Author: Ikuo Kudawara[1], Hiroyuki Aono[1]

[1] Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.

Address of Correspondence
Dr. Ikuo Kudawara,
Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, Japan.
E-mail: kudawara.ikuo.rf@mail.hosp.go.jp

Abstract

Introduction: Primary schwannoma of the bone is extremely rare. Spinal schwannoma usually rises in the nerve root or the cauda equina and their branches that occasionally scallop on the adjacent bone. On radiology, their features often mimic those of bone tumors such as osteoblastoma, hemangioma, aneurysmal bone cyst, plasmacytoma, or bone metastasis. Therefore, the diagnosis of pure spinal schwannoma of the bone should be evaluated carefully when referring to radiological and histopathological findings.
Case Report: A 64-year-old female presented with back pain and lower leg dysesthesia. The tumor within the left lamina of the 12th thoracic spine showed an expansile and lytic lesion on computed tomography (CT) and intermediate signals on the T1-weighted image and high signals on the T2-weighted image on magnetic resonance imaging. In addition, an old compression fracture in the same vertebra was observed. ACT-guided biopsy specimen suggested schwannoma. The tumor was successfully excised, and afterward, remission of the symptoms was observed. A definitive diagnosis of intraosseous schwannoma was made. There has been no recurrence in the 6 years following surgery.
Conclusion: We have presented the radiological and histopathological findings as well as the clinical outcomes of an unusual case of intraosseous schwannoma of the posterior element of the 12th thoracic spine. Pre-operative CT-guided biopsy was useful in making a diagnosis and planning a surgical strategy.

Keywords: Schwannoma, Thoracic spine, Bone.

References:

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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:
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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:
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2. Trãistaru R, Enãchescu V, Manu CD, Gruia C, Ghiluşi M. Multiple right schwannoma. Rom J Morphol Embryol 2008;49:235-9.
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6. White NB. Neurilemomas of the extremities. J Bone Joint Surg Am 1967;49:1605-10.
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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

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