Posts

Schwannoma in the Bifurcation of the Sciatic Nerve: A Case Report and Literature Review

Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 4-8 | Daniela Kristina D. Carolino, Ai E. Gamboa, Edwin Joseph R. Guerzon. DOI: 10.13107/jbst.2021.v07i01.41

Author: Daniela Kristina D. Carolino[1], Ai E. Gamboa[1], Edwin Joseph R. Guerzon[1]

[1]Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Philippines.

Address of Correspondence
Dr. Daniela Kristina D. Carolino,
Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Philippines.
E-mail: dkdcarolino@gmail.com

 


Abstract

Purpose: The schwannoma is a benign tumor and is known to be the most common type of tumor of the peripheral nerve sheath. They are known to arise from the nerves of the head and neck; however, outside this region, it is found more often in the upper extremity, and if occurring in the lower extremity, is likely found in the posterior tibial nerve. Schwannoma of the sciatic nerve is considered a very rare entity, accounting for only 1% of all schwannomas, with an estimated incidence of about 6 cases per million individuals.
Methods: In our literature search, it is noted that they are more likely to arise from the proximal aspect of the nerve, as it exits the sciatic notch, presenting as a mass in the proximal thigh. This case reports tackles an even more unusual presentation of this tumor, occurring adjacent to the bifurcation of the sciatic nerve.
Results: A 46-year- old male presented with sharp, shooting pain from the back of his thigh to the plantar aspect of his left foot of 2 years duration. Patient was initially diagnosed as a case of plantar fasciitis and hamstring tightness that was managed conservatively. However, due to persistence as well as appearance of a small mass on the posterior thigh and positive Tinel’s sign over the mass, patient underwent work-up and subsequent surgery.
Conclusion: Due to its presentation that closely mimics sciatica of a lumbosacral discal pathology and other musculoskeletal disorders, these are often diagnosed and managed late. Despite its rarity, it should be suspected in patients with history of radicular pain without any neurologic deficits, which is poorly controlled by analgesics and supportive therapy, with physical examination pointing to a localized neural pathology.
Keywords: Schwannoma, sciatic nerve, bifurcation.


References:
1. Omezzine SJ, Zaara B, Ali MB, Abid F, Sassi N, Hamza HA. A rare cause of non discal sciatica: Schwannoma of the sciatic nerve. Orthop Traumatol Surg Res 2009;95:543-6.
2. Rhanim A, El Zanati R, Mahfoud M, Berrada MS, El Yaacoubi M. A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve. J Clin Orthop Trauma 2013;4:89-92.
3. Nahar S, Goyal A. A large schwannoma of sciatic nerve-a case report. J Peripher Nerve Surg 2018;2:86-9.
4. Godkin O, Ellanti P, O’Toole G. Large schwannoma of the sciatic nerve. BMJ Case Rep 2016;2016:bcr201617717.
5. As-Sultany M, Ben-Ghashir N, Mistry A, Chandrasekar C. Giant schwannomas of the sciatic nerve. BMJ Case Rep 2017;2017:bcr2016218466.
6. Wu WT, Chang KV, Hsu YC, Yang YC, Hsu PC. Ultrasound imaging for a rare cause of sciatica: A schwannoma of the sciatic nerve. Cureus 2020;12:e8214.
7. Maes R, Ledoux P. A rare cause of sciatica: Sciatic nerve schwannoma-report of one case with long subclinical course and misleading presentation. SICOT J 2020;6:16.
8. Naik H, Velho V. Sciatic nerve schwannoma: A rare case. Neurol India 2019;67:151-3.
9. Rosario MS, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Inatani H, et al. A case of infected schwannoma mimicking malignant tumor. World J Surg Oncol 2016;14:302.
10. Eroglu U, Bozkurt M, Ozates O, Akturk S, Tuna H. Sciatic nerve schwannoma: Case report. Turk Neurosurg 2014;24:120-2.
11. Cavalcante JB, Cembraneli PN, Cavalcante RB, Valente VF, Cavalcante JE. Unusual presentation of giant schwannoma in the sciatic nerve. Case Rep Int 2020;9:100081Z06JC2020.
12. Haspolat Y, Ozkan FU, Turkmen I, Kemah B, Turhan Y, Sarar S, et al. Sciatica due to schwannoma at the sciatic notch. Case Rep Orthop 2013;2013:510901.
13. Gorgan M, Sandu AM, Bucur N, Neacsu A, Pruna V, Voina A, et al. Sciatic nerve schwannoma: A case report. Rom Neurosurg 2008;15:27-31.
14. Rekha A, Ravi A. Sciatic nerve schwannoma. Int J Low Extrem Wounds 2004;3:165-7.
15. Hamdi MF, Aloui I, Ennouri K. Sciatica secondary to sciatic nerve schwannoma. Neurol India 2009;57:685-6.
16. Mansukhani SA, Butala RR, Shetty SH, Khedekar RG. Sciatic nerve schwannoma: A case report. J Orthop Surg (Hong Kong) 2015;23:259-61.
17. Kumar S, Ralli M, Sharma J, Sansanwal P, Singh G. Sciatic schwannoma: A rare entity. Clin Cancer Investig J 2015;4:720-2.
18. Munakomi S, Shrestha P. Case report: Sciatic nerve schwannoma-a rare cause of sciatica. F1000Res 2017;6:267.


