Drumond Gustavo Costalonga, Nakagawa Suely Akiko, Costa Felipe D'Almeida, de Souza Murilo Yokoo Teodoro, Comunello Juliane, Chung Wu Tu
Hospital AC Camargo Câncer Center de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ortop (Sao Paulo). 2020 Apr;55(2):258-262. doi: 10.1016/j.rbo.2018.02.003. Epub 2019 Dec 19.
Schwannoma is a benign neural sheath tumor of the soft tissue, and its intraosseous presentation is very rare. It is estimated that intraosseous schwannomas represent 0.2% of all bone tumors. The tumor may affect any site of the skeleton, including the mandible, the sacrum, vertebral bodies, the ulna, the humerus, the femur, the tibia, the patella, the scapula, the ribs, and small bones of the hand. The involvement of the calcaneus has only been reported four times in the literature. The present study reports the case of a 49-year-old male with right hindfoot pain and a radiological finding of an osteolytic bone lesion in the calcaneus. The diagnosis was confirmed by histopathological study. The treatment of choice was an intralesional resection with adjuvant local control, and bone defect substitution with polymethylmethacrylate and fixation with two cannulated screws. The patient had a satisfactory postoperative evolution; after 1 year, he is asymptomatic, with good functional response and no evidence of disease. The present case report shows the clinical, radiological, and pathological features of a rare benign bone neoplasm. Moreover, intraosseous schwannoma should be included in the differential diagnosis of osteolytic calcaneal lesions.
施万细胞瘤是一种软组织良性神经鞘瘤,其骨内表现非常罕见。据估计,骨内施万细胞瘤占所有骨肿瘤的0.2%。该肿瘤可累及骨骼的任何部位,包括下颌骨、骶骨、椎体、尺骨、肱骨、股骨、胫骨、髌骨、肩胛骨、肋骨和手部小骨。跟骨受累在文献中仅报道过4次。本研究报告了一例49岁男性,有右后足疼痛,影像学检查发现跟骨有溶骨性骨病变。通过组织病理学研究确诊。治疗选择为病灶内切除并辅助局部控制,用聚甲基丙烯酸甲酯替代骨缺损并用两枚空心螺钉固定。患者术后恢复良好;1年后,他无症状,功能反应良好,无疾病迹象。本病例报告展示了一种罕见的良性骨肿瘤的临床、影像学和病理特征。此外,骨内施万细胞瘤应纳入溶骨性跟骨病变的鉴别诊断。