Malignant schwannoma mistakenly diagnosed as carpal tunnel syndrome

Magnetic Resonance Imaging of the Digital Nerves of the Hand: Anatomy and Spectrum of Pathology

Digital nerves are intrinsic to the sensory and motor function of the hand. These nerves represent the terminal ramifications of the ulnar, median, and radial nerves and are located distal to the carpal tunnel and Guyon canal. With magnetic resonance imaging, traumatic and nontraumatic abnormalities of the digital nerves can be shown with high contrast as well as high spatial resolution. Digital nerve abnormalities are most commonly posttraumatic in nature; however, infection, inflammatory, vascular malformations, and neoplasms can rarely occur. Magnetic resonance imaging is playing an increasing role in the assessment of peripheral nerve injury throughout the body, and in the hand, which can accurately identify the extent and character of digital nerve abnormalities before operative intervention.

Giant schwannoma of the first metatarsal: a rare entity

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.

Role of sonography in the preoperative assessment of neurilemmoma

This case report illustrates the role of high-resolution sonography in the preoperative assessment of a neurilemmoma of the median nerve in the forearm. Sonography identified the 3-dimensional localization of the nerve tumor its origin from a nerve fascicle, and its relationship with noninvolved nerve fascicles, facilitating the surgeon's approach to preserve noninvolved fascicles.

Multiple schwannomas of the median nerve: a case report and literature review

We report a case of multiple schwannomas of the median nerve. Multiple schwannomas can be difficult to diagnose on clinical grounds and can be mistakenly diagnosed as carpal tunnel syndrome or ganglia as in our case. Nerve conduction studies helped locate non-visible tumours. Magnetic resonance imaging (MRI) is useful in the preoperative planning of these tumours. The appearances on scanning however can be sometimes confused for ganglia as in this case. Intraneural dissection of the schwannomas was carried out and the pathology is described.

An unusual schwannoma of the median nerve: effects on the motor branch

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.

Malignant schwannoma of the digital nerve in a child. A case report

An extremely rare case of malignant schwannoma (malignant peripheral nerve sheath tumor) arising in the digital nerve in the right ring finger of a child is described. The patient was an 8-year-old boy who did not have neurofibromatosis (von Recklinghausen's disease). He noticed a small tender mass on the tip of his right ring finger in 1991. The lesion was excised twice. However, the tumor recurred soon after each surgery. Histologic examination revealed malignant schwannoma. He eventually underwent disarticulation of the ring finger at the metacarpophalangeal joint in 1995. There was no recurrence or distant metastasis at followup in July 1999. Solitary malignant schwannomas can occur in the small peripheral nerves and in the major nerves.

Intraosseous neurilemmoma of the radius: a case report

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.