How to Cite this article: Carolino DK, Gamboa AE, Guerzon EJ. | Schwannoma in the Bifurcation of the Sciatic Nerve: A Case Report and Literature Review | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2021; 7(1): 4-8.

[Full Text HTML] [Full Text PDF] [XML]


Role of Intraoperative Nerve Stimulator? In a Case of Ulnar Nerve Schwannoma. A Case Report with Four-Year Follow-up and Review of Literature

Original Article | Volume 6 | Issue 3 | JBST September – December 2020 | Page 13-15 | Kalaivanan Kanniyan, Ying Lee Lam, Ho Wai Yip Kenneth, Yau Raymond DOI: 10.13107/jbst.2020.v06i03.33

Author: Kalaivanan Kanniyan[1],[2], Ying Lee Lam[1], Ho Wai Yip Kenneth[1], Yau Raymond[1]

[1]Department of Orthopaedic Oncology, Queen Mary Hospital, University of Hong Kong, Hong Kong,
[2]Department of Arthroplasty and Oncology, Asian Joint Reconstruction Institute – AJRI at SIMS Hospitals, Chennai, Tamil Nadu, India.

Address of Correspondence
Dr. Kalaivanan Kanniyan,
Division of General Orthopaedics and Oncology, Queen Mary Hospital, University of Hong Kong, Hong Kong.
E-mail: drkkbriyan@gmail.com


Introduction: Schwannoma (neurolimmea) is an uncommon benign nerve sheath tumor arising from the peripheral nerve system with an incidence of 5%. They are slow growing tumors affecting all age group and occur in isolation. They are common in upper extremity followed by the lower extremity.
Case report: She presented with complaint of pain and swelling over her right wrist disturbing her daily activities such as eating and holding her walker. The swelling was sudden on onset slowly progressive in nature over many years. She was on treatment for diabetes mellitus, hypertension, and Parkinson. She had left leg weakness due to polio and hence walker bound. She underwent occipitocervical fusion for cervical vertebrae C1 and C2 subluxation and cervical myelopathy. The swelling was 2.5 cm × 2.5 cm, soft-tissue mass over the volar aspect of right wrist mobile only in the longitudinal direction. Hand grip was fair with sensory loss along the ulnar nerve distribution. There was no hypothenar muscle wasting. Magnetic resonance imaging suggested of neurogenic tumor of ulnar nerve origin. Patient was planned for enucleation (excision biopsy). The anesthesia nerve block device was used as nerve stimulator to identify the motor nerve and preserved it. Enucleation was not possible and hence the tumor was removed with a segment of sensory fibers. Histology finding was consistent with schwannoma. Postoperatively, the patient was pain free and able to hold the walker and carry on her daily activities. At 4 year follow-up the patient had no recurrence of such tumor or any other complication in the operated side.
Conclusion: Enucleation is the treatment of choice. Patient age, complaints, comorbidities, functional demand, tumor location, and intraoperative findings with nerve stimulator help in deciding the choice of nerve grafting along with enucleation.
Keywords: Schwannoma, ulnar nerve, enucleation, sural nerve graft, intraoperative nerve stimulator.


