Plexiform schwannoma of the foot

Diagnosis of plexiform schwannoma of the foot in a 66-year-old male: a case report and literature review

Plexiform schwannoma is a rare tumor in the lower extremity which grows slowly and is noninvasive. The tumor size is usually less than 2 cm. The main affected population of this disease is concentrated on the age group of 20 to 50 years old. In this study, we reported a rare case of 66-year-old male with a large soft tissue mass on his right foot with a tumor size larger than 7 cm. The ultrasound was performed and showed circumscribed hypoechoic image, indicating a suspected diagnosis of lipoma. The subsequent MRI showed a multilobulated heterogenous signal on T2WI and STIR sequence with mild enhancement, suggesting hemangiomas. Then the tumor of the patient was removed for pathological examination and the results confirmed the diagnosis of plexiform schwannoma. Patient recovered well and had no recurrence in 9 months after the surgery. CT, MRI, and ultrasound are useful to distinguish these rare tumors from other soft tissue lesions, in contrast, MRI has higher sensitivity and provides more accurate diagnostic information. This case report provides a deep understanding of plexiform schwannoma. In the diagnosis of large soft tissue tumors in the lower extremity of the elderly, attention should be paid to the differential diagnosis of plexiform schwannoma to improve the diagnosis level.

Giant plexiform schwannoma in the plantar aspect of the foot: a case report

Plexiform schwannoma is a rare Schwann cell tumor that usually occurs in the head and neck. Here, we report a giant plexiform schwannoma (5.5 × 4.0 cm) in the right plantar aspect of the foot. This tumor presented from the dermis to the subcutaneous fat in the plantar aspect, forming a multiocular shape.

Schwannoma of the foot: report of four cases and literature review

Schwannoma is a soft tissue tumor that rarely presents in the foot. Patients are usually asymptomatic, but in some cases symptoms typically result from the mass effect and direct involvement of the nerve and surrounding tissue. We report on four consecutive cases. The first patient was a 57-years-old female that referred symptoms similar to the Morton’s neuroma with a mass arising from the medial plantar nerve. The second patient was treated for a schwannoma in the plantar area. The third case was a female with a schwannoma arising from the sural nerve and the fourth patient had a tumor arising from the medial plantar nerve. All patients underwent surgical excision and histological evaluation. No signs of neurological deficit or recurrence were observed at final follow-up. Purpose of the study was to define clinical features, optimal management and outcome of schwannomas of the foot, through an accurate review of the literature. (www.actabiomedica.it)

Successful enucleation of large multinodular/plexiform schwannoma of the foot and ankle

Background

It is often challenging to completely resect multinodular/plexiform schwannomas involving important deep nerves using minimally invasive surgically techniques.

Case description

A 32-year-old woman presented with a 5-year history of a slowly growing, painful mass in the medial aspect of the right ankle. Magnetic resonance imaging (MRI) demonstrated multiple nodular lesions with iso-signal intensity relative to skeletal muscle on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Mild to moderate enhancement was identified after gadolinium administration. All 58 tumors were completely enucleated using an intracapsular technique. Histological examination confirmed the diagnosis of schwannoma consisting mainly of Antoni A areas. The burning sensation was relieved immediately after surgery. The patient had no aggravated neurological deficit and was very satisfied with the outcome of the treatment at final follow-up.

Discussion and evaluation

We experienced a very rare case of a large multinodular/plexiform schwannoma arising from the posterior tibial nerve and its larger terminal branch. Our case had the characteristic MRI features of this condition. It is extremely important to differentiate multinodular/plexiform schwannoma from plexiform neurofibroma and malignant peripheral nerve sheath tumor, with complete surgical enucleation being curative.

Conclusions

MRI is a clinically useful modality in the evaluation and detection of deep-seated multinodular/plexiform schwannoma. Intracapsular enucleation seems to be an acceptable treatment for this peculiar tumor located in the foot and ankle.

Multiple plexiform schwannomas in the plantar aspect of the foot: case report and literature review

Background

Plexiform schwannoma (PS) is a rare, peripheral nerve sheath tumor arranged in a plexiform pattern.

Case presentation

We report an unusual case of a 19-year-old woman, who complained of pain in the plantar aspect of the left foot. Magnetic resonance image (MRI) demonstrates three solitary nodules of varying sizes in the deep soft tissue of the plantar aspect of the foot that are homogeneously isointense to skeletal muscle on T1-weighted images and hyperintense on T2-weighted fat-suppressed images, especially the rim of the lesion. Subsequent pathological examination confirmed the diagnosis of PS.

Conclusion

MRI characteristic plays an important role in detecting this rare lesion. A review of the literature on PS is also presented.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-342) contains supplementary material, which is available to authorized users.

Expression of noggin, an antagonist of bone morphogenetic protein, in schwannoma: A possible mechanism

Schwannoma is a benign peripheral nerve sheath tumor derived from Schwann cells. Bone scalloping, including spinal foramen enlargement, develops when the tumor is located adjacent to a bone and is a characteristic radiological feature. In the present study, to investigate the pathomechanism of bone resorption, the expression of noggin (a potent antagonist of bone morphogenetic protein) was analyzed in schwannoma tissues and compared with that observed in other soft tissue tumors. Quantitative polymerase chain reaction analysis revealed that the mRNA levels of noggin in schwannomas were significantly increased compared with the levels in other tumors. The gene product of noggin was only detected in a subset of schwannomas using immunohistochemistry and western blot analysis. Furthermore, the tissue extract from a noggin-producing schwannoma was found to inhibit osteoblastic differentiation in MC3T3 mouse osteoblastic cells in a dose-dependent manner. These findings indicate that bone scalloping in radiology may be induced by schwannoma-secreted noggin. In addition, noggin may have potential as a novel molecular and diagnostic marker for identifying certain types of schwannoma.

