Case Report

Ancient Schwannoma involving the Superficial Peronial nerve: A case report and review of the literature.

  Abstract :

INTRODUCTION: Schwannomas are benign ,encapsulated,slow-Growing and usually solitary tumors originating from Schwann cells of the peripheral nerve sheath. Histological findingsare these seen as in conventional schwannomas, but ancient schwannomas additionally demonstrate cystic, hemorrhagic changes and degenerative nuclei with pleomorphism andhyperchromasia. Due to the nuclear atypia, and cystic degeneration, ancient schwannomas might be confused with malignant tumors on histology and imaging, leading to a radical surgical approach .Schwannomas of the superficial peroneal nerves are very rare, We present a rare case of an ancient schwannoma involving the Superficial Peroneal nerve of right lower leg. The tumor slowly grew up within one year and become symptomatic with local pain, mild numbness in the distribution of the Peroneal nerve in the right leg. The tumor was successfully removed by separating it from the nerve fascicles to negative margins. Post-operatively local symptomsrelieved but minor sensory loss in the Peroneal nerve distribution in the leg was noticed which improved in the following six months. Ancient schwannomas can be misdiagnosed as sarcomas due to specific imaging and histologic findings. Patients physical examination, history andfine radiologic and pathology features should be cautiously interpreted in order to achieve correct diagnosis and avoid unnecessary wide tumor excisions. PRESENTATION OF CASE:A 72-yr old male patient presented to us with complaints of swelling over the anterolateral aspect of right leg lower third region with pain and numbness since 1yr. Swelling was in initial size being that of pea nut which gradually progressed to about 6 x 3 x 2 cm at the time of presentation. Patient did not give any history of trauma/prick injury Diagnosis of a benign peripheral nerve tumor was achieved and the patient was treated by surgical excision of the lesion. DISCUSSION: The intermittent symptomatology presentation on this case suggest a mechanical compression etiology, allied to classical pain and paresthesia often exhibited by this kind of the tumor. An intercompartmental pressure elevation could explain why the symptoms disclosed an episodic pattern, due to a constricted ,in closed nerve. CONCLUSION:We describe a rare case of a patient with an unusual superficial peroneal nerve Schwannoma clinical presentation.Literature on this topic is scarce and,therefore,this case report intends to add further data about this kind of lesion.

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