Vojnosanitetski pregled 2023 Volume 80, Issue 4, Pages: 356-361
https://doi.org/10.2298/VSP211010034V
Full text (
664 KB)
Large schwannoma of the median nerve at the distal forearm
Vulović Dejan 
(University Clinical Center Kragujevac, Center for Plastic Surgery, Kragujevac, Serbia + University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia)
Kozarski Jefta (Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Vulović Tatjana (University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia + University Clinical Center Kragujevac, Centre for Anesthesia and Reanimatology, Kragujevac, Serbia)
Spasić Marko (University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia + University Clinical Center Kragujevac, Clinic for General Surgery, Kragujevac, Serbia), drmspasic@gmail.com
Šarenac-Vulović Tatjana (University Clinical Center Kragujevac, Clinic for Ophtalmology, Kragujevac, Serbia + University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia)
Mubarak Tahir Ahmed T. (Aseer Central Hospital, Plastic Surgery and Burn Department, Abha, Kingdom of Saudi Arabia)
Stanković Vesna (University Clinical Center Kragujevac, Centre for Pathological Anatomical Diagnostics, Kragujevac, Serbia + University of Kragujevac, Faculty of Medical Sciences, Department of Pathology, Kragujevac, Serbia)
Al-Shraim Mubarak (King Khalid University, College of Medicine, Department of Pathology, Abha, Kingdom of Saudi Arabia)
Rakić Dejana (University Clinical Center Kragujevac, Clinic for Gynecology and Obstetrics, Kragujevac, Serbia + University of Kragujevac, Faculty of Medical Sciences, Department of Gynecology and Obstetrics, Kragujevac, Serbia)
Introduction. Schwannoma, also known as neurilemmoma, is a rare but one of the most common tumors of the peripheral nerves. It originates from Schwann cells of the peripheral nerve sheaths. Schwannoma mostly occurs in adults between 20 to 70 years of age. The regions where the tumor most commonly occurs are the head and neck, but it can occur almost anywhere in the body or the organs. Schwannomas are usually up to 2.5 cm in size but may grow to 4–5 cm. In this study, the rare case of large schwannoma of the median nerve in the distal part of the forearm is presented. Case report. A 46-year-old male patient was referred to a plastic surgeon with a diagnosis of lipoma on the anterior side of the distal third of the left forearm. Ultra-sound and magnetic resonance imaging were done, and the surgery was performed after that. An encapsulated tumor of the median nerve was found, and the tumor was completely removed without nerve damage. Histological analysis showed a benign schwannoma of cellular type and biphasic shape. In the postoperative course, there was transient paresthesia. One year after surgery, no tumor recurrence nor neurological deficit was recorded. Conclusion. Schwannoma is the most common benign tumor of peripheral nerves. Schwannomas over 5 cm in size are extremely rare. Appropriate physical examination, pre-operative imaging studies, and histological verification are required for the final diagnosis. The method of choice in treating large schwannomas is complete surgical excision.
Keywords: diagnosis, median nerve, neurilemmoma, peripheral nervous system neoplasms, schwann cells
Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III 41007
Show references
Sonig A, Gandhi V, Nanda A. From the cell of Schwann to schwannoma- a century's fruition. World Neurosurg 2014; 82(5): 906-11.
Kehoe N, Reid R, Semple J. Solitary benign peripheral-nerve tumours. Review of 32 years' experience. J Bone Joint Surg Br 1995; 77(3): 497-500.
Rockwell G, Thoma A, Salama S. Schwannoma of the hand and wrist. Plast Reconstr Surg 2003; 111(3): 1227-32.
Kurtkaya-Yapicier O, Scheithauer B, Woodruff J. The pathobiologic spectrum of Schwannomas. Histol Histopathol 2003; 18(3): 925-34.
Knight DM, Birch R, Pringle J. Benign solitary schwannomas: a review of 234 cases. J Bone Joint Surg Br 2007; 89(3): 382-7.
Angelini A, Bevoni R, Biz C, Cerchiaro MC, Girolami M, Ruggieri P. Schwannoma of the foot: Report of four cases and literature review. Acta Biomed 2019; 90(Suppl 1): 214-20.
Hao X, Levine D, Yim J, Qi C, Firestone L, Beiser I, et al. Schwannoma of foot and ankle: Seven case reports and literature review. Anticancer Res 2019; 39(9): 5185-94.
Eroglu U, Yakar F, Zaimoglu M, Ozgural O, Kahilogulları G. Median nerve schwannoma. ANZ J Surg 2019; 89(9): 1158-9.
Salar M, Kaye MB. Multiple Schwannomas of the Median Nerve: A Case Report and Review of the Literature. J Orth Case Reports 2020; 10(6): 60-3.
Hakan T, Kılıç Y, Çelikoğlu E, Ekemen S. An Unusual Schwannoma in the Proximal Forearm: A Case Report. Cureus 2019; 11(11): e6231.
Barber CM, Fahrenkopf MP, Adams NS, Naum SC. Multiple Peripheral Schwannomas. Eplasty 2018; 18: ic7.
Unnithan AKA, Joseph A. Schwannoma of median nerve: Case report and review of literature. Interdisciplin Neurosurg 2019; 17: 75-8.
Hubert J, Landes G, Tardif M. Schwannoma of the median nerve. J Plast Surg Hand Surg 2013; 47(1): 75-7.
Padasali PS, Shankaregowda VS, Kshirsagar SD. Median nerve schwannoma: A case and review of literature. Asian J Neurosurg 2015; 10(3): 212-5.
Vlychou M, Dailiana ZH. Ancient schwannoma of the hand. J Hand Surg Am 2011; 36(12): 2030-3.
Rutka V, Castel T, Burnier M, Herzberg G. Atypical schwannoma of the median nerve. A case report. Hand Surg Rehabil 2019; 38(4): 273-5.
Boufettal M, Azouz M, Rhanim A, Abouzahir M, Mahfoud M, Bardouni AE, et al. Schwannoma of the median nerve: diagnosis sometimes delayed. Clin Med Insights Case Rep 2014; 7: 71-3.
Dusad T, Meena DS, Saini N, Sharma Y, Khurana D. Schwannoma of the Median Nerve at Mid Forearm Level. J Orthop Case Rep 2016; 6(2): 66-8.