Plexiform schwannoma of the foot: a review of the literature and case report

Plexiform schwannoma is a rare variety of benign nerve sheath tumor that is usually confined to the head and neck or trunk. In this article, we describe the case of a plexiform schwannoma of the foot in an adult male. In addition to a review of the literature, we discuss diagnostic characteristics and differentiators for this tumor, an approach to surgical treatment, including reconstruction of the plantar foot defect after tumor extirpation, and why it is important for practicing foot and ankle surgeons to differentiate plexiform schwannoma from other similar tumors.

Multinodular/plexiform (multifascicular) schwannomas of major peripheral nerves: an underrecognized part of the spectrum of schwannomas

OBJECT

In clinical practice, schwannomas are among the most common types of nerve sheath tumors. Their clinical presentation, imaging characteristics, and operative features are well known. Over the past 20 years, clinical outcomes have improved due to resection of these tumors at a fascicular level. Despite these advances, a subgroup of patients with schwannomas is associated with a disappointing neurological outcome following resection. The purpose of this study was to correlate the imaging and histological features in this group of patients with more anatomically complex forms of schwannomas.

METHODS

In a retrospective review performed at their institution over a 10-year period, the authors found a subgroup of patients with complex multinodular/plexiform schwannomas affecting major peripheral nerves. Eleven patients were identified, and the clinical, imaging, and pathological features of their disease were reviewed.

RESULTS

The clinical presentation of multinodular/plexiform schwannomas of major peripheral nerves may be similar to that of conventional schwannomas, but their imaging features, operative appearance, and outcomes differ.

CONCLUSIONS

Preoperatively and intraoperatively, the distinguishing features of multinodular/plexiform schwannomas of major peripheral nerves may be subtle and can easily go unrecognized, thus explaining the often suboptimal surgical results. Familiarity with the imaging and operative features of multinodular/plexiform schwannomas will no doubt alter treatment approaches and improve neurological function in this subgroup of patients.

Plexiform schwannoma of the posterior tibial nerve: a case report

Introduction

Plexiform schwannoma is one of the least common variants of schwannoma. It is usually found on the trunk, head, neck and upper extremities. Most reported cases are small tumors, less than 2cm in maximum diameter, arising from superficial nerves. Trauma and neurofibromatosis type 2 are well-recognized risk factors for plexiform schwannoma. It is important to differentiate it from plexiform neurofibroma, because the former has neither an association with von Recklinghausen’s disease nor a malignant potential.

Case presentation

We report a case of a large plexiform schwannoma arising from the posterior tibial nerve in proximity with the medial malleolus. The patient had no history of ankle strain, fracture or neurofibromatosis type 2. Magnetic resonance imaging demonstrated a multinodular, inhomogeneous lesion, measuring 6 × 4 × 2.8 cm. Fine needle biopsy was suggestive of a benign lesion, deriving from neural elements. The mass was excised marginally. Permanent section showed that the lesion was multilobular, surrounded by a thin fibrous capsule and consisting of elongated cells, rare typical mitosis, cells with degenerative features and stained positive for S-100 protein. The patient was not evident disease at the latest follow-up 2.3 years later, with an excellent functional result. No sensory or motor deficits were encountered.

Conclusion

There are no reports in the literature for large plexiform schwannomas arising from the tibial nerve. Marginal excision seems to be the recommended therapy for this rare tumor.

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.

Intra-extradural plexiform schwannoma of the cervical spine

STUDY DESIGN

Case report.

OBJECTIVE

To describe the clinical and radiographic features of an extremely rare case with intra-extradural plexiform schwannoma of the cervical spine.

SUMMARY OF BACKGROUND DATA

Plexiform schwannoma is a rare neurogenic tumor that predominantly occurs in the dermis and subcutis. Noncutaneous deep-seated lesions have rarely been described. No cases of intra-extradural plexiform schwannoma of the cervical spine have previously been reported.

METHODS

A 16-year-old boy presented with a 3-month history of left neck and shoulder angle pain, motor weakness of the left upper extremity, clumsiness of bilateral hands, and mild gait disturbance. Preoperative magnetic resonance imaging showed a multinodular inhomogeneous dumbbell-shaped tumor encroaching on the cord at C3-C4. T1-weighted imaging showed the tumor as inhomogeneous with slightly higher intensity than muscle. T2-weighted imaging demonstrated a multinodular inhomogeneous tumor with much higher intensity than muscle, and each nodule of the tumor displayed a peripheral rim of higher intensity and central relatively lower intensity.

RESULTS

Through hemi-laminectomy from C3-C4 and facetectomy of the left side of C3-C4, the intradural parts of the multinodular tumor were completely extirpated and extradural parts of the multinodular tumor were enucleated as much as possible. Gross examination of the tumor showed yellowish-white soft contents that were encapsulated and multilobulated. Histologic examination revealed benign schwannoma. After surgery, preoperative neurologic symptoms completely resolved.

CONCLUSION

To the best of our knowledge, this is the first reported case of intra-extradural plexiform schwannoma. Careful magnetic resonance imaging might be helpful in suggesting this rare plexiform schwannoma before surgery.