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Median nerve schwannoma: A case and review of literature.

Padasali PS, Shankaregowda VS, Kshirsagar SD - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: Symptoms are caused by an entrapment syndrome resulting from the growing tumor.These characteristics include mobility, Tinel's sign, S-100 histological staining, and Antoni patterns.With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a low risk of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India.

ABSTRACT
We report a case of a median nerve schwannoma, a rare type of a benign tumor of Schwann cells that presents as a palpable and painful mass on the flexor aspect of the forearm. Schwannomas of the median nerve make up 0.1-0.3% of all hand tumors. Symptoms are caused by an entrapment syndrome resulting from the growing tumor. Pain is the most common complaint of schwannomas. Imaging studies include computed tomography and magnetic resonance imaging and ultrasound. It is difficult to differentiate schwanommas from neurofibromas solely on the basis of a radiological investigation. Tumors of the median nerve are diagnostically challenging and median nerve schwannomas are rare. Diagnostic pearls are described to facilitate a more accurate and timely diagnosis. These characteristics include mobility, Tinel's sign, S-100 histological staining, and Antoni patterns. With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a low risk of recurrence.

No MeSH data available.


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Histology of schwannoma with its characteristics pattern
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Figure 5: Histology of schwannoma with its characteristics pattern

Mentions: The histopathology result demonstrated an ovoid tumor measuring 3.5 cm × 4 cm. The center of the mass was solid and firm. Histologically, the characteristic features include the presence of alternating Antoni A and Antoni B areas. Antoni A area is composed of spindle-shaped Schwann cells arranged in interlacing fascicles. There may be nuclear palisading. In between two compact rows of well aligned nuclei, the cell processes form eosinophilic Verocay bodies [Figure 5]. Mitotic figures may be present. Antoni B area consists of a loose meshwork of gelatinous and microcystic tissue. Large, irregularly spaced, thick-walled blood vessels are noted in Antoni B area. These may contain thrombus material in the lumina. Immunohistochemistry shows S-100 stain was positive. The final pathology report was consistent with schwannoma. At 6 months follow-up the wound is well healed with no pain upon palpation. The patient returned to full labor work as a farmer.


Median nerve schwannoma: A case and review of literature.

Padasali PS, Shankaregowda VS, Kshirsagar SD - Asian J Neurosurg (2015 Jul-Sep)

Histology of schwannoma with its characteristics pattern
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553734&req=5

Figure 5: Histology of schwannoma with its characteristics pattern
Mentions: The histopathology result demonstrated an ovoid tumor measuring 3.5 cm × 4 cm. The center of the mass was solid and firm. Histologically, the characteristic features include the presence of alternating Antoni A and Antoni B areas. Antoni A area is composed of spindle-shaped Schwann cells arranged in interlacing fascicles. There may be nuclear palisading. In between two compact rows of well aligned nuclei, the cell processes form eosinophilic Verocay bodies [Figure 5]. Mitotic figures may be present. Antoni B area consists of a loose meshwork of gelatinous and microcystic tissue. Large, irregularly spaced, thick-walled blood vessels are noted in Antoni B area. These may contain thrombus material in the lumina. Immunohistochemistry shows S-100 stain was positive. The final pathology report was consistent with schwannoma. At 6 months follow-up the wound is well healed with no pain upon palpation. The patient returned to full labor work as a farmer.

Bottom Line: Symptoms are caused by an entrapment syndrome resulting from the growing tumor.These characteristics include mobility, Tinel's sign, S-100 histological staining, and Antoni patterns.With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a low risk of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India.

ABSTRACT
We report a case of a median nerve schwannoma, a rare type of a benign tumor of Schwann cells that presents as a palpable and painful mass on the flexor aspect of the forearm. Schwannomas of the median nerve make up 0.1-0.3% of all hand tumors. Symptoms are caused by an entrapment syndrome resulting from the growing tumor. Pain is the most common complaint of schwannomas. Imaging studies include computed tomography and magnetic resonance imaging and ultrasound. It is difficult to differentiate schwanommas from neurofibromas solely on the basis of a radiological investigation. Tumors of the median nerve are diagnostically challenging and median nerve schwannomas are rare. Diagnostic pearls are described to facilitate a more accurate and timely diagnosis. These characteristics include mobility, Tinel's sign, S-100 histological staining, and Antoni patterns. With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a low risk of recurrence.

No MeSH data available.


Related in: MedlinePlus