Giant Ancient Solitary Schwannoma Masquerading as Juxtacortical Osteosarcoma of Femur – A Rare Case Report and Literature Review

Vol 5 | Issue 1 | Jan-April 2019 | page: 28-30 | Julfiqar, Mohd. Aslam, Najmul Huda, Ajay Pant.

Authors: Julfiqar [1], Mohd. Aslam [1], Najmul Huda [1], Ajay Pant [1].

[1] Dept of Orthopaedic Surgery, Faculty of Medicine, J.N.Medical College, Aligarh Muslim University, Aligarh, India
[2] Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, TMU, Moradabad, India

Address of Correspondence
Dr. Julfiqar:
Assistant professor, Department of Orthopaedic Surgery, Faculty of Medicine, J.N.Medical College, Aligarh Muslim University, Aligarh, India.
Email: ???

Abstract

Introduction: Ancient schwannomas are rare variant of peripheral nerve sheath tumors characterized by the degeneration and hypocellular areas due to long-standing growth. Clinicoradiologically, these tumors can masquerade other tumors arising from the adjacent tissues. Their resemblance to malignant bone tumor has been reported very rarely in the literature. We tend to report a case of benign peripheral nerve schwannoma that greatly mimicked a juxtacortical osteosarcoma of femur.
Case Report: A 23-year-old male presented with a slow-growing painless mass with paresthesias in his right thigh for the last 2½ years. Clinically, it was suspected to be soft tissue tumor with secondary involvement of adjacent neurovascular bundle; however, plain radiograph and magnetic resonance imaging of his right thigh were suggestive of juxtacortical osteosarcoma of the right femur. Surgical exploration of the mass revealed a well-defined encapsulated mass over the anterior aspect of the right thigh, under the quadriceps muscle without infiltration into the surrounding tissue. Histopathological examination confirmed it to be an ancient schwannoma.
Results: The patient was extremely satisfied with outcomes of surgery, and he was symptom-free and there was no clinical evidence of the recurrence on subsequent follow-up.
Conclusion: A correct pre-operative diagnosis of benign peripheral nerve sheath tumors can be difficult at times. However, a slow-growing mass with the absence of other features of a malignant growth and subsequent histopathological examination including immunostaining can settle the diagnosis in almost all the cases.
Keywords: Benign, Peripheral nerve, Ancient schwannoma, Juxtacortical osteosarcoma.

References

1. Dahl I. Ancient neurilemmoma (schwannoma). Acta Pathol Microbiol Scand 1977;85:812-8.
2. Kuriakose S, Vikram S, Salih S, Balasubramanian S, Pareekutty NM, Nayanar S. Unique surgical issues in the management of a giant retroperitoneal schwannoma and brief review of literature. Case Rep Med 2014;2014:781347.
3. Isobe K, Shimizu T, Akahane T, Kato H. Imaging of ancient schwannoma. AJR Am J Roentgenol 2004;183:331-6.
4. Mwaka ES, Senyonjo P, Kakyama M, Nyati M, Orwotho N, Lukande R. Giant, solitary, ancient schwannoma of the cervico-thoracic spine: A case report and review of the literature. OA Case Reports 2013;2:2.
5. Choudry HA, Nikfarjam M, Liang JJ, Kimchi ET, Conter R, Gusani NJ, et al. Diagnosis and management of retroperitoneal ancient schwannomas. World J Surg Oncol 2009;7:12.
6. Jayaraj SM, Levine T, Frosh AC, Almyeda JS. Ancient schwannoma masquerading as parotid pleomorphic adenoma. J Laryngol Otol 1997;111:1088-90.
7. Lee YS, Kim JO, Park SE. Ancient schwannoma of the thigh mimicking a malignant tumour: A report of two cases, with emphasis on MRI findings. Br J Radiol 2010;83:e154-7.
8. Ackerman LV, Taylor FH. Neurogenous tumors within the thorax; A clinicopathological evaluation of forty-eight cases. Cancer 1951;4:669-91.
9. Enzinger FM, Weiss SW. Benign tumours of peripheral nerves. Soft Tissue Tumours. 3rd ed. St Louis: Mosby; 1995. p. 821-88.
10. Takeuchi M, Matsuzaki K, Nishitani H, Uehara H. Ancient schwannoma of the female pelvis. Abdom Imaging 2008;33:247-52.
11. Kransdorf MJ, Murphey MD, editors. Neurogenic tumours. Imaging of Neurogenic Tumours. 2nd ed. Philadelphia, PA: Lippincot Williams &Wilkins; 2006. p. 328-80.
12. Dahlin DC, Coventy MB. Osteogenic sarcoma: A study of six hundred cases. J Bone Joint Surg Am 1967;49:101-10.
13. Wong KT, Haywood T, Dalinka MK, Kneeland B. Chondroblastic, grade 3 periosteal osteosarcoma. Skeletal Radiol 1995;24:69-71.
14. Sorensen DM, Gokden M, El-Naggar A, Byers RM. Quiz case 1. Periosteal osteosarcoma (PO) of the mandible. Arch Otolaryngol Head Neck Surg 2000;126:550, 552.
15. Murphey MD, Jelinek JS, Temple HD, Flemming DJ, Gannon FH. Imaging of periosteal osteosarcoma: Radiologic-pathologic comparison. Radiol 2004;233:129-38.

How to Cite this article: Julfiqar, Aslam M, Huda N, Pant A. Giant Ancient Solitary Schwannoma Masquerading as Juxtacortical Osteosarcoma of Femur-A Rare Case Report and Literature Review. Journal of Bone and Soft Tissue Tumors Jan-April 2019;5(1): 28-30.

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