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Kang YJ, Woo OH, Kim A. Nipple Schwannoma: A Case Report and Literature Review on Nipple Mass. J Breast Cancer 2024; 27:72-77. [PMID: 37985385 PMCID: PMC10912579 DOI: 10.4048/jbc.2023.0119] [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: 06/05/2023] [Revised: 08/12/2023] [Accepted: 11/12/2023] [Indexed: 12/20/2023] Open
Abstract
Schwannomas are slow-growing benign tumors originating from the Schwann cells of the peripheral nerve sheaths. Herein, we report the first documented case of a schwannoma presenting as a painful nipple mass in a 32-year-old woman. This mass initially developed six years ago following a period of breastfeeding. Breast magnetic resonance imaging (MRI) scans revealed an iso-intense mass, with an approximate size of 2.2 cm, on a T1-weighted image with internal cystic changes. The mass exhibited heterogeneously delayed enhancement and restricted diffusion. Surgical excision was performed, and the diagnosis of cutaneous plexiform nipple schwannoma was confirmed histopathologically. A literature review revealed that the MRI findings of the nipple mass in our case were consistent with the common features of a schwannoma.
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Affiliation(s)
- Ye Ju Kang
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea.
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
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Tiger-Striped PASH: Recognition of a Unique Morphology Allows for a Zippered-Up Diagnosis of Pseudoangiomatous Stromal Hyperplasia of Breast. Case Rep Pathol 2022; 2021:7697987. [PMID: 34987877 PMCID: PMC8720602 DOI: 10.1155/2021/7697987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) of the breast is histologically characterized by anastomosing and slit-like spaces invested by collagenous stroma and lined by flattened, spindle cells. These clear spaces that may mimic microscopic vascular channels do not contain red blood cells. Immunohistochemistry (IHC) studies may also help to confirm a diagnosis of PASH, with the spindled cells marking positively with CD34 and PR while demonstrating no reactivity with more specific endothelial antigens such as CD31 and ERG. In the current case, a 39-year-old female was diagnosed with cellular PASH of the right breast with unique histological patterns showing “tiger-striped” and “zippered” histologies. To our knowledge, this is the first report of these unique variant PASH morphologies.
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Lee HS, Jung EJ, Kim JM, Kim JY, Kim IK, Kim JR, Kim TH, Jang JY, Woo JW, Lee J, Park T, Jeong SH, Cho E, Song DH. Schwannoma of the breast presenting as a painful lump: A case report. Medicine (Baltimore) 2021; 100:e27903. [PMID: 34889239 PMCID: PMC8663845 DOI: 10.1097/md.0000000000027903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Schwannoma in the breast parenchyma is very unusual. It usually develops on the head, neck, and extensor surfaces of the upper and lower extremities. PATIENT CONCERNS We report a case of a 60-year-old woman with a palpable and painful mass. Clinically, she experienced neuropathic pain at the mass site. DIAGNOSES The tumor was a 1 cm, well-circumscribed mass, and revealed schwannoma on core needle biopsy. INTERVENTIONS The patient underwent wide excision. OUTCOMES No postoperative complications were observed. A six-month follow-up revealed no recurrence. LESSONS SUBSECTIONS Although breast schwannoma is a very rare tumor, it is a very important consideration in case of a Breast Imaging-Report and Data System 4A lesion with a painful and palpable mass.
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Affiliation(s)
- Han Shin Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Myung Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Ju Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - In Kyeong Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Ri Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Tae Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jung Woo Woo
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - JinKwon Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sang Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Cho
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dae Hyun Song
- Department of Pathology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
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Breast Shwannoma - Time to explore alternative management strategy? Ann Diagn Pathol 2021; 54:151773. [PMID: 34273600 DOI: 10.1016/j.anndiagpath.2021.151773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
Schwannoma (SCH) is a benign peripheral nerve sheath neoplasm of Schwann cell origin. It can be observed anywhere whilst the breast is uncommon site. Preliminary investigations are not entirely diagnostic and surgical excision is often required to reach a conclusion. We conducted a retrospective review in two European Breast units to know more about this rare condition. Herein, we provide a comprehensive review and we question whether the surgical approach to management can be changed.
