Petrova Kristina, Gaydarski Lyubomir, Panev Atanas, Landzhov Boycho, Tubbs R Shane, Georgiev Georgi P
Clinical Laboratory, Medical University of Sofia, Sofia, BGR.
Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR.
Cureus. 2024 Aug 5;16(8):e66190. doi: 10.7759/cureus.66190. eCollection 2024 Aug.
Schwannomas are benign tumors derived from Schwann cells, typically occurring in the head, neck, and upper extremities, but are less frequent in the lower extremities. They can arise sporadically or from genetic conditions such as neurofibromatosis type 2, associated with gene mutations. This report details the case of a 57-year-old female with a two-year history of a painless, slowly growing mass in the posterior aspect of the right proximal cruris. Physical examination revealed a 2 cm, elastic-hard, mobile, non-tender mass with a positive Tinel's sign. Ultrasound and magnetic resonance imaging suggested a benign nerve sheath tumor characterized by hypoechoic features. The performed surgery revealed that the tumor involved the medial sural cutaneous nerve. Histologic analysis confirmed the diagnosis of schwannoma, showing typical Antoni A and Antoni B regions. Postoperative recovery was uneventful, with no recurrence or neurological deficits at the two-month follow-up. This case demonstrates an unusual localization of a sural schwannoma and highlights the importance of precise physical examination and imaging to diagnose schwannomas accurately. Clinicians should consider schwannoma as a differential diagnosis in patients presenting with slow-growing palpable masses in the lower extremities.
施万细胞瘤是起源于施万细胞的良性肿瘤，通常发生于头、颈和上肢，但在下肢较少见。它们可散发出现，或源于诸如2型神经纤维瘤病等遗传疾病，与基因突变相关。本报告详细介绍了一名57岁女性的病例，该患者右侧小腿近端后侧有无痛性、缓慢生长的肿块，病史两年。体格检查发现一个2厘米大小、质地硬如橡皮、可活动、无压痛的肿块，Tinel征阳性。超声和磁共振成像提示为具有低回声特征的良性神经鞘瘤。手术显示肿瘤累及腓肠内侧皮神经。组织学分析证实为施万细胞瘤，可见典型的Antoni A区和Antoni B区。术后恢复顺利，在两个月的随访中无复发或神经功能缺损。该病例展示了腓肠施万细胞瘤的不寻常定位，并强调了精确体格检查和影像学检查对准确诊断施万细胞瘤的重要性。临床医生在诊断下肢出现缓慢生长、可触及肿块的患者时应考虑施万细胞瘤作为鉴别诊断。
