Harahap Rudiansyah, Harahap Nurmaliannysa Dwinandia
Faculty of Medicine, Muhammadiyah University, Semarang, Central Java, Indonesia.
Faculty of Medicine, Sultan Agung Islamic University, Semarang, Central Java, Indonesia.
Case Rep Oncol Med. 2024 May 2;2024:9397436. doi: 10.1155/2024/9397436. eCollection 2024.
Schwannoma in the popliteal fossa is still rare, often diagnosed late because it grows slowly and has no symptoms. It is often misdiagnosed with connective tissue tumors or with neurological disorders originating in the spine or disorders of the peroneal nerve. Schwannoma within the common peroneal nerve is still rare in the popliteal fossa, with most tumor sizes around 2 cm in diameter due to their smaller size of nerve but can cause neurologic disturbance, especially when it is large. And over a long time, it can cause serious complaints like neurological deficits and make surgery difficult by leaving greater sequelae. There is no data yet showing the incidence of schwannoma in the common peroneal nerve. In this case, a 36-year-old woman, for 5 years, feels soreness in the popliteal fossa and pain in the right instep, suspected that a nerve was pinched, due to an abnormality in the spine. As time went on, there was a lump in the fold of the right knee, suspected to be a Baker's cyst. As time went by, the complaint was burning pain in the right instep to the lateral ankle and distal right lower leg, disturbing sleep. Tinel's sign was positive. The right instep has hypoesthesia and a slight drop in the foot. On radiological examination of the right knee, a circumferential mass appeared, measuring 5 cm × 4 cm. The diagnosis is suspicious for a common peroneal nerve tumor. The encapsulated operation to remove the tumor was carried out with a size measuring 5 cm × 4.5 cm × 4 cm. The histopathological examination showed schwannoma. After surgery, the pain disappeared, hypoesthesia and a slight drop in the foot underwent physiotherapy, and stimulation with the result gradually improved. A thorough early examination includes correct and systematic anamnesis, physical examination, and neurological evaluation such as paraesthesia, hypoesthesia, and Tinel's sign; also, additional examinations, such as radiographic, ultrasound, and MRI, are needed for early detection of schwannoma so that delays in diagnosis and surgery can be avoided to prevent neurological deficits.
腘窝处的神经鞘瘤仍然罕见，由于其生长缓慢且无症状，常被误诊。它常被误诊为结缔组织肿瘤或源于脊柱的神经疾病或腓总神经疾病。腘窝处腓总神经内的神经鞘瘤仍然罕见，由于神经较细，大多数肿瘤直径约为2厘米，但可引起神经功能障碍，尤其是肿瘤较大时。长期来看，它可导致诸如神经功能缺损等严重症状，并因留下较大后遗症而使手术困难。目前尚无数据显示腓总神经神经鞘瘤的发病率。在本病例中，一名36岁女性，5年来一直感到腘窝处酸痛及右足背疼痛，怀疑因脊柱异常导致神经受压。随着时间推移，右膝褶皱处出现肿块，怀疑是贝克囊肿。随着时间流逝，症状变为右足背至外踝及右小腿远端的灼痛，影响睡眠。Tinel征阳性。右足背感觉减退，足背轻度下垂。对右膝进行放射学检查时，出现一个大小为5厘米×4厘米的环形肿块。诊断怀疑为腓总神经肿瘤。进行了肿瘤切除的包膜内手术，切除的肿瘤大小为5厘米×4.5厘米×4厘米。组织病理学检查显示为神经鞘瘤。手术后，疼痛消失，对感觉减退和足背轻度下垂进行了物理治疗，经刺激后结果逐渐改善。全面的早期检查包括正确且系统的病史采集、体格检查以及诸如感觉异常、感觉减退和Tinel征等神经学评估；此外，还需要进行额外检查，如放射学、超声和MRI检查，以便早期发现神经鞘瘤，从而避免诊断和手术延迟，防止神经功能缺损。