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Magro G, Salvatorelli L, Puzzo L, Piombino E, Bartoloni G, Broggi G, Vecchio GM. Practical approach to diagnosis of bland-looking spindle cell lesions of the breast. Pathologica 2020; 111:344-360. [PMID: 31965112 PMCID: PMC8145669 DOI: 10.32074/1591-951x-31-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022] Open
Abstract
The diagnosis of bland-looking spindle cell lesions of the breast is often challenging because there is a close morphological and immunohistochemical overlap among the different entities. The present review will discuss reactive spindle cell nodule/exuberant scar, nodular fasciitis, inflammatory pseudotumor, myofibroblastoma (classic type), lipomatous myofibroblastoma, palisaded myofibroblastoma, benign fibroblastic spindle cell tumor, spindle cell lipoma, fibroma, leiomyoma, solitary fibrous tumor, myxoma, schwannoma/neurofibroma, desmoid-type fibromatosis, dermatofibrosarcoma protuberans, low-grade fibromatosis-like spindle cell carcinoma, inflammatory myofibroblastic tumor and low-grade myofibroblastic sarcoma arising in the breast parenchyma. The pathologist should be aware of each single lesion to achieve a correct diagnosis to ensure patient a correct prognostic information and therapy. Accordingly representative illustrations and morphological/immunohistochemical diagnostic clues will be provided.
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Affiliation(s)
- G Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - L Salvatorelli
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - L Puzzo
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - E Piombino
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - G Bartoloni
- Anatomic Pathology, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - G Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - G M Vecchio
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
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Waldman RA, Finch J, Grant-Kels JM, Stevenson C, Whitaker-Worth D. Skin diseases of the breast and nipple. J Am Acad Dermatol 2019; 80:1467-1481. [DOI: 10.1016/j.jaad.2018.08.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
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Abstract
Schwannoma is a usually benign peripheral nerve sheath tumor with rare breast incidence and few reported cases. We report a case which was presented to and managed in the Oncology center, Mansoura University in November 2017.
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Affiliation(s)
- Omar Hamdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Sara Raafat
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad Hamdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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Abstract
Spindle cell lesions of the breast cover a wide spectrum of diseases ranging from reactive tumor-like lesions to high-grade malignant tumors. The recognition of the benign spindle cell tumor-like lesions (nodular fasciitis; reactive spindle cell nodule after biopsy, inflammatory pseudotumor/inflammatory myofibroblastic tumor; fascicular variant of pseudoangiomatous stromal hyperplasia) and tumors (myofibroblastoma, benign fibroblastic spindle cell tumor, leiomyoma, schwannoma, spindle cell lipoma, solitary fibrous tumor, myxoma) is crucial to avoid confusion with morphologically similar but more aggressive bland-appearing spindle cell tumors, such as desmoid-type fibromatosis, low-grade (fibromatosis-like) spindle cell carcinoma, low-grade fibrosarcoma/myofibroblastic sarcoma and dermatofibrosarcoma protuberans.
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Affiliation(s)
- Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, Via S. Sofia 87, Catania 95123, Italy.
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Schwannoma mamario: un diagnóstico inesperado por resonancia magnética. RADIOLOGIA 2018; 60:85-89. [DOI: 10.1016/j.rx.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/13/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
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Abstract
Benign and malignant peripheral nerve sheath tumors can involve the breast, presenting as masses in the dermis, deep breast parenchyma or axillary soft tissue. Although the histologic features are frequently characteristic, diagnosis can be challenging on core needle biopsy, and the differential diagnosis includes a variety of other benign and malignant spindle cell lesions of the breast. Here, we review the key clinical and pathological features of breast schwannoma, neurofibroma, granular cell tumor, and malignant peripheral nerve sheath tumor.
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Affiliation(s)
- Vivek Charu
- Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
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Abstract
A schwannoma is a tumor that develops on peripheral nerves or spinal roots. Although any part of the body can be affected, the breast is a quite unusual site for schwannomas. We report herein a case of schwannoma presenting as a breast tumor. In the current case, the tumor showed both clinically and mammographically as a well-defined breast mass. Of interest, sonographically, the well-defined mass appeared to be located in subcutaneous tissue, not in breast parenchyma, and this finding was confirmed histopathologically. These findings indicate the possibility that a schwannoma arising from subcutaneous breast tissue can show exophytic growth to the breast and appear as a breast tumor. In other words, our case implies the possible presence of a “pseudo” breast schwannoma.
