Lim Kai Xuan, Wu Karl
Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City.
J Int Med Res. 2021 Feb;49(2):300060520987732. doi: 10.1177/0300060520987732.
Schwannoma or neurilemmoma is a common soft tissue neoplasm arising from the neural sheath of Schwann cells. However, intraosseous schwannoma is rare, accounting for less than 0.2% of primary bone tumours. Several variants of schwannoma have been reported; among them, intraosseous schwannoma with ancient change is extremely rare. This current report presents an extremely rare case of ancient intraosseous neurilemmoma. The patient presented with right elbow pain and disability. A radiolucent, well-defined, lobulated lesion with a thin sclerotic rim in the proximal ulnar metaphysis that had caused a pathological fracture was noted. The mass was surgically excised using marginal resection and bone curettage was undertaken. The bone deficit was grafted with hydroxyapatite and β-tricalcium phosphate and augmented with bone cement. There were no signs of any recurrence after 3 years. This is the first case of an ancient intraosseous schwannoma of the proximal ulna. Although rare, intraosseous schwannoma should be considered in the differential diagnosis of radiographically benign-appearing osseous tumours in the bone. The cement technique is recommended for the treatment of intraosseous schwannoma.
施万细胞瘤或神经鞘瘤是一种常见的软组织肿瘤，起源于施万细胞的神经鞘。然而，骨内施万细胞瘤较为罕见，占原发性骨肿瘤的比例不到0.2%。已有多种施万细胞瘤变体的报道；其中，伴有陈旧性改变的骨内施万细胞瘤极为罕见。本报告展示了一例极其罕见的陈旧性骨内神经鞘瘤病例。患者表现为右肘疼痛和功能障碍。在尺骨近端干骺端发现一个透亮的、边界清晰的分叶状病变，有薄的硬化边缘，该病变导致了病理性骨折。通过边缘切除手术切除肿块，并进行了骨刮除术。骨缺损处用羟基磷灰石和β - 磷酸三钙移植，并使用骨水泥增强。3年后无任何复发迹象。这是首例尺骨近端陈旧性骨内施万细胞瘤病例。尽管罕见，但在对影像学表现为良性的骨肿瘤进行鉴别诊断时，应考虑骨内施万细胞瘤。建议采用骨水泥技术治疗骨内施万细胞瘤。
