Karna Made Bramantya, Kinanta Putu Bihan Surya, Aprilya Dina
Department of Orthopaedic and Traumatology, Prof Ngoerah General Hospital/Faculty of Medicine, University of Udayana, Denpasar, Indonesia.
Department of Orthopaedic and Traumatology, Prof Ngoerah General Hospital/Faculty of Medicine, University of Udayana, Denpasar, Indonesia.
Int J Surg Case Rep. 2023 Feb;103:107915. doi: 10.1016/j.ijscr.2023.107915. Epub 2023 Feb 6.
Schwannoma is the most common benign tumor of peripheral nerves and usually occurs solitary with a very low risk of recurrence. Schwannoma of the hand, particularly involving the digital nerve, is sporadic and most commonly leads to a misdiagnosis due to its rarity. Histopathology remains the gold standard diagnostic, however, with a thorough physical examination and radiologic imaging, this benign tumor can be managed well with the preservation of nerve function.
We reported a rare case of digital nerve schwannomas on the bilateral hands of a 52-year-old white male with one recurrent mass on the right hand despite a previously complete debulking of the mass.
Intraoperatively, we removed lobulated whitish-yellow masses and left the nerve origin of the tumor intact (common palmar digital nerve and ulnar-side digital nerve). The histopathology supported the diagnosis of schwannoma. At the one-year follow-up, there is no recurrence and the patient remains asymptomatic.
Determining differential diagnosis by both clinical and preoperative imaging is essential, especially in the case of recurrence and multiple tumorous lesions. Malignancy or malignant degeneration should still be kept in mind. Complete removal is needed to prevent recurrence followed by a long-term follow-up.
神经鞘瘤是周围神经最常见的良性肿瘤，通常为单发，复发风险极低。手部神经鞘瘤，尤其是累及指神经的，较为散在，因其罕见常导致误诊。组织病理学仍是金标准诊断方法，然而，通过全面的体格检查和影像学检查，这种良性肿瘤在保留神经功能的情况下可得到良好处理。
我们报告了一例罕见的52岁白人男性双侧手部指神经鞘瘤病例，尽管之前已将肿瘤完整切除，但右手仍有一个复发性肿块。
术中，我们切除了分叶状的灰白色肿块，保留了肿瘤的神经起源（掌侧指总神经和尺侧指神经）。组织病理学支持神经鞘瘤的诊断。在一年的随访中，无复发，患者仍无症状。
通过临床和术前影像学进行鉴别诊断至关重要，尤其是在复发和多发肿瘤性病变的情况下。仍应考虑恶性或恶性变。需要完整切除以防止复发，并进行长期随访。