Reference:
1. Forthman CL, Blazar PE. Nerve tumors of the hand and upper extremity. Hand Clin 2004;20:233-42.
2. Trãistaru R, Enãchescu V, Manu CD, Gruia C, Ghiluşi M. Multiple right schwannoma. Rom J Morphol Embryol 2008;49:235-9.
3. Ozdemir O, Ozsoy MH, Kurt C, Coskunol E, Calli I. Schwannomas of the hand and wrist: Long term results and review of the literature. J Ortho Surg (Hong Kong) 2005;13:267-72.
4. Chris YK, Fung B, Fok M, Zhu J. Schwannoma in the upper limbs. BioMed Res Int 2013;2013:167196.
5. Donner TR, Voorhies RM, Kline DG. Neural sheath tumors of major nerves. J Neurosurg 1994;81:362-73.
6. White NB. Neurilemomas of the extremities. J Bone Joint Surg Am 1967;49:1605-10.
7. Di Lorenzo S, Corradino B, Cordova A, Moschella F. Unexpected ulnar nerve schwannoma. The reasonable risk of misdiagnosis. Acta Chir Plast 2007;49:77-9.
8. Hems TE, Burge PD, Wilson DJ. Role of magnetic resonance imaging in the management of peripheral nerve tumours. J Hand Surg 1997;22:57-60.
9. Beaman FD, Kransdorf MJ, Menke DM. Schwan-noma: Radiologic-pathologic correlation. Radiographics 2004;24:1477-81.
10. Van Herendael B, Heyman S, Schepper A, Gielen J, Parizel PM. Schwannoma of left ulnar nerve. JBR BTR 2006;89:156-7.


How to Cite this article: Kanniyan K, Lam YL, Kenneth HWY, Raymond Y | Role of Intraoperative Nerve Stimulator? In a Case of Ulnar Nerve Schwannoma. A Case Report with Four-Year Follow-up and Review of Literature | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2020; 6(3): 13-15.

[Full Text HTML] [Full Text PDF] [XML]


Primary Intraosseous Schwannoma

Vol 3 | Issue 2 | Sep-Dec 2017 | Page 14-15| Asawari Ambekar, Chitralekha Soman.


Authors: Asawari Ambekar [1], Chitralekha Soman [1].

[1] Department of Histopathology, Mumbai Reference Laboratory, SRL Limited, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Asawari Ambekar,
Reserve Bank of India Soc number 2 B 5 Gavand Path Thane West 400602
E-mail: asawariaa61@gmail.com


Abstract

Schwannomas are benign tumors arising from the peripheral nerve sheath. Neurogenic tumors of bone are extremely uncommon and they compose less than 1% of all benign tumors [1]. We present a case of intraosseous schwannoma in a 15 year old girl who presented with pain and pathological fracture of tibia. The radiology revealed an expansile and lytic lesion in the diaphysis. Histopathology confirmed the diagnosis of intraosseous schwannoma. The tumor cells were immunoreactive for S100protein. We present this case as tibial schwannoma is extremely rare and its diaphyseal location in the bone is virtually unknown.
Keywords: Schwannoma, tibia, diaphysis


References

1. Mark JM, Natalie C., Donald K.Schwannoma: A case report.The Foot and Ankle Online Journal 2009
2. Rosai, J., Ackerman, L. V. 1. &Rosai, J. (2004). Rosai and Ackerman’s surgical pathology (9th ed.). St. Louis, Mo. : London: Mosby
3. Fletcher, CDM. Bridge, JA. Hogendoorn, P., Mertens, F.WHO Classification of Tumours of Soft Tissue and Bone. Fourth Edition.2002
4. Ryan MI, Kevin BJ, Nathan L, Joseph AB.Intraosseous neurilemmoma involving the distal tibia and fibula: A case report.The Iowa Orthopaedic Journal.
5. K. Krishnan Unni Carrie Y. Inwards.Dahlin’s Bone Tumors, 6e.GENERAL ASPECTS AND DATA ON 10,165 CASES.
6. Chelsea P,Hamad G, Shweta B. Vikram Dogra.Schwannoma of the Tibial Nerve.Journal of Diagnostic Medical Sonography.2010
7. Manasa AM. Intraosseous Schwannoma of the Maxilla Mimicking a Periapical Lesion: A Diagnostic Challenge. Journal of Clinical and Diagnostic Research. 2015.
8. Kaihu Li et al.Giant intraosseous Schwannoma of the calcaneusInt J ClinExp Med 2016.
9. S.A. Lacerda et al.Intraosseous Schwannoma of Mandibular Symphysis: Case Report.Braz Dent J 2006.
10. Suzuki et al.Association between intraosseous schwannoma occurrence and the position of the intraosseous nutrient vessel: A case report.ONCOLOGY LETTERS.2016


How to Cite this article: Ambekar A, Soman C. Primary Intraosseous Schwannoma. Journal of Bone and Soft Tissue Tumors Sep-Dec 2017;3(2): 14-15.


                 


(Abstract    Full Text HTML)      (Download PDF)