Atypical schwannoma of the median nerve. A case report

A rare case of a median nerve schwannoma: Case report

A median nerve schwannoma is an uncommon type of tumor that develops from Schwann cells in the peripheral nerves. We present a case report of a young prisoner with a rare median nerve schwannoma presenting as a swelling on the anterior aspect of the right wrist along the radial edge, with associated paresthesia and a positive Tinel's sign. The case was diagnosed using MRI which showed the target sign of biphasic contrast enhancement in both the mass's center and periphery as well as distinct encapsulation. The mass was managed with surgical excision which confirmed the mass to be a neurilemmoma. The radiological finding for neurinomas are not specific and the diagnosis cannot be established unless an excision is made, as neurinomas share common radiological signs with other peripheral nerve tumors and vascular tumors. This case highlights the importance of considering nerve sheath tumors, however rare, in the differential diagnosis of wrist masses, even in young patients with no history of trauma.

Median nerve schwannoma with a diagnostic delay of 8 years: a case report

Introduction

Schwannomas are benign tumors of the peripheral nerve sheath, and the median nerve is the most commonly involved nerve. These benign tumors of the peripheral nerve sheath are very rare; they are clinically and radiologically similar to most other benign swellings of the hand; thus, they are often misdiagnosed.

Case Presentation

A 41-year-old lady presented with an 8-year-long history of swelling over the distal forearm. The tumor measured 3.5×3.5×3.5 mm and was located over the flexor aspect of the distal part of her right forearm. Schwannoma was suspected from the clinical presentation and imaging, but the final diagnosis was established only after the surgery and histopathological analysis. At the follow-up after 1 year, the patient is doing well and her symptoms have not recurred.

Conclusion

Imaging characteristics of schwannoma can be misinterpreted as some other condition, making the preoperative diagnosis very difficult and important. Thus, clinicians should be aware of such swellings, especially those that have been unnoticed or misdiagnosed, and provide optimal diagnoses to confer good outcomes.

Recurrent schwannoma of digital nerve on both hands: A very rare case report

INTRODUCTION AND IMPORTANCE

Schwannoma is the most common benign tumor of peripheral nerves and usually occurs solitary with a very low risk of recurrence. Schwannoma of the hand, particularly involving the digital nerve, is sporadic and most commonly leads to a misdiagnosis due to its rarity. Histopathology remains the gold standard diagnostic, however, with a thorough physical examination and radiologic imaging, this benign tumor can be managed well with the preservation of nerve function.

CASE PRESENTATION

We reported a rare case of digital nerve schwannomas on the bilateral hands of a 52-year-old white male with one recurrent mass on the right hand despite a previously complete debulking of the mass.

CLINICAL DISCUSSION

Intraoperatively, we removed lobulated whitish-yellow masses and left the nerve origin of the tumor intact (common palmar digital nerve and ulnar-side digital nerve). The histopathology supported the diagnosis of schwannoma. At the one-year follow-up, there is no recurrence and the patient remains asymptomatic.

CONCLUSION

Determining differential diagnosis by both clinical and preoperative imaging is essential, especially in the case of recurrence and multiple tumorous lesions. Malignancy or malignant degeneration should still be kept in mind. Complete removal is needed to prevent recurrence followed by a long-term follow-up.

An Unusual Schwannoma in the Proximal Forearm: A Case Report

Schwannomas are common, well-encapsulated benign tumors of the peripheral nerves. They rarely emerge from the median nerve in the forearm. Here we report a case of an unusual schwannoma measuring 3 × 4 × 3 cm originating from the median nerve in the proximal forearm of a 49-year-old man. The mass was painless, but Tinel’s sign was positive. Ultrasonography showed a solid, hypoechoic mass with central cystic areas in the flexor muscle group in the left forearm. Magnetic resonance imaging with contrast enhancement in T1 sequences revealed that it originated from the median nerve. Surgical resection was performed by separating the nerve fibers from the tumor without any complications. Histological examination confirmed it as a schwannoma.