Abebe Metasebia W, Weldemicheal Hanna A
Plastic and Reconstructive Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Plast Reconstr Surg Glob Open. 2023 Apr 24;11(4):e4950. doi: 10.1097/GOX.0000000000004950. eCollection 2023 Apr.
Schwannomas are benign tumors of the nerve sheath that arise from the proliferation of active peripheral Schwann cells. Although schwannomas are the most common benign peripheral nerve sheath tumors, superficial peroneal nerve schwannomas are rare in published works of literature. We report a 45-year-old woman with a 4-year history of progressively worsening dull aching pain and paresthesia over the right lateral leg. Physical examination revealed a 4 × 3 cm firm palpable mass and a decreased touch and pain sensation over the lateral aspect of the right calf and dorsum of the foot. She also had an electric shock-like pain on palpation and percussion of the mass. Magnetic resonance imaging demonstrated a well-defined, oval, smooth-walled heterogeneous lesion beneath the peroneus muscle with avid postcontrast enhancement and a split fat sign. Fine needle aspiration cytology also suggested the diagnosis of schwannoma. Based on clinical findings of a mass, decreased sensation, and a positive Tinel sign on the dermatome of superficial peroneal nerve, surgical management was decided. Upon surgical exploration, a firm, glistening mass arising from the superficial peroneal nerve was identified, carefully dissected, and shelled out while maintaining continuity of the nerve. At the 5-month follow-up, the patient reported complete resolution of the pain and paresthesia. Physical examination revealed intact sensation in the lower lateral aspect of the right calf and dorsum of the foot. Therefore, surgical excision should be considered a reasonable option in the management of this rare condition, with most patients achieving good to excellent results.
施万细胞瘤是神经鞘的良性肿瘤，由活跃的外周施万细胞增殖形成。尽管施万细胞瘤是最常见的良性外周神经鞘瘤，但在已发表的文献中，腓浅神经施万细胞瘤较为罕见。我们报告了一名45岁女性，她有4年的病史，右侧小腿外侧逐渐加重的钝痛和感觉异常。体格检查发现一个4×3厘米的可触及的坚实肿块，右小腿外侧和足背的触觉和痛觉减退。触诊和叩击肿块时，她还出现电击样疼痛。磁共振成像显示腓骨肌下方有一个边界清晰、椭圆形、壁光滑的不均匀病变，增强扫描后有明显强化及脂肪分离征。细针穿刺细胞学检查也提示施万细胞瘤的诊断。基于肿块、感觉减退以及腓浅神经皮节区Tinel征阳性的临床表现，决定进行手术治疗。手术探查时，发现一个源自腓浅神经的坚实、有光泽的肿块，小心分离并完整切除，同时保持神经的连续性。在5个月的随访中，患者报告疼痛和感觉异常完全消失。体格检查显示右小腿外侧下部和足背感觉正常。因此，手术切除应被视为治疗这种罕见疾病的合理选择，大多数患者可取得良好至极佳的效果。