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Tan QT, Chuwa EWL, Chew SH, Hong GS. Schwannoma: an unexpected diagnosis from a breast lump. J Surg Case Rep 2014. [PMCID: PMC4150249 DOI: 10.1093/jscr/rju085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qing Ting Tan
- KKWCH Breast Department,KK Women's and Children's Hospital, Singapore 229899
- Correspondence address. Tel: +65-394-5815; Fax: +65-394-5817; E-mail:
| | | | - Sung Hock Chew
- KKWCH Department of Histopathology and Cytology, KK Women's and Children's Hospital, Singapore 229899
| | - Ga Sze Hong
- KKWCH Breast Department,KK Women's and Children's Hospital, Singapore 229899
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Lattin GE, Jesinger RA, Mattu R, Glassman LM. From the radiologic pathology archives: diseases of the male breast: radiologic-pathologic correlation. Radiographics 2013; 33:461-89. [PMID: 23479708 DOI: 10.1148/rg.332125208] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Male breast disease includes a variety of benign and malignant conditions, many of which are hormonally influenced. Gynecomastia and skin lesions account for the majority of conditions in symptomatic men with a palpable abnormality, and these conditions should be accurately recognized. Imaging patterns of gynecomastia include nodular, dendritic, and diffuse patterns. Histopathologically, the nodular and dendritic patterns correlate with the florid and quiescent (fibrotic) phases of gynecomastia, respectively. The diffuse pattern may have features of both phases and is associated with exposure to exogenous estrogen. Benign-appearing palpable masses in male patients should be approached cautiously, given the overlapping morphologic features of benign and malignant tumors. In addition to gynecomastia, other benign male breast tumors include lipoma, pseudoangiomatous stromal hyperplasia, granular cell tumor, fibromatosis, myofibroblastoma, schwannoma, and hemangioma. Male breast cancer accounts for 1% of all breast carcinomas. Invasive ductal carcinoma accounts for the majority of cases in adult males and typically appears as a subareolar mass without calcifications that is eccentric to the nipple. Other epithelial and mesenchymal tumors that may occur, albeit not as commonly as in women, include papillary carcinoma, invasive lobular carcinoma, adenoid cystic carcinoma, liposarcoma, dermatofibrosarcoma, pleomorphic hyalinizing angiectatic tumor, basal cell carcinoma of the nipple, hematopoietic malignancies, and secondary tumors. Knowledge of the natural history, clinical characteristics, and imaging features of tumors that occur in the male breast will help narrow the radiologic differential diagnosis and optimize treatment.
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Affiliation(s)
- Grant E Lattin
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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Thejaswini M, Padmaja K, Srinivasamurthy V, Rao MS. Solitary intramammary schwannoma mimicking phylloides tumor: Cytological clues in the diagnosis. J Cytol 2013; 29:258-60. [PMID: 23326032 PMCID: PMC3543597 DOI: 10.4103/0970-9371.103947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 30-year-old woman presented with a huge exophytic lobulated mass in the right breast, clinically and radiologically resembling phylloides tumor. Fine needle aspiration cytology smears showed clusters and singly scattered spindle cells along with structures reminiscent of verocay bodies. However, the epithelial elements were absent. A cytological diagnosis of benign mesenchymal spindle cell lesion, suggestive of schwannoma was rendered. Subsequent histopathological examination and strong S-100 positivity of tumor cells on immunohistochemistry confirmed the diagnosis.Breast is an uncommon location for benign schwannoma. The present case describes the unusual clinical picture, highlights cytological features and discusses the differential diagnoses of schwannoma from other benign spindle cells lesions of the breast on cytology smears.
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Affiliation(s)
- Mu Thejaswini
- Department of Pathology, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, Karnataka, India
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Lagha A, Chraiet N, Oueslati I, Krimi S, Ayadi M, Allani B, Rifi H, Raies H, Mezlini A. Schwannoma of the Breast: Presentation of Four Cases and Review of the Literature. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2012.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aymen Lagha
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Nesrine Chraiet
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Imen Oueslati
- Department of Surgical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Sarra Krimi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Mouna Ayadi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Bassem Allani
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Hela Rifi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Henda Raies
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Amel Mezlini
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
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Abstract
Schwannomas arise from Schwann cells of the peripheral nerve sheath. The most common locations include the head, neck, and extensor surfaces of the extremities. Intramammary schwannomas are very rare and account for only 2.6% of schwannomas. A review of the English literature reveals 27 such cases of breast schwannoma. In this paper we describe another such rare case.
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Achach T, Rammeh S, Trabelsi A, Abid A, Essaidi H, Mokni M, Korbi S. Schwannome mammaire. IMAGERIE DE LA FEMME 2008. [DOI: 10.1016/s1776-9817(08)71715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Punia RS, Dhingra N, Mohan H. Cutaneous plexiform schwannoma of the finger not associated with neurofibromatosis. Am J Clin Dermatol 2008; 9:129-31. [PMID: 18284268 DOI: 10.2165/00128071-200809020-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Plexiform schwannoma is a rare, benign, peripheral nerve sheath tumor that occurs as an uncommon nodular variant of schwannoma. It is important to recognize this tumor because it can be misdiagnosed as plexiform neurofibroma. In contrast to the latter, however, plexiform schwannoma is not associated with neurofibromatosis (von Recklinghausen disease). We report a case of plexiform schwannoma located on the index finger of a 20-year-old male patient with no signs of neurofibromatosis.
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Affiliation(s)
- Rajpal Singh Punia
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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