Rutka V, Castel T, Burnier M, Herzberg G
Service de chirurgie orthopédique main-membre supérieur, hôpital Édouard-Herriot, place d'Arsonval, 69437 Lyon cedex 03, France.
Service de chirurgie orthopédique main-membre supérieur, hôpital Édouard-Herriot, place d'Arsonval, 69437 Lyon cedex 03, France.
Hand Surg Rehabil. 2019 Sep;38(4):273-275. doi: 10.1016/j.hansur.2019.05.001. Epub 2019 May 9.
Schwannomas of the hand are very rare tumors and represent less than 3% of all soft tissue tumors in the hand. These tumors share clinical, epidemiological and imaging characteristics with the other soft tissue and peripheral nerve tumors; thus, it can be difficult to make a preoperative diagnosis. Here we report the case of a 48-year-old woman who presented with a schwannoma arising from the palmar branch of the median nerve. The tumor measured 54 × 41 x 52 mm and was located in the thenar eminence. The first hypothesis was a vascular tumor. After surgery and histological analysis, the final diagnosis of an atypical schwannoma was established. The presence of shared immunohistochemical characteristics with cellular histiocytoma and myoepithelial tumors forced us to adopt an aggressive follow-up protocol. As of the last follow-up at 9 years, the patient had good clinical outcomes and no recurrence. This case highlights the difficulties encountered in clinical practice to diagnose such tumors.
手部神经鞘瘤是非常罕见的肿瘤，占手部所有软组织肿瘤的比例不到3%。这些肿瘤与其他软组织及周围神经肿瘤具有共同的临床、流行病学和影像学特征；因此，术前诊断可能会很困难。在此，我们报告一例48岁女性患者，其正中神经掌支发生神经鞘瘤。肿瘤大小为54×41×52mm，位于鱼际隆起处。最初考虑为血管性肿瘤。经过手术及组织学分析，最终确诊为非典型神经鞘瘤。因其与细胞组织细胞瘤和肌上皮瘤具有共同的免疫组化特征，我们不得不采取积极的随访方案。截至9年的最后一次随访，患者临床预后良好，无复发。该病例凸显了临床实践中诊断此类肿瘤所遇到的困难。
