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. |
