Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian, 116011, China.
Department of Neurology, First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian, 116011, China.
Eur J Med Res. 2021 Jul 9;26(1):72. doi: 10.1186/s40001-021-00541-7.
Intraosseous schwannomas are extremely rare in the humerus, and less than five cases have been reported previously in the literature. This is the first report of its origin in the proximal humerus with pathologic fracture. We herein present this case to discuss the reason for its rarity and share our experience of management.
A 55-year-old female patient presented with pain in the right shoulder, which was caused by tripping and falling over a board. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) showed considerable tumor in proximal humerus, which connected with a fracture. For this suspected tumor, we performed two operations. Pathological examination demonstrated typical picture of a schwannoma, showing whorls and interlacing fascicles of schwannoma spindle cells. Immunohistochemistry, the tumor cells were diffusely positive for S-100 protein, SOX-10 and CD68, while they were completely negative for desmin, DOG-1, AE1/AE3 and P63. The Ki-67 index was about 10%. No mitoses or features of malignancy were identified. The final diagnosis of intraosseous schwannoma was made. The treatment for intraosseous schwannoma with pathologic fracture includes excisional biopsy, curettage, bone allograft, and fracture fixation. The patient recovered well. After the surgery, the patient gradually regained mobility and the pain subsided. There was no recurrence after 6 months of follow-up by X-ray.
Although very rare, intraosseous schwannoma should be taken under consideration in the differential diagnosis of benign-appearing osseous tumor in the proximal humerus with pathologic fracture.
骨内神经鞘瘤在肱骨中极为罕见，文献中以前报道的病例少于 5 例。这是首例起源于肱骨近端伴病理性骨折的病例。我们在此报告该病例，讨论其罕见的原因，并分享我们的治疗经验。
一名 55 岁女性患者因被木板绊倒而摔倒导致右肩部疼痛。X 线片、计算机断层扫描（CT）和磁共振成像（MRI）显示肱骨近端有相当大的肿瘤，与骨折相连。对于这个疑似肿瘤，我们进行了两次手术。病理检查显示典型的神经鞘瘤表现，具有神经鞘瘤梭形细胞的漩涡和交织束。免疫组织化学染色，肿瘤细胞弥漫性表达 S-100 蛋白、SOX-10 和 CD68，而完全不表达结蛋白、DOG-1、AE1/AE3 和 P63。Ki-67 指数约为 10%。未见有丝分裂或恶性特征。最终诊断为骨内神经鞘瘤。伴有病理性骨折的骨内神经鞘瘤的治疗包括切除活检、刮除、骨移植和骨折固定。患者恢复良好。术后，患者逐渐恢复活动能力，疼痛减轻。经 X 线随访 6 个月后未见复发。
虽然非常罕见，但在肱骨近端伴病理性骨折的良性骨肿瘤的鉴别诊断中，应考虑骨内神经鞘瘤。
