LARGE SOLITARY ENCAPSULATED NEUROFIBROMA OF UPPER ARM – A CASE REPORT

  • Zoran Terzic Clinical Center of Montenegro, Department of Plastic surgery, Podgorica
  • Dubravka Radonjic Clinical Center of Montenegro, Department of Plastic surgery, Podgorica
  • Marinko Paunovic Clinical Center of Montenegro, Department of Plastic surgery, Podgorica
  • Agima Ljaljevic Institute for Public Health, School of Medicine, University of Montenegro, Podgorica
  • Miloš Bojic Department of Plastic surgery, Clinical Center of Montenegro, Podgorica, Montenegro
Keywords: peripheral nerve sheath tumors, neurofibroma, magnetic resonance imaging, surgery, upper arm

Abstract


Introduction: Neurofibromas are benign tumors of neuronal origin, occurring most commonly in young adults, with no gender predilection. The connection of neurofibroma with disorders on a general level as von Recklinghausen’s disease makes its diagnosis critical. Case report: A 32-old female patient was administered to the Clinic of Plastic surgery, Clinical Center of Montenegro in Podgorica, with a 10-year history of painless, subcutaneous tumor of the right upper arm that grew in size over the last ten years. The patient reported progressive pain and tingling in her right forearm and right hand for the last 12 months. An MRI showed a non-homogenous tumor of the middle third portion of the triceps muscle, in close contact with the humerus but without infiltrating it. The tumor was removed, with a definitive histopathological result of a solitary benign neurofibroma. Conclusions: This example of successful treatment of solitary neurofibroma may serve to increase the awareness of surgeons and radiologists in small countries regarding benign peripheral nerve sheath tumors. The patient is under observation for two years with no signs of relapse and no other features indicative of neurofibromatosis type 1.

References

Weiss WS, Folpe LA. Enzinger and Weiss’s soft tissue tumours. 4th ed. St. Louis: Mosby-Harcourt Health Sciences Company, 2001.

Legius E, Messiaen L, Wolkenstein P, Pancza P, Avery RA, Berman Y, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation. Genet Med. 2021;23(8):1506-13. doi: 10.1038/s41436-021-01170-5.

Keel SB, Rosenberg AE. Soft tissue pathology of the head and neck. In: Pilch BZ. ed. Head and neck surgical pathology. Philadelphia: Lippincott Williams and Wilkins,.2001;417- 8.

Sivapathasundaram B, Lavanya S, Deeplakshmi, Saravanakumar R, Ahathya RS. Solitary neurofibroma of the gingiva. J Oral Maxillofac Pathol. 2004;8(2):107-9.

Goldblum J, Weiss S, Folpe LA. Enzinger and Weiss’s soft tissue tumours. 7th ed. Elsevier,2019.

Dwivedi S, Baisakhiya N, Bhake A, Bhatt M, Agrawal A. Giant solitary neurofibroma presents as a neck mass in an infant. J Neurosci Rural Pract. 2010;1(1):32-4. doi: 10.4103/0976-3147.63100.

Pontes HA, Pontes FS, Cruz e Silva BT, Fonseca FP, Carneiro JT Jr, Paiva HB et al. Solitary neurofibroma of the temporal bone. J Craniofac Surg. 2010;21(6):1984-7. doi: 10.1097/SCS.0b013e3181f503be.

Njoumi N, Elabsi M, Attolou G, Elouazzani H, Elalami FH, Chkoff MR. Solitary preperitoneal neurofibroma: a case report. BMC Res Notes. 2015;8:115. doi: 10.1186/s13104-015-1098-8.

Shen XQ, Shen H, Wu SC, Lv Y, Lu H, Lin XJ. Surgically treated solitary giant gluteal and retroperitoneal neurofibroma: a case report. World J Surg Oncol. 2016;14:125. doi:10.1186/s12957-016-0880-y

Topsakal C, Erol FS, Ozercan I, Murat A, Gurates B. Presacral solitary giant neurofibroma without neurofibromatosis type 1 presenting as a pelvic mass--case report. Neurol Med Chir (Tokyo). 2001;41(12):620-5. doi: 10.2176/nmc.41.620.

Gosavi SR, Jain RS, Datarkar A. Prevalence of oral neurofibroma in Central Indian population: A retrospective study of 20 years. J Oral Maxillofac Pathol. 2021;25(1):25-30. doi: 10.4103/jomfp.JOMFP_237_20.

Marocchio LS, Oliveira DT, Pereira MC, Soares CT, Fleury RN. Sporadic and multiple neurofibromas in the head and neck region: a retrospective study of 33 years. Clin Oral Investig. 2007;11(2):165-9. doi: 10.1007/s00784-006-0096-6.

Sharma G, Saxena S, Seenivasagam R, Tarafdar S, Ilahi I. A Rare Case of Primary Pleural Neurofibroma. Cureus. 2021;13(8):e17062. doi: 10.7759/cureus.17062.

Kim KS, Lee DG, Lee DH, Hwang JH, Lee SY. Slowly growing solitary neurofibroma of the thumb. Medicine. 2021;100(2):e23611. doi:10.1097/md.0000000000023611.

Kubiena H, Entner T, Schmidt M, Frey M. Peripheral neural sheath tumors (PNST)--what a radiologist should know. Eur J Radiol. 2013;82(1):51-5. doi: 10.1016/j.ejrad.2011.04.037.

Chennakeshaviah G, Ravishankar S, Maggad R, Manjunath GV. Solitary giant intramuscular myxoid neurofibroma resulting in an above elbow amputation. Case Rep Pathol. 2012;2012:353215. doi: 10.1155/2012/353215.

Jiang S, Shen H, Lu H. Multiple schwannomas of the digital nerves and common palmar digital nerves: An unusual case report of multiple schwannomas in one hand. Medicine (Baltimore). 2019;98(10):e14605. doi: 10.1097/MD.0000000000014605.

Wang Y, Lu H. Multiple intraneural glomus tumors in different digital nerve fascicles. BMC Cancer. 2019;19(1):888. doi: 10.1186/s12885-019-6098-y.

Published
2022/06/02
Section
Case report