Salar Mohamed, Kaye Marc B
Department of Orthopaedic Surgery and Rehabilitation, University of Florida-Jacksonville, Jacksonville, FL 32209, United States.
J Orthop Case Rep. 2020 Sep;10(6):60-63. doi: 10.13107/jocr.2020.v10.i06.1876.
Schwannomas are rare benign tumors affecting the peripheral nerves. They can grow in clusters when associated with neurofibromatosis Type II or with schwannomatosis. Typically, patients present with a palpable painless mass. However, some patients, on the other hand, present with symptomatic lesions that resemble a focal nerve compression caused by the encapsulating nature of these tumors. Surgical excision is an excellent solution for solitary symptomatic lesions. However, multiple schwannomas affecting the same nerve add another level of complexity to the surgery since these secondary masses can be too small to be detected on physical examination. A high index of suspension for schwannomatosis complemented with magnetic resonance imaging (MRI) ensures a more efficient pre-operative workup that can save the patient potentially an additional visit to the operating room.
This is a case of a 36-year-old right-handed female presented to our clinic with a several-years history of a painful mass in her forearm. On physical examination, she had a palpable painful mass that was Tinel positive with pain and paresthesia radiating distally over the median nerve distribution. A subsequent MRI scan showed a second smaller mass distally adjacent to the main lesion along with the median nerve, both appearing to be schwannomas of the median nerve. In this case report, we discuss the patient presentation, diagnostic workup and radiographic finding, surgical technique, and pathological findings in addition to a review of the literature regarding multiple schwannomas affecting the upper extremity.
Schwannomas are rare benign tumors affecting the peripheral nerves. Despite their solitary nature, a handful of cases are reported in the literature that describes multiple masses encapsulating the same nerve. MRI is utilized to allow proper pre-operative planning and more accurate localization of these tumors to avoid an unplanned return to the operating room.
施万细胞瘤是一种罕见的影响周围神经的良性肿瘤。当与II型神经纤维瘤病或施万细胞瘤病相关时，它们可呈簇状生长。通常，患者表现为可触及的无痛肿块。然而，另一方面，一些患者表现为有症状的病变，类似于这些肿瘤的包膜性质所导致的局灶性神经受压。手术切除是孤立性有症状病变的理想解决方案。然而，影响同一神经的多个施万细胞瘤会给手术增加另一层面的复杂性，因为这些继发性肿块可能太小而在体格检查中无法检测到。对施万细胞瘤病保持高度警惕并辅以磁共振成像（MRI）可确保更有效的术前检查，这可能为患者节省一次潜在的额外手术室就诊。
这是一名36岁右利手女性的病例，她因前臂有多年疼痛性肿块病史前来我们诊所就诊。体格检查时，她有一个可触及的疼痛性肿块，Tinel征阳性，疼痛和感觉异常沿正中神经分布向远端放射。随后的MRI扫描显示，在主要病变远端与正中神经相邻处有第二个较小的肿块，两者似乎均为正中神经的施万细胞瘤。在本病例报告中，除了回顾关于影响上肢的多个施万细胞瘤的文献外，我们还讨论了患者的表现、诊断检查和影像学发现、手术技术及病理结果。
施万细胞瘤是一种罕见的影响周围神经的良性肿瘤。尽管它们通常为孤立性，但文献中报道了少数多发包膜同一神经的病例。利用MRI进行适当的术前规划并更准确地定位这些肿瘤，以避免意外返回手术室。
