In our opinion, spinal pathology with rapid progression of neurological symptoms requires early diagnosis and emergency management. Complete excision of haemorrhagic tumours is the goal of treatment to prevent recurrence, which can effectively avoid irreversible damage to the spinal cord resulting from spinal cord compression.     

Plexiform schwannoma of the ulnar nerve

Plexiform schwannoma is a rare benign neurogenic tumour; we report a case that arose in the ulnar nerve of a 59-year-old woman. Exploration showed a continuous multinodular tumour that involved the ulnar nerve from the hand to the upper arm; the length of the tumour was 35 cm.     

原发性膀胱神经鞘瘤1例报告并文献复习

目的 探讨原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤在组织病理学、临床表现、治疗和预后上的特点,确立两者的鉴别诊断思路.方法 回顾1例原发于膀胱的神经鞘瘤的临床诊疗过程,结合有关膀胱神经鞘瘤及膀胱恶性周围神经鞘瘤的文献资料进行分析.结果 在组织病理和免疫组化方面,原发于膀胱的神经鞘瘤和恶性周围神经鞘瘤有明显差异.结论 原发于膀胱的神经鞘瘤临床极其少见,易与膀胱常见肿瘤混淆,造成误诊,免疫组化为重要的确诊依据.膀胱恶性周围神经鞘瘤应以高度恶性的软组织肉瘤进行处理.临床上应重视两种疾病的鉴别,以正确地指导临床诊疗.     

Giant retroperitoneal schwannoma from the fifth lumbar nerve root with vertebral body osteolysis: a case report and literature review

Study design  To report a rare case of retroperitoneal schwannoma from lumbar nerve root with difficult surgery and potential vascular complication. Objective  We report a rare case of giant schwannoma which arises from fifth lumbar root with L5 vertebral body destruction. Summary of background data  Retroperitoneal schwannomas are rare, and those with bony involvement are even rarer and may be mimicking malignant tumors. Methods  Retroperitoneal removal of the tumor with partial killing of right L5 nerve root and allograft of L5 vertebral body defect were performed. Incidental injury of common iliac vein was encountered due to adhesion of the vein to tumor capsule. The laceration was repaired by cardiovascular surgeon. Results  At final follow-up, the patient had mild weakness of dorsi-flexion of right ankle and mild right L5 dermatome numbness. No walking difficulty and no sign of local recurrence in the image studies. Conclusions  Retroperitoneal schwannomas are rare, and they can become very large when diagnosed. Major vessels impingement and adhesion can occur which make the surgery difficult. Careful pre-operative evaluation and explanation is very important.     

Vestibular schwannoma and tuberculoma occurring In collision in the posterior fossa: A case report

IntroductionThough acoustic schwannoma is the most common primary tumour in the cerebello-pontine angle, its occurrence with tuberculoma has never been reported.Presentation of caseA case of a vestibular schwannoma and tuberculoma occurring as collision tumors in the posterior fossa in a 46 years old female is reported. She presented with chronic raised intracranial pressure manifesting as headache, occasional diplopia, speech disturbance, and unsteady gait. Magnetic resonance imaging of the brain demonstrated a vestibular schwannoma and tuberculoma in the right cerebello-pontine angle. The lesions were resected through retro sigmoid route. The caudal mass was vestibular schwannoma while the rostral and medial portion was tuberculoma.DiscussionThe occurrence of a vestibular schwannoma and tuberculoma in collision has hitherto never been reported. The pathogenesis, surgical challenges and management of such a rare entity is discussed and the relevant literature is briefly reviewed.ConclusionThe association of vestibular schwannoma and tuberculoma is rare. Surgical excision of lesions occurring in collision can be formidable. They require careful planning and strategy.     

Pancreatic schwannoma: Report of a case

Among pancreatic neoplasms, pancreatic schwannoma is quite rare. We report a case of solitary pancreatic schwannoma, plus a literature review of this tumor. A 71-year-old woman was diagnosed by abdominal ultrasonography as having a pancreatic tumor and was hospitalized in our department at Kumamoto University Hospital on January 26, 2006. Abdominal computed tomography, magnetic resonance imaging, and endoscopic ultrasonography all showed this tumor, which was located in the body of the pancreas, to have cystic and solid components, and with a septum in the cystic part of the lesion. The tumor, preoperatively identified as a mucinous cystic neoplasm, was clearly separated from the normal pancreatic parenchyma. We performed a spleen-preserving distal pancreatectomy with a lymph node dissection on February 7, 2006. A histopathological examination of the resected specimen by means of hematoxylin and eosin revealed the tumor to consist of two parts: one with a compact spindle cell pattern (Antoni type A), and the other showing degeneration of fat (Antoni type B). We also found positive results for immunohistochemical staining for S-100 and vimentin. These findings confirmed the tumor’s classification as a pancreatic schwannoma.