Al-Lhedan Fahad
Nuclear Medicine Fellow, the Ottawa Hospital, Ottawa, Canada.
Medical Imaging Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
J Bone Oncol. 2017 May 22;8:1-3. doi: 10.1016/j.jbo.2017.05.002. eCollection 2017 Sep.
Schwannoma is a benign tumor derived from Schwann cells that cover myelinated nerve fibers (1). Among primary bone tumors, intraosseous schwannoma accounts for less than 0.2% (2). We are reporting a rare case of an 18-year-old female presented with swelling in the posterior right thigh. The patient was asymptomatic and this was incidentally discovered by her massage therapist. However, the swelling was gradually growing since then. The plain radiograph findings were suggestive of a benign bone tumor. MRI with gadolinium was performed for further evaluation but it demonstrated suspicious features as evidenced by the extra osseous enhancing soft tissue component. Three phase bone scan was done thereafter and it showed hyperemia with mild increased uptake of the lesion on the delayed phase. Osteosarcoma was suspected and chest CT was performed for staging purposes which turned out to be negative for metastasis. The lesion was biopsied under ultrasound guidance. The histologic features and the immunohistochemically profile were consistent with a benign schwannoma. The posterior thigh soft tissue mass was surgically resected with femur bone grafting. Recurrence of schwannoma should be considered but its malignant transformation is exceedingly rare and this can be discounted (3).
神经鞘瘤是一种源自覆盖有髓神经纤维的施万细胞的良性肿瘤(1)。在原发性骨肿瘤中,骨内神经鞘瘤占比不到0.2%(2)。我们报告一例罕见病例,一名18岁女性右大腿后部出现肿胀。患者无症状,是其按摩治疗师偶然发现的。然而,自那时起肿胀逐渐增大。X线平片表现提示为良性骨肿瘤。随后进行了钆增强磁共振成像(MRI)以进一步评估,但显示出可疑特征,表现为骨外强化软组织成分。此后进行了三相骨扫描,结果显示病变在延迟期有充血且摄取轻度增加。怀疑为骨肉瘤,为进行分期目的进行了胸部CT检查,结果显示无转移。在超声引导下对病变进行了活检。组织学特征和免疫组化特征与良性神经鞘瘤一致。右大腿后部软组织肿块通过股骨植骨手术切除。应考虑神经鞘瘤复发,但其恶性转化极为罕见,可不予考虑(3)。