Large schwannoma of the median nerve at the distal forearm

Dejan Vulović; Jefta Kozarski; Tatjana Vulović; Marko Spasić; Tatjana Šarenac Vulović; Tahir Ahmed T. Mubarak; Vesna Stanković; Mubarak Al-Shraim; Dejana Rakić

doi:10.2298/VSP211010034V

Dejan Vulović University Clinical Center Kragujevac, Center for Plastic Surgery, Kragujevac, Serbia
Jefta Kozarski Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia
Tatjana Vulović University of Kragujevac, Faculty of Medical Sciences, Department of Surgery Kragujevac, Serbia
Marko Spasić University of Kragujevac, Faculty of Medical Sciences, Department of Surgery Kragujevac, Serbia
Tatjana Šarenac Vulović University Clinical Center Kragujevac, Clinic for Ophtalmology, Kragujevac, Serbia
Tahir Ahmed T. Mubarak Aseer Central Hospital, Plastic Surgery and Burn Department, Abha, Kingdom of Saudi Arabia
Vesna Stanković University Clinical Center Kragujevac, Centre for Pathological Anatomical Diagnostics, Kragujevac, Serbia
Mubarak Al-Shraim King Khalid University, College of Medicine, Department of Pathology, Abha, Kingdom of Saudi Arabia
Dejana Rakić University Clinical Center Kragujevac, Clinic for Gynecology and Obstetrics, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP211010034V

Keywords: diagnosis, median nerve, neurilemmoma, peripheral nervous system neoplasms, schwann cells

Abstract

Introduction. Schwannoma, also known as neurilemmoma, is a rare but one of the most common tumors of the peripheral nerves. It originates from Schwann cells of the peripheral nerve sheaths. Schwannoma mostly occurs in adults between 20 to 70 years of age. The regions where the tumor most commonly occurs are the head and neck, but it can occur almost anywhere in the body or the organs. Schwannomas are usually up to 2.5 cm in size but may grow to 4–5 cm. In this study, the rare case of large schwannoma of the median nerve in the distal part of the forearm is presented. Case report. A 46-year-old male patient was referred to a plastic surgeon with a diagnosis of lipoma on the anterior side of the distal third of the left forearm. Ultrasound and magnetic resonance imaging were done, and the surgery was performed after that. An encapsulated tumor of the median nerve was found, and the tumor was completely removed without nerve damage. Histological analysis showed a benign schwannoma of cellular type and biphasic shape. In the postoperative course, there was transient paresthesia. One year after surgery, no tumor recurrence nor neurological deficit was recorded. Conclusion. Schwannoma is the most common benign tumor of peripheral nerves. Schwannomas over 5 cm in size are extremely rare. Appropriate physical examination, preoperative imaging studies, and histological verification are required for the final diagnosis. The method of choice in treating large schwannomas is complete surgical excision.